A 10+10+30 Radio Campaign Is Associated with Increased Infant Vaccination and Decreased Morbidity in Jimma Zone, Ethiopia: A Prospective, Quasi-experimental Trial

"This study provides compelling initial evidence that a radio drama integrated with discussion and phone-in components may improve infant vaccination coverage and timeliness, and may reduce infant morbidity."

Mass media interventions can reach large audiences and possibly influence health behaviours and outcomes, including around vaccination. Particularly for rural areas, which are more likely to include illiterate and low-income individuals, community radio has the potential to be a tailored, cost-effective method of engaging communities in behaviour change. This paper describes the implementation and impact of a 3-month-long radio campaign implemented in Jimma Zone, Ethiopia called "10+10+30". It involved a weekly 10-minute radio drama series on vaccination, followed by a 10-minute discussion by community health workers, and then a 30-minute listener phone-in segment. This study evaluated the effectiveness of the participatory radio intervention in improving coverage and timeliness of infant vaccination and reducing morbidity related to vaccine-preventable diseases (VPDs).

The intervention was based on the Health Belief Model (HBM), which emphasises key constructs that shape health behaviour, including perceived benefit, perceived susceptibility, perceived barriers, and cues to action. The HBM suggests that mothers or caregivers who believe that their infants are at risk of VPDs and who believe that their infants would benefit from vaccinations are more likely to adopt the behaviour of vaccinating their infants.

The 10+10+30's theory of change incorporates two main interrelated causal pathways: (i) availability of a local, radio drama serial ("Egeree Ijoollee", or "Child's Future"), whose primary audience was women/caregivers of infants, as well as husbands or household heads as secondary audiences and health workers and community leaders and social networks as tertiary audiences; and (ii) trained health extension workers (HEWs) to lead on-air discussion of each drama episode and to answer questions from listeners, thereby improving engagement with priority populations to promote uptake of childhood vaccinations. A trained radio journalist acted as a facilitator for the discussion of the drama, took questions from listeners, and invited HEWs to answer them. The use of education-entertainment was designed to contribute to behaviour change and increased uptake of preventive services.

"Egeree Ijoollee" aired on Jimma Community Radio from October 23 2020 through January 10 2021. Each episode was aired twice: for the first time on Fridays, and then again on Sundays. Although the same drama was repeated on both days, the 10-minute discussion and the 30-minute phone-in were unique to each airing. Each episode was preceded by a one-minute song with a slogan of "Now more than ever for children".

To assess the impact of the intervention, the researchers recruited mothers of infants up to 5 weeks old in intervention district clusters that were inside the radio station's reception range (n = 328 dyads) and control district clusters that were outside of the range (n = 332 dyads). Intention-to-treat and per-protocol analyses, adjusted for pre-intervention differences between the districts, were conducted to examine the co-primary outcome of Penta-3 vaccination coverage and timeliness as well as those of other vaccines (Penta 1, Penta 2, Rotavirus (Rota) 1, Rota 2, Oral Poliovirus (OPV) 1, OPV 2, OPV 3, pneumococcal conjugate vaccine (PCV) 1, PCV 2, and PCV 3) and outcomes related to infant morbidity.

According to the intent-to-treat analysis, Penta 3 vaccine coverage was significantly higher in the intervention group (89.8%, 95% confidence interval (CI): 85.9-92.9%) compared with the control group (65.1%, 95% CI: 59.7-70.3%). Similar results were obtained in the per-protocol analysis, with the intervention group showing coverage of 97.2% (95% CI: 92.1-99.4%) versus 62.9% (95% CI: 57.2-68.4%). Indeed, vaccination rates were significantly higher across all of the childhood vaccinations examined in both the intention-to-treat and per-protocol analyses. Infants in the intervention district were 39% more likely to receive a Penta 3 vaccination (adjusted risk ratio (RR): 1.39, p<0.001).

In addition, adjusted regression analyses of maternal retrospective reports over a 2-week period revealed 80% less infant diarrhoea (RR: 0.20, p<0.001), 40% less fever (RR: 0.60, p<0.001) and 58% less cough (RR: 0.42, p<0.001) in the intervention district relative to the control district.

One hundred and eight of the 314 mothers (34.4%) in the intervention district reported having listened to "Egeree Ijoollee". However, 22 of the 324 mothers (6.8%) in the control district also reported having listened, even though the control district did not have such a programme. This may suggest possible confusion with other radio programmes, a tendency to provide socially desirable answers, or perhaps a lack of understanding of the question. Regardless of the source, the per-protocol analyses included only those in the intervention district who reported they listened the programme.

Thus, these results suggest that listeners exposed to edutainment programming about the benefits of vaccinating their children and the dangers of not doing so were encouraged to have their infants vaccinated in a timely manner. The researchers suggest that randomised controlled trials (RCTs) are needed to verify and extend the present results and to examine population-level changes.