Introduction Child health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale.
Methods We collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012–2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention’s incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD.
Results The provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI −38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018–2020, varied between $7 in Malawi to $27 in Burundi.
Conclusion This study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale.
Trial registration number NCT01517230; Results.
- health economics
- health education and promotion
- child health
- cluster randomized trial
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Handling editor Sanni Yaya
Contributors RH and SC conceived the cost-effectiveness study and obtained the funding. JB, RH, FK and JM designed the cost-effectiveness study. SC and SS designed the trial. SS, NM MO, JM, JS and FK collected the data. SS analysed the effectiveness data. JM modelled the health impact. FK analysed the cost data and developed the economic model. FK and JB wrote the paper. RH, JM, SC and SS contributed to data interpretation and critically revised the paper. All authors read and approved the final version. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Funding The Wellcome Trust provided the funding for the research component of the trial (grant number 091367/Z/10/Z) and the Planet Wheeler Foundation supported the development and implementation of the intervention.
Disclaimer The funders had no role in any aspect pertinent to the study, in the writing of the manuscript or in the decision to submit it for publication.
Competing interests RH is the CEO of DMI. JM is an employee of DMI and JS is a former employee of DMI. The other authors declare no conflict of interest.
Patient consent Not required.
Ethics approval The study was registered as a randomised controlled trial with www.clinicaltrials.gov (reference number: NCT01517230) and was approved by the ethics committees of the Ministry of Health of Burkina Faso and the London School of Hygiene and Tropical Medicine Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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