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ORIGINAL ARTICLE
Open Access

Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso

Sophie Sarrassat, Nicolas Meda, Moctar Ouedraogo, Henri Some, Robert Bambara, Roy Head, Joanna Murray, Pieter Remes and Simon Cousens
Global Health: Science and Practice December 2015, 3(4):557-576; https://doi.org/10.9745/GHSP-D-15-00153
Sophie Sarrassat
aCentre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
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Nicolas Meda
bCentre Muraz, Bobo Dioulasso, Burkina Faso
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Moctar Ouedraogo
cAfricsanté, Bobo Dioulasso, Burkina Faso
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Henri Some
cAfricsanté, Bobo Dioulasso, Burkina Faso
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Robert Bambara
dDirection Générale des Études et des Statistiques Sectorielles (DGESS), Ministère de la Santé, Ouagadougou, Burkina Faso
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Roy Head
eDevelopment Media International, London, UK
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Joanna Murray
eDevelopment Media International, London, UK
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Pieter Remes
fDevelopment Media International, Ouagadougou, Burkina Faso
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Simon Cousens
aCentre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
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  • FIGURE 1.
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    FIGURE 1.

    Pair-Matched Randomization of Clusters Based on Geography and Radio Penetration Rate

    Adapted from Wikipedia.

  • FIGURE 2.
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    FIGURE 2.

    Prevalence of Target Behaviors at Baseline

    Abbreviations: ACT/QN, artemisinin‐based combination therapy/quinine; ANC, antenatal care; CI, confidence interval; HWWS, hand washing with soap; ITN, insecticide‐treated bed net; ORS, oral rehydration solution.

  • FIGURE 3.
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    FIGURE 3.

    Radio Listenership and Campaign Recognition at Midline (%, 95% CI)

    Abbreviation: CI, confidence interval.

  • FIGURE 4.
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    FIGURE 4.

    Correlation Between Changes in Targeted Behaviors and Broadcasting Intensity (Intention‐to‐Treat Analysis)

    Abbreviations: ACT/QN, artemisinin‐based combination therapy/quinine; ANC, antenatal care; DiD, difference‐in‐difference; HMS, homemade solution; HWWS, hand washing with soap; ITN, insecticide‐treated bed net; ORS, oral rehydration solution.

    Numbers in charts pertain to the targeted behaviors: (1) 4 or more ANC visits, (2) Savings‐Pregnancy, (3) Facility delivery, (4) Breastfeeding within 1 h, (5) 1st bath 24 h or more, (6) Exclusive breastfeeding, (7) Complementary feeding, (8) Growth monitoring, (9) Care seeking: Fever, (10) Care seeking: Fast/difficult breathing, (11) Care seeking: Diarrhea, (12) ACT/QN‐Fever, (13) Antibiotic‐Fast/difficult breathing, (14) ORS/more liquids‐Diarrhea, (15) HMS‐Diarrhea, (16) ITN use‐Children, (17) Bed net use‐Pregnancy, (18) Latrine ownership, (19) Stools' safe disposal, (20) HWWS.

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    TABLE 1 Target Behaviors and Broadcasting Intensity Up to the Month Preceding the Midline Survey (October 2013)
    Target BehaviorsNo. of Weeks for Short SpotsNo. of Long-Format Modules
    Maternal health
    4 or more ANC visits332
    Saving money during pregnancy332
    Health facility delivery525
    Newborn health
    Breastfeeding initiation within 1 hour after birth625
    First bath delayed for 24 hours or more after birth in low birth weight infants17
    Child nutrition
    Exclusive breastfeeding in 0- to 5-month-old children551
    Complementary feeding in 6- to 11-month-old children429
    Growth monitoring in 0- to 23-month-old children420
    Health care seeking for childhood illnesses
    Health care seeking for fever1041
    Health care seeking for pneumonia743
    Health care seeking for diarrhea1279
    Diarrhea home treatment
    ORS or increase in fluids for diarrhea1279
    Bed net use
    Bed net use among under-5 children and pregnant women685
    Sanitation
    Household latrine ownership268
    Safe disposal of children's stool368
    Hand washing with soap855
    • Abbreviations: ANC, antenatal care; ORS, oral rehydration solution.

