Elsevier

The Lancet

Volume 386, Issue 9988, 4–10 July 2015, Pages 97-100
The Lancet

Viewpoint
Can mass media interventions reduce child mortality?

https://doi.org/10.1016/S0140-6736(14)61649-4Get rights and content

Summary

Many people recognise that mass media is important in promoting public health but there have been few attempts to measure how important. An ongoing trial in Burkina Faso (ClinicalTrials.gov, NCT01517230) is an attempt to bring together the very different worlds of mass media and epidemiology: to measure rigorously, using a cluster-randomised design, how many lives mass media can save in a low-income country, and at what cost. Application of the Lives Saved Tool predicts that saturation-based media campaigns could reduce child mortality by 10–20%, at a cost per disability-adjusted life-year that is as low as any existing health intervention. In this Viewpoint we explain the scientific reasoning behind the trial, while stressing the importance of the media methodology used.

Section snippets

Child mortality and the case for a focus on demand

Logic suggests that however much money is spent on health services, they will only work effectively if people use those services and behave in life-protecting ways. UNICEF's “Facts for Life”1 is based on this concept. Reflecting on the limited progress made towards reducing child mortality by two-thirds by 2015, the 2012 Countdown to 2015 report2 suggested that, although supply-side investments have worked well in many countries, “Interventions…requiring behaviour change (early initiation of

An epidemiological approach to mass media campaigns

Why is evidence for the importance of demand missing? Why do most of the data either fall short of the standards required to impress policy makers, or show negative results? The most comprehensive attempt to answer this question is provided by Bob Hornik,3 in Public Health Communication, Evidence for Behaviour Change. Hornik looks carefully at the evidence from controlled trials of health communications campaigns. The few major trials that have taken place “have shown either ambiguous or no

The intervention: the Saturation+ method

Concluding his analysis of whether public health communication can change behaviours, Hornik3 asks whether the dominant literature6, 20, 23, 24 has missed something important:

“Most of the innovative work in public health has focused on the problem of developing high quality messages reflecting particular evidence about the underpinnings of health behaviour. This has been a good thing. At the same time there has been less attention to the problem of exposure to those messages and how to

Modelling the effect of comprehensive campaigns

To estimate the potential effect of a comprehensive campaign, we gathered evidence from previous multiple-issue media campaigns to predict how much they could increase coverage of key interventions (such as breastfeeding, or seeking treatment for pneumonia). We adjusted our predictions for service provision and media penetration in each country. We then analysed the effect on mortality of these increases in intervention coverage in a range of sub-Saharan African countries using the Lives Saved

Putting these predictions to the test

We are currently running a 35 month cluster-randomised trial in Burkina Faso, funded by the Wellcome Trust and Planet Wheeler Foundation, to evaluate the effect of a comprehensive mass media campaign on child mortality (ClinicalTrials.gov, number NCT01517230). The trial is, to our knowledge, the largest, most rigorous evaluation ever conducted of a mass media intervention in a low-income setting.

We have been able to solve, exceptionally, the problem of randomising a mass media intervention by

Implications of our work

If the trial yields results that are broadly consistent with the predictions of our model, the implications for the public health community will be substantial. Our model predicts that if comprehensive campaigns are implemented in ten African countries for 5 years, one million lives of children younger than 5 years should be saved. If this claim is sustained by the trial, saturation-based media campaigns should belong in the mainstream of public health interventions and a priority for

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