title: 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.
abstract: BACKGROUND
  In Burkina Faso, a comprehensive 35-month radio campaign addressed key, multiple family behaviors for improving under-5 child survival and was evaluated using a repeated cross-sectional, cluster randomized design. The primary outcome of the trial was postneonatal under-5 child mortality. This paper reports on behavior change achieved at midline.
  
  
  METHODS
  Fourteen community radio stations in 14 geographic areas were selected based on their high listenership. Seven areas were randomly allocated to receive the intervention while the other 7 areas served as controls. The campaign was launched in March 2012. Cross-sectional surveys of about 5,000 mothers of under-5 children, living in villages close to the radio stations, were conducted at baseline (from December 2011 to February 2012) and at midline (in November 2013), after 20 months of campaigning. Statistical analyses were based on cluster-level summaries using a difference-in-difference (DiD) approach and adjusted for imbalances between arms at baseline. In addition, routine health facility data were analyzed for evidence of changes in health facility utilization.
  
  
  RESULTS
  At midline, 75% of women in the intervention arm reported recognizing radio spots from the campaign. There was some evidence of the campaign having positive effects on care seeking for diarrhea (adjusted DiD, 17.5 percentage points; 95% confidence interval [CI], 2.5 to 32.5; P= .03), antibiotic treatment for fast/difficult breathing (adjusted DiD, 29.6 percentage points; 95% CI, 3.5 to 55.7; P= .03), and saving money during pregnancy (adjusted DiD, 12.8 percentage points; 95% CI, 1.4 to 24.2; P= .03). For other target behaviors, there was little or no evidence of an impact of the campaign after adjustment for baseline imbalances and confounding factors. There was weak evidence of a positive correlation between the intensity of broadcasting of messages and reported changes in target behaviors. Routine health facility data were consistent with a greater increase in the intervention arm than in the control arm in all-cause under-5 consultations (33% versus 17%, respectively), but the difference was not statistically significant (P= .40).
  
  
  CONCLUSIONS
  The radio campaign reached a high proportion of the primary target population, but the evidence for an impact on key child survival-related behaviors at midline was mixed.
authors.affiliation: Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Sarrassat
authors.affiliation: Centre Muraz, Bobo Dioulasso, Burkina Faso.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: Africsanté, Bobo Dioulasso, Burkina Faso.
authors.forename: Moctar
authors.initials: M
authors.lastname: Ouedraogo
authors.affiliation: Africsanté, Bobo Dioulasso, Burkina Faso.
authors.forename: Henri
authors.initials: H
authors.lastname: Some
authors.affiliation: Direction Générale des Études et des Statistiques Sectorielles (DGESS), Ministère de la Santé, Ouagadougou, Burkina Faso.
authors.forename: Robert
authors.initials: R
authors.lastname: Bambara
authors.affiliation: Development Media International, London, UK.
authors.forename: Roy
authors.initials: R
authors.lastname: Head
authors.affiliation: Development Media International, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Murray
authors.affiliation: Development Media International, Ouagadougou, Burkina Faso.
authors.forename: Pieter
authors.initials: P
authors.lastname: Remes
authors.affiliation: Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
mesh_terms: D000328:Adult; D002050:Burkina Faso; D002648:Child; D000067576:Child Health; D046688:Child Mortality; D002675:Child, Preschool; D003142:Communication; D003906:Developing Countries; D003967:Diarrhea; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008402:Mass Media; D009035:Mothers; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011845:Radio; D012424:Rural Population; D011795:Surveys and Questionnaires