    • View popup
    TABLE 2 Other Major Programs Implemented in Intervention and Control Clusters at Time of DMI Radio Campaign Midline Survey (November 2013)
    ClusterPrograms/Organizations by Health Sector
    NutritionSanitationCommunity Case Management
    Intervention clusters
    BanforaEl Mundo––
    BogandeNUTRIFASO program; GRET; Action Contre la Faim (ACF); Programme Alimentaire Modial (PAM)SaniFaso program–
    DjiboCroix Rouge (Red Cross)Oxfam–
    KantchariACF; PAMACF–
    OuahigouyaTerre des Hommes–UNICEF
    Sapouy–––
    Solenzo–––
    Control clusters
    Boromo–SaniFaso program; WaterAid–
    GayeriNUTRIFASO program; PAMSaniFaso program–
    KongoussiThe Hunger ProjectPlan InternationalUNICEF
    KoudougouPAM––
    NounaUNICEF––
    Po–––
    Pouytenga–Plan International–
    • View popup
    TABLE 3 Baseline Sociodemographic Characteristics, Distance to Health Facility, and Radio Ownership Among Sampled Women
    Control ArmaIntervention Armb
    Baseline (N = 2,567)Midline (N = 2,586)Baseline (N = 2,476)Midline (N = 2,596)
    Sociodemographic characteristics
    Age, mean, y28.930.028.429.2
    Resident for 5 years or more in the village, %80.388.283.686.4
    Ethnicity, %
     Mossi42.143.630.132.2
     Gourmantche11.512.326.927.1
     Gourounssi22.123.73.21.8
     Peulh6.55.717.016.6
     Gouin/Karaboro/Turka0.20.113.913.9
     Marka/Dafing/Dioula8.47.03.53.3
     Bwaba/Bobo7.56.03.33.6
     Other1.61.72.11.6
    Religion, %
     Muslim47.243.460.159.5
     Catholic/Protestant45.049.526.428.0
     Animist7.87.113.512.5
    School attendance, %15.615.710.28.4
    Income-generative activity in the past 2 weeks, %34.939.029.331.8
    Household socioeconomic status, %c
     1 (poorest)14.2–18.8–
     216.6–20.6–
     319.3–20.2–
     421.8–20.1–
     5 (least poor)28.1–20.3–
    Two or more under-5 children, %39.435.546.442.8
    Married, %97.198.098.399.0
     Polygamous union, %39.639.740.344.2
    Distance to the closest health facility, %
     <2 km39.547.118.316.3
     2–5 km33.228.928.226.1
     >5 km27.424.053.457.6
    Radio ownership, %
     No radio20.535.113.221.9
     Radio in the compound16.718.422.326.2
     Radio in the household62.846.464.551.9
    • ↵a At baseline: 36 missing values for age; 13 for number of children; 10 for ethnicity; 9 for socioeconomic status; 5 for residence, religion, school attendance, income-generative activity, and marital status; 8 for radio ownership. At midline: 4 missing values for radio ownership; 3 for age; 2 for religion and marital status; 1 for number of children, school attendance, and income-generative activity.

    • ↵b At baseline: 23 missing values for age; 18 for socioeconomic status; 17 for number of children; 13 for radio ownership; 9 for religion; 7 for ethnicity; 6 for residence, school attendance, income-generative activity, and marital status. At midline: 3 missing values for radio ownership; 1 missing value for religion.

    • ↵c Household socioeconomic status was measured only at baseline.

