Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial

Sarrassat, Sophie; Méda, Nicolas; Badolo, Hermann; Ouédraogo, Moctar; Somé, Henri; Bambara, Robert; Murray, Joanna; Remes, Pieter; Lavoie, Matthiew; Head, Roy

doi:10.1016/s2214-109x(18)30004-4

Cited by 36 publications

(59 citation statements)

References 22 publications

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“…Rate ratios for child mortality were computed using a mixed‐effects Poisson regression, with cluster fitted as a fixed effect and village fitted as random effect. Controlling for cluster accounted for any effect of the radio campaign on child mortality, though the evaluation did not detect an effect .…”

Section: Methodsmentioning

confidence: 83%

“…The analysis of the association between distance to the closest facility and care seeking behaviours used mixed‐effects logistic regression with cluster as a fixed effect and village as a random effect. The evaluation of the radio campaign found some evidence for an effect on care seeking behaviours and controlling for cluster will have accounted for this. The model included the household wealth quintile, mother's age at interview, child's gender and age at interview as forced variables.…”

Section: Methodsmentioning

confidence: 99%

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Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population‐based cross‐sectional survey

Sarrassat

Méda

Badolo

et al. 2018

Tropical Med Int Health

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Objective Although distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self‐reported care seeking behaviours, neonatal and post‐neonatal under‐five child mortality in rural areas of Burkina Faso. Methods We performed a cross‐sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed‐effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey. Results Thirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care ( P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care ( P = 0.028), but not for late neonatal mortality ( P = 0.479) and post‐neonatal under‐five child mortality ( P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility ( RR = 1.18; 95% CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility ( RR = 1.18; 95% CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association. Conclusion While better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services.

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Section: Methodsmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population‐based cross‐sectional survey

Sarrassat

Méda

Badolo

et al. 2018

Tropical Med Int Health

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“…Postneonatal under-five child mortality risk also differed between the intervention and control zones (see online supplementary appendix 1 for map and baseline characteristics of clusters). A cluster-level summary confounder score was calculated using principal component analysis (described elsewhere 6 ) and used to control for imbalance between the groups.…”

Section: Introductionmentioning

confidence: 99%

Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool (LiST): findings from a cluster randomised trial in Burkina Faso

Murray¹,

Head²,

Sarrassat

et al. 2018

BMJ Glob Health

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BackgroundA cluster randomised trial (CRT) in Burkina Faso was the first to demonstrate that a radio campaign increased health-seeking behaviours, specifically antenatal care attendance, health facility deliveries and primary care consultations for children under 5 years.MethodsUnder-five consultation data by diagnosis was obtained from primary health facilities in trial clusters, from January 2011 to December 2014. Interrupted time-series analyses were conducted to assess the intervention effect by time period on under-five consultations for separate diagnosis categories that were targeted by the media campaign. The Lives Saved Tool was used to estimate the number of under-five lives saved and the per cent reduction in child mortality that might have resulted from increased health service utilisation. Scenarios were generated to estimate the effect of the intervention in the CRT study areas, as well as a national scale-up in Burkina Faso and future scale-up scenarios for national media campaigns in five African countries from 2018 to 2020.ResultsConsultations for malaria symptoms increased by 56% in the first year (95% CI 30% to 88%; p<0.001) of the campaign, 37% in the second year (95% CI 12% to 69%; p=0.003) and 35% in the third year (95% CI 9% to 67%; p=0.006) relative to the increase in the control arm. Consultations for lower respiratory infections increased by 39% in the first year of the campaign (95% CI 22% to 58%; p<0.001), 25% in the second (95% CI 5% to 49%; p=0.010) and 11% in the third year (95% CI −20% to 54%; p=0.525). Diarrhoea consultations increased by 73% in the first year (95% CI 42% to 110%; p<0.001), 60% in the second (95% CI 12% to 129%; p=0.010) and 107% in the third year (95% CI 43% to 200%; p<0.001). Consultations for other diagnoses that were not targeted by the radio campaign did not differ between intervention and control arms. The estimated reduction in under-five mortality attributable to the radio intervention was 9.7% in the first year (uncertainty range: 5.1%–15.1%), 5.7% in the second year and 5.5% in the third year. The estimated number of under-five lives saved in the intervention zones during the trial was 2967 (range: 1110–5741). If scaled up nationally, the estimated reduction in under-five mortality would have been similar (9.2% in year 1, 5.6% in year 2 and 5.5% in year 3), equating to 14 888 under-five lives saved (range: 4832–30 432). The estimated number of lives that could be saved by implementing national media campaigns in other low-income settings ranged from 7205 in Burundi to 21 443 in Mozambique.ConclusionEvidence from a CRT shows that a child health radio campaign increased under-five consultations at primary health centres for malaria, pneumonia and diarrhoea (the leading causes of postneonatal child mortality in Burkina Faso) and resulted in an estimated 7.1% average reduction in under-five mortality per year. These findings suggest important reductions in under-five mortality can be achieved by mass media alone, particularly when conducted at national scale.

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“…2 for schematic presentation of the sampling procedure). This is a repeated, cross-sectional, cluster-randomized design, which has been used to measure campaign effectiveness [ 40 ], particularly when a panel design is ideal for tracking individual changes in knowledge, attitudes, and behaviors. However, this design is not realistic at a large scale.…”

Section: Pre- and Post-media Campaign Assessment Surveymentioning

confidence: 99%

Rationale, design, and characteristics of the multimedia family planning campaign for a small, happy, and prosperous family in Ethiopia (SHaPE)

Paek¹,

Kim²,

Cho³

et al. 2018

BMC Public Health

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BackgroundEthiopia, the second most populous country in Africa, has a total fertility rate of 4.6, a decrease from 5.5 in 2000. However, only 35.3% of women in the reproductive age group use modern family planning (FP) methods, and the 22.3% of them who have an unmet need for family planning is among the highest rates in sub-Saharan African countries. The Small, Happy, and Prosperous family in Ethiopia (SHaPE) is one of the country’s first comprehensive multimedia family planning campaigns. Its purpose is to increase FP-related knowledge, attitude, and practice of Ethiopians, particularly women of reproductive age.Methods/DesignThe SHaPE campaign has multiple components: (1) a nationwide representative survey, which serves as formative research to identify region-specific and culture-appropriate media, messages, and barriers and determinants of family planning; (2) a multimedia communication campaign intervention, including radio dramas and other interpersonal, community-level, and mass media channels; and (3) campaign evaluation, including pre-, process-, and post-evaluation research using both quantitative and qualitative methodologies. The main target population for SHaPE is reproductive age women and men in three regions: Amhara, Oromia, and Somali. These regions take up about 66.6% of the entire country and have distinct ethnicities, cultures, and languages.DiscussionSHaPE contributes to existing family planning research and intervention because it is theory- and evidence-based, and it employs integrated marketing communications and entertainment-education approaches with key messages that are tailored to audiences within unique cultures. But even within a country, a nationwide campaign with uniform messages is neither possible nor desirable due to different cultures, norms, and languages across regions. Last, media campaigns in developing and underdeveloped countries require constant monitoring of political situations.

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Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial

Cited by 36 publications

References 22 publications

Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population‐based cross‐sectional survey

Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population‐based cross‐sectional survey

Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool (LiST): findings from a cluster randomised trial in Burkina Faso

Rationale, design, and characteristics of the multimedia family planning campaign for a small, happy, and prosperous family in Ethiopia (SHaPE)

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