Promoting parent-child relationships and preventing violence via home-visiting: A pre-post cluster randomised trial among Rwandan families linked to social protection programmes

Abstract Background: Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty ( Ubudehe 1, the poorest category in the Government of Rwanda’s wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC). Methods: Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programs operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n=541 families in 100 treatment clusters with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate the clustering. Results: Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen’s d =0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen’s d =0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR=0.30: 95% CI: 0.22, 0.51) and violent victimization of female caregivers by their partners (OR=0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 hours (Cohen’s d =0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR=4.43, 95% CI: 1.95, 10.10) and fever (OR=3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR=3.39, 95% CI: 2.16, 3.69) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR=0.58, 95% CI: 0.38, 0.88). Conclusions: Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. Trial registration: ClinicalTrials.gov number NCT02510313.

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Promoting parent-child relationships and preventing violence via home-visiting: A pre-post cluster randomised trial among Rwandan families linked to social protection programmes

10.21203/rs.2.13621/v2 ◽

2019 ◽

Author(s):

Theresa S. Betancourt ◽

Sarah K.G. Jensen ◽

Dale A. Barnhart ◽

Robert T. Brennan ◽

Shauna M. Murray ◽

...

Keyword(s):

Child Development ◽

Home Visiting ◽

Social Protection ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Care Seeking ◽

Cohen’S D ◽

Cluster Randomised ◽

Cohen's D ◽

Parent Child Relationships

Abstract Background: Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty ( Ubudehe 1, the poorest category in the Government of Rwanda’s wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC). Methods: Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programs operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n=541 families in 100 treatment clusters with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate the clustering. Results: Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen’s d =0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen’s d =0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR=0.30: 95% CI: 0.22, 0.51) and violent victimization of female caregivers by their partners (OR=0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 hours (Cohen’s d =0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR=4.43, 95% CI: 1.95, 10.10) and fever (OR=3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR=3.39, 95% CI: 2.16, 3.69) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR=0.58, 95% CI: 0.38, 0.88). Conclusions: Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. Trial registration: ClinicalTrials.gov number NCT02510313.

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Promoting parent child relationships and preventing violence via home visiting: A pre-post cluster randomised trial among Rwandan families linked to social protection programs

10.21203/rs.2.13621/v1 ◽

2019 ◽

Author(s):

Theresa S. Betancourt ◽

Sarah K.G. Jensen ◽

Dale A. Barnhart ◽

Robert T. Brennan ◽

Shauna M. Murray ◽

...

Keyword(s):

Child Development ◽

Home Visiting ◽

Social Protection ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Care Seeking ◽

Extreme Poverty ◽

Cohen’S D ◽

Cluster Randomised ◽

Cohen's D

Abstract Background: Sugira Muryango (SM) is an early child development and violence-prevention home-visiting program delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty who receive SM in combination with government-provided social protection demonstrate greater responsive and positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC).Methods: Sugira Muryango (SM) was delivered to families with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and UC control families using structured surveys and observation. Analyses were intent to treat using mixed models.Results: Families receiving SM improved significantly on responsive caregiving using the Home Observation for Measurement of the Environment (Cohen’s d= 0.78; p< 0.001) and the Observation of Mother-Child Interaction (Cohen’s d= 0.29; p< 0.001) and showed decreased violent discipline (OR:0.34: 95% CI: 0.22, 0.51) compared with UC. Children in families receiving SM also had a 0.44 higher increase in food groups consumed in the past 24 hours (Cohen’s d= 0.34, p< 0.001), increased care seeking for diarrhoea (OR=2.2, 95% CI: 1.5, 3.1) and fever (OR: 3.3, 95% CI: 2.3, 4.8), and improved hygiene behaviours such as proper treatment of water (OR: 3.6; 95% CI: 2.4, 5.5) compared with UC. SM was also associated with a decreased intimate partner violence (OR=0.67, 95% CI: 0.33, 1.3) and caregiver depression and anxiety (OR=0.9, 95% 0.58, 1.4).Conclusions: Sugira Muryango led to improvements in family functioning and caregiver behaviours linked to child development and health.

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Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes

BMC Public Health ◽

10.1186/s12889-020-08693-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Theresa S. Betancourt ◽

Sarah K. G. Jensen ◽

Dale A. Barnhart ◽

Robert T. Brennan ◽

Shauna M. Murray ◽

...