    • View popup
    TABLE 4 Changes From Baseline in Self-Reported Behaviors (Intention-to-Treat Analysis)
    Cluster-Level DiD Analysis
    Adjusted for Baseline PrevalenceAdjusted for Baseline Prevalence and Confounder Score
    BehaviorsSurveyControl Arm
    No. (%)
    Intervention Arm
    No. (%)
    Crude DiDDiD (95% CI)P ValueDiD (95% CI)P Value
    Maternal health
    4 or more ANC visitsBS2562 (50.8)2470 (37.0)
    MD1012 (61.0)1212 (48.4)1.2-3.5 (-17.8, 10.9).61-5.6 (-23.7, 12.5).50
    Saving money during the pregnancyBS2562 (62.8)2474 (56.4)
    MD1012 (67.4)1212 (69.8)8.89.8 (1.0, 18.6).0312.8 (1.4, 24.2).03
    Health facility deliveryBS2562 (81.8)2470 (56.0)
    MD1012 (92.4)1212 (65.3)-1.31.1 (-11.0, 13.2).85-1.0 (-12.6, 10.6).85
    Newborn health
    Breastfeeding initiation within 1 hour after birthBS2556 (32.6)2463 (26.8)
    MD1003 (31.2)1194 (31.5)6.18.5 (-6.7, 23.6).249.0 (-16.9, 34.9).46
    First bath delayed for 24 hours or more after birthBS2556 (55.9)2463 (49.3)
    MD1003 (66.0)1194 (52.0)-7.4-5.5 (-16.3, 5.4).29-3.4 (-19.1, 12.4).64
    Health care seeking in a health facility or with a CHW (2 weeks prior to interview)
    FeverBS735 (63.7)637 (50.2)
    MD777 (73.1)744 (65.9)6.34.2 (-7.9, 16.3).465.0 (-9.7, 19.6).47
    Fast/difficult breathingBS302 (56.6)381 (44.4)
    MD203 (70.9)180 (62.8)4.1-2.9 (-27.0, 21.2).8010.5 (-18.0, 39.1).43
    DiarrheaBS559 (57.8)514 (44.9)
    MD264 (65.5)349 (65.0)12.412.0 (-2.0, 26.1).0917.5 (2.5, 32.5).03
    Treatment (2 weeks prior to interview)
    ACT or quinine IM/IV for feverBS735 (17.3)639 (16.9)
    MD797 (34.6)766 (32.8)-1.4-4.1 (-12.7, 4.5).320.0 (-11.5, 11.5)>.99
    Antibiotic for fast/difficult breathingBS302 (28.2)382 (27.0)
    MD210 (33.8)188 (45.2)12.613.8 (-7.9, 35.5).1929.6 (3.5, 55.7).03
    ORS or more liquids for diarrheaBS560 (41.1)516 (30.6)
    MD274 (42.0)354 (55.9)24.414.9 (2.0, 27.8).039.5 (-5.6, 24.7).19
    Homemade solutions for diarrheaBS560 (6.8)516 (6.8)
    MD275 (6.2)362 (8.3)2.13.3 (-6.2, 12.9).463.2 (-10.5, 16.8).62
    Nutrition
    Exclusive breastfeeding (day prior to interview, 0–5 months old)BS428 (44.6)450 (42.4)
    MD323 (61.6)361 (50.4)-9.0-10.3 (-24.3, 3.6).13-8.7 (-28.2, 10.8).34
    Complementary feeding (day prior to interview, 6–11 months old)BS418 (55.5)411 (49.9)
    MD313 (57.8)394 (52.3)0.1-3.3 (-17.4, 10.7).61-10.0 (-27.6, 7.7).24
    Growth monitoring (past 6 months, 0–23 months old)BS1525 (59.7)1615 (51.1)
    MD1358 (66.3)1513 (58.1)0.40.1 (-11.1, 11.4).98-2.6 (-17.3, 12.0).70
    Bed net use
    Children under an ITN the night prior to interviewBS2567 (60.3)2475 (58.5)
    MD2585 (91.4)2596 (87.8)-1.8-2.7 (-8.9, 3.5).35-3.9 (-12.4, 4.7).34
    Women under a bed net during their last pregnancyBS2560 (65.6)2468 (62.5)
    MD2586 (79.2)2594 (80.0)3.92.1 (-5.3, 9.5).55-0.6 (-10.6, 9.3).89
    Sanitation
    Household latrine ownershipBS2559 (19.5)2458 (25.0)
    MD2585 (27.8)2596 (35.2)1.90.0 (-11.2, 11.3)>.996.0 (9.3, 21.4).40
    Safe disposal of children's last stoolsaBS2566 (14.1)2475 (15.3)
    MD2562 (19.1)2577 (21.2)0.90.2 (-6.4, 6.8).952.4 (-7.0, 11.8).58
    Hand washing with soap the last time women cleaned their child who defecatedBS2535 (37.5)2401 (36.4)
    MD2428 (45.6)2426 (44.2)-0.3-1.6 (-21.0, 17.8).86-10.5 (-35.9, 14.9).38
    • Abbreviations: ACT, artemisinin-based combination therapy; ANC, antenatal care; BS: Baseline survey; CHW, community health worker; CI, confidence interval; DiD, difference-in-difference; IM/IV, intramuscular/intravenous; MD: Midline survey; ORS, oral rehydration solution.

    • ↵a Defined when the child used a latrine or when the stool was thrown into a latrine or buried.

    • View popup
    TABLE 5 Number of Attendances for Targeted Health Services in Primary Health Facilities Located in Control (N = 40) and Intervention (N = 37) Arms, Based on Routine Health Facility Data, 2011 and 2013
    Arm20112013% Change From 2011 to 2013P Value
    4 ANC visitsControl4,4904,6824
    Intervention6,2836,7237.75
    Health facility deliveriesControl10,05410,1051
    Intervention11,91112,9289.54
    All-cause under-5 child consultationsControl67,17278,26517
    Intervention78,892104,53533.40

Additional Files

  • Figures
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  • GHSP-D-15-00153 Supplementary Material

    Sarrassat et al. doi: 10.9745/GHSP-D-15-00153

    • Supplementary Material - Sarrassat et al. doi: 10.9745/GHSP-D-15-00153
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Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso
Sophie Sarrassat, Nicolas Meda, Moctar Ouedraogo, Henri Some, Robert Bambara, Roy Head, Joanna Murray, Pieter Remes, Simon Cousens
Global Health: Science and Practice Dec 2015, 3 (4) 557-576; DOI: 10.9745/GHSP-D-15-00153

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Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso
Sophie Sarrassat, Nicolas Meda, Moctar Ouedraogo, Henri Some, Robert Bambara, Roy Head, Joanna Murray, Pieter Remes, Simon Cousens
Global Health: Science and Practice Dec 2015, 3 (4) 557-576; DOI: 10.9745/GHSP-D-15-00153
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  • Development of a digital platform for the equitable promotion of mother and child health among marginalized populations: Formative study from a lower-middle income country
  • Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso
  • Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition?
  • The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
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