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Making waves: can radio reduce child mortality?

Making waves: can radio reduce child mortality? Tim Colbourn, Audrey Prost. The Lancet Global Health, Volume 6, March 2018. DOI:
Abstract / Summary: 
In The Lancet Global Health, Sophie Sarrassat and colleagues report on the first cluster randomised controlled trial of a radio intervention to reduce child mortality. The study is exceptional in its design and ambition: a systematic review of 111 mass media interventions to improve child survival found that only 32 used moderate to strong evaluation designs and only one measured an actual health outcome.2This elegant Burkinabé trial bucks all trends. Unfortunately, the study found no effect of the radio campaign on child mortality, or on any of 17 self-reported protective behaviours, except perhaps one. Using time series analyses of routinely collected health facility data, the authors reported a 7·7% increase in antenatal care attendance, a 7·3% increase in facility deliveries, and a 23·7% increase in all-cause consultations for children over 3 years of intervention. The researchers conclude that the radio campaign did not reduce child mortality but improved health service use.
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Is the lack of effect on child mortality surprising? Perhaps not. This study wrestled with three familiar problems. First, it assumed that giving information would be sufficient for caregivers to practice behaviours that protect children: “virtually all mothers are highly motivated to protect their child with the proper knowledge of how to do so”. This statement underestimates other social, financial, and geographic constraints on behaviour. People need capabilities and opportunities to change behaviour in addition to the knowledge and motivation that radio messages might provide. Other community-focused interventions, such as participatory women's groups and home visits, go beyond providing information: ideally, they build women's, families', and communities' capacities to problem-solve in order to overcome social and financial barriers.

Is there a role for mass media in promoting child survival in low and middle-income countries? Undoubtedly. Campaigns focusing on fewer behaviours linked to child survival (eg, vaccination uptake) have recorded positive effects... Do mass media campaigns reduce or worsen inequalities in knowledge, practices, access to services, and ultimately survival? Trials incorporating a realist approach might help us understand who benefits and why.

Few mass media campaigns are done only via local radios — many use national media and a combination of television, radio, digital, and print media. Most are also done in combination with community engagement and activities to strengthen health services. This is what makes isolating the contribution of mass media challenging.

Could a standalone radio campaign reduce child mortality in low-income and middle-income countries? Probably not.


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Tim Colbourn, Audrey Prost.

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