Learn how we use evidence-based behaviour change campaigns to improve and save lives in low-income countries.
Learn about how DMI brings together two different worlds: demonstrable scientific practice and creative storytelling.
Location Child survival, Nutrition
The under-five mortality rate in Madagascar is 50 per 1,000 live births, compared to a global average of 37 (UN IGME, 2020). Many of these deaths are due to preventable illnesses such as diarrhoea, pneumonia, and malaria, yet treatment-seeking rates for all three of these diseases are below the average rate for sub-Saharan Africa (UNICEF, 2018). DMI has therefore selected Madagascar as one of our priority countries in which to conduct a child survival campaign.
DMI has evidence from our randomised control trial in Burkina Faso that shows our campaigns have impact on improving maternal and child health outcomes at scale. We have modelled where we can save the most lives of children under five and are scaling-up our child survival intervention nationwide across Madagascar.
Child survival – care seeking and prevention for diarrhoea, pneumonia, and malaria, and promoting breastfeeding and diversity of nutrition.
60 x 1-minute radio spots.
Our campaign runs 10 times a day, every day, on 37 radio stations from November 2022 to November 2024.
Following the success of our landmark child survival RCT, and subsequent scale-up campaigns in Burkina Faso and Mozambique, we calculated where further child survival campaigns would save the most under-5 lives at the lowest cost per life. We reviewed the countries in the world with the highest child mortality rates and analysed the cost of radio airtime, radio listenership rates, health service provision, and current health behaviours.
Madagascar is one of our priority countries in which to scale up this campaign. DMI is conducting formative research in three regions of varying socioeconomic conditions to understand the barriers to treatment-seeking. Our spots will reflect these beliefs and behaviours. As this project is helping to establish a longer presence for DMI in Madagascar, we are also investing in a media survey to understand the country’s very complex radio situation.
Zaza Salama means “young child health”. The first year of our radio campaign will promote the prevention of diarrhoea (including improved handwashing and defecation practices) and malaria (encouraging the use of insecticide treated nets). It will also focus on care-seeking for children under five who show symptoms of diarrhoea, pneumonia, and malaria. The second year of the campaign will include spots promoting early initiation of breastfeeding for infants under six months. Further spots will promote complimentary feeding and diversity of nutrition for under 5s. We are working with Malagasy scriptwriters to ensure the stories and messages produced are locally resonant.
DMI Madagascar has strong existing relationships with 32 radio stations as part of the FCDO-funded WISH2ACTION project, which has been broadcasting in Madagascar since 2019. Five of the 37 stations on which we are broadcasting Zaza Salama are national stations, with the remaining 32 reaching distinct regions of Madagascar. Our spots are played 10 times a day, every day, for 24 months. All spots are broadcast in Malagasy, the national language.
A before-and-after panel survey will be conducted to assess the impact of Zaza Salama. A cohort of 180 women and 180 men of childbearing age with children under 5 will be recruited across three distinct research locations. Analysis will explore changes in behaviours, barriers, and motivations over time. We expect to publish these results in 2025.
We are grateful to multiple partners who helped fund this campaign through unrestricted funding.