The role of Kilimani Sesame in the healthy development of Tanzanian preschool children

Abstract

Kilimani Sesame, a media intervention that employs print, radio, and television, was developed to entertain and educate preschool children in Tanzania. This study examined the effects of a six-week intervention delivering Kilimani Sesame material to 223 children in the rural district of Kisarawe and the city of Dar es Salaam. Results offer evidence that literacy and numeracy, social and emotional development, and health and hygiene significantly improved from baseline to post-intervention; those with the greatest receptivity to Kilimani Sesame performed the best after the intervention, controlling for baseline scores, sex, age, location, and general media receptivity. This study shows that an educational media intervention directed towards very young children can have an impact on their healthy development, even in locales where populations have minimal resources and face extreme hardships.

Introduction

According to the most recent Demographic and Household Survey (DHS), the children of Tanzania face hardships that affect their daily and long-term health. An average of 4.9 people live in the typical Tanzanian household and the fertility rate is 5.7 births per woman, one of the highest rates in sub-Saharan Africa. Three-quarters of Tanzanian adults have attended primary school, but just 7% have attended secondary school. Only 11% of households have electricity, and fewer have piped water coming into the dwelling or yard (7%) or flush toilets (3%) (NBS, 2004).

In Tanzania, there are 8.3 million children who are 5 years and younger. Malaria is the major cause of morbidity and mortality, especially among this youngest age group. In the two weeks preceding the DHS survey, 24% of Tanzanian children had had a fever, and almost half (42%) did not receive appropriate medication such as anti-malaria drugs. There are efforts to equip households with mosquito netting, but still half lack even one net and just 23% report that the nets are treated with insecticide. Less than a third of Tanzanian children under five years, regularly sleep under a net (NBS, 2004).

According to 2003–2004 data, 7% of Tanzanian adults were infected with the HIV virus. Although knowledge levels about HIV/AIDS are high (over 80% of adults knew a healthy-looking person could have AIDS), stigma and prejudice are quite prevalent. Among those who have heard of HIV/AIDS, slightly more than half the men and women (49% and 45%, respectively) said they would NOT buy fresh food from a shopkeeper with AIDS. Stigma associated with HIV and AIDS affects the children of Tanzania. Tanzania currently has around 2.5 million orphans and about half were orphaned because their parents had died of HIV/AIDS (NBS, 2004). Besides concerns over their own and their family members' health, these children suffer from grief and isolation.

Few health communication interventions and evaluations that have been done in Tanzania, or even East Africa, have been published. Although research does exist considering media's negative and positive impact on children, most studies occurred in developed countries such as United States, the United Kingdom, and Australia. With regard to negative effects, research studies suggest that extensive early exposure to media can be significantly associated with reduced physical activity, poor eating habits, behavioral issues, poor academic achievement, and other risky behaviors (Bushman and Huesmann, 2006, Hancox et al., 2005, Mistry et al., 2007, Strasburger and Donnerstein, 1999, Wiecha et al., 2006). When the presented media content is educational, however, exposure has been found to have beneficial outcomes. Studies with samples of American preschool children offer evidence that watching educational programming before the age of 5 can be related to short- and long-term increases in cognitive and academic scores (Anderson et al., 2001, Bickham et al., 2001). There are data suggesting that exposure to certain types of educational media can also affect social tolerance and greater acceptance among children of different ethnicities (Bogatz and Ball, 1971, Lovelace et al., 1994). Media has also been shown to increase health knowledge and encourage positive behaviors (Fisch, 2004, Galst, 1980, Potts and Swisher, 1998, Sanders et al., 2000).

Media interventions can improve the lives of disadvantaged children, but none have been as popular or as successful as the children's television program Sesame Street. Created 40 years ago in the United States and now in 120 different countries, there is evidence that this program has been able to address literacy and numeracy, intergroup relations in conflict settings, environmental concerns, and health and hygiene (Cole et al., 2008, Fisch and Truglio, 2001, Moran, 2006;). In 2008, Sesame Workshop launched a multimedia pilot project in Tanzania, funded by the United States Agency for International Development. Working with Tanzanian educators, producers, and filmmakers, the project involved the adaptation of 13 television episodes and two storybooks from Sesame Workshop's South African co-production, Takalani Sesame, and the creation of 13 new radio episodes, six new live action films, a new guide for teachers and parents, and one new storybook. All materials followed an expert-driven and theory-based framework to promote literacy, mathematics and life skills among Tanzanian children age three to seven years (U.S. State Dept, 2008). The produced program was titled Kilimani Sesame.

As with other Sesame Workshop media productions and interventions (Fisch & Truglio, 2001), Albert Bandura's social cognitive theory (SCT) provided a conceptual foundation for the production and evaluation of Kilimani Sesame. SCT offers important pathways and constructs that producers and researchers can consider when delivering lessons and determining whether those lessons have been learned. In developing the print, radio and video materials, educational and life skill lessons were presented in culturally-appropriate and accessible ways, specific to the needs and environments of Tanzanian children. Producers were made aware of the SCT concept of reciprocal interplay, that is the interacting relationship of personal, behavioral, and environmental factors (Bandura, 1986). Drawing on Bandura's concept of observational learning, Kilimani Sesame encouraged its young audience to attend to, imitate, and practice behaviors shown by the actors and models. This was done in ways to encourage children's self-efficacy, another important SCT factor that relates to behavior change.

In assessing whether children learn messages through various media, the evaluation was guided by measured constructs relevant to the SCT processes of attention, retention, production and motivation (Bandura, 1986). For example, this study considered whether children not only attended to but also remembered the material to which they were exposed. Also children were asked questions about existing behaviors as well as their intentions to engage in behaviors.

This paper describes a theory-based evaluation, using a quasi-experimental design, examining the impact of Kilimani Sesame on urban and rural Tanzanian children. Three main developmental areas were assessed: (1) literacy and numeracy; (2) emotional and social development; and (3) health and hygiene. The main research question examined by this research was “does exposure to the Kilimani Sesame project have a positive impact on a Tanzanian child's (1) literacy and numeracy; (2) emotional and social development; and (3) health and hygiene?” It was hypothesized that children with the greatest receptivity to the materials would perform best on the post-intervention measures, controlling for demographics, previous knowledge of the constructs, and receptivity to other media.