Keyword(s):

Home Visiting ◽

Social Protection ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Cluster Randomised ◽

Parent Child Relationships ◽

Parent Child

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Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: a cluster-randomised trial in rural Bihar, India

British Journal Of Nutrition ◽

10.1017/s000711451800140x ◽

2018 ◽

Vol 120 (2) ◽

pp. 176-187 ◽

Cited By ~ 6

Author(s):

Leila M. Larson ◽

Melissa F. Young ◽

Patricia J. Bauer ◽

Rukshan Mehta ◽

Amy Webb Girard ◽

...

Keyword(s):

Executive Function ◽

Child Development ◽

Randomised Trial ◽

Intervention Group ◽

Mental Development ◽

Cluster Randomised Trial ◽

Control Group ◽

Nutrition Counselling ◽

Cluster Randomised ◽

Home Fortification

AbstractResearch demonstrates the importance of nutrition for early brain development. Few studies have examined the effectiveness of multiple micronutrient powders (MNP) on child development. This study examined the impacts of home fortification with MNP on motor and mental development, executive function and memory of children living in Bihar. This two-arm cluster-randomised effectiveness trial selected seventy health sub-centres to receive either MNP and nutrition counselling (intervention) or nutrition counselling alone (control) for 12 months. Front-line health workers delivered the intervention to all households in study communities with a child aged 6–18 months. Data were collected using cross-sectional surveys at baseline and endline by selecting households from intervention (baseline,n2184; endline,n2170) and control (baseline,n2176; endline,n2122) communities using a two-stage cluster-randomised sampling strategy. Children in the intervention group had a significantly larger improvement from baseline to endline compared with those in the control group on scores for motor and mental development (Cohen’sd, motor=0·12; 95 % CI 0·03, 0·22; mental=0·15; 95 % CI 0·06, 0·25). Greater impacts of MNP on motor and mental development were observed in children from households with higher stimulation scores at baseline compared with those with lower stimulation (Cohen’sd, motor=0·20v. 0·09; mental=0·22v. 0·14;Pinteraction<0·05). No significant treatment differences were seen for executive function or memory. Home fortification with MNP through the existing health infrastructure in Bihar was effective in improving motor and mental development and should be considered in combination with other child development interventions such as stimulation.

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Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster-randomised trial

The Lancet Global Health ◽

10.1016/s2214-109x(15)00099-6 ◽

2015 ◽

Vol 3 (8) ◽

pp. e458-e469 ◽

Cited By ~ 99

Author(s):

Daisy R Singla ◽

Elias Kumbakumba ◽

Frances E Aboud

Keyword(s):

Child Development ◽

Randomised Trial ◽

Parenting Intervention ◽

Psychological Wellbeing ◽

Cluster Randomised Trial ◽

Community Based ◽

Cluster Randomised

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Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

The Lancet Psychiatry ◽

10.1016/s2215-0366(20)30258-3 ◽

2020 ◽

Vol 7 (9) ◽

pp. 775-787 ◽

Cited By ~ 1

Author(s):

Joanna Maselko ◽

Siham Sikander ◽

Elizabeth L Turner ◽

Lisa M Bates ◽

Ikhlaq Ahmad ◽

...

Keyword(s):

Child Development ◽

Maternal Depression ◽

Psychosocial Intervention ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Cluster Randomised

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Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda

BMJ Global Health ◽

10.1136/bmjgh-2020-003508 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003508

Author(s):

Sarah KG Jensen ◽

Matias Placencio-Castro ◽

Shauna M Murray ◽

Robert T Brennan ◽

Simo Goshev ◽

...

Keyword(s):

Early Childhood ◽

Home Visiting ◽

Social Protection ◽

Early Childhood Development ◽

Randomised Trial ◽

Child Growth ◽

Childhood Development ◽

Cluster Randomised Trial ◽

Demographic And Health Surveys ◽

Father Engagement

IntroductionFamilies living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda’s social protection system to promote ECD and reduce violence compared with usual care (UC).MethodsFamilies with children aged 6–36 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments.ResultsA total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI −0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth.ConclusionSocial protection programmes provide a means to deliver ECD intervention.Trial registration numberNCT02510313.

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