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 R...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-08693-7 |
| _version_ | 1818511966532009984 |
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| author | Theresa S. Betancourt Sarah K. G. Jensen Dale A. Barnhart Robert T. Brennan Shauna M. Murray Aisha K. Yousafzai Jordan Farrar Kalisa Godfroid Stephanie M. Bazubagira Laura B. Rawlings Briana Wilson Vincent Sezibera Alex Kamurase |
| author_facet | Theresa S. Betancourt Sarah K. G. Jensen Dale A. Barnhart Robert T. Brennan Shauna M. Murray Aisha K. Yousafzai Jordan Farrar Kalisa Godfroid Stephanie M. Bazubagira Laura B. Rawlings Briana Wilson Vincent Sezibera Alex Kamurase |
| author_sort | Theresa S. Betancourt |
| collection | DOAJ |
| description | 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 programmes 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 n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate 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: 0.19, 0.47) and in violent victimisation 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 h (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, 5.30) 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 . |
| first_indexed | 2024-12-10T23:40:11Z |
| format | Article |
| id | doaj.art-82f53c6a9f8e42d7b649bf35762802db |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-10T23:40:11Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-82f53c6a9f8e42d7b649bf35762802db2022-12-22T01:29:03ZengBMCBMC Public Health1471-24582020-05-0120111110.1186/s12889-020-08693-7Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmesTheresa S. Betancourt0Sarah K. G. Jensen1Dale A. Barnhart2Robert T. Brennan3Shauna M. Murray4Aisha K. Yousafzai5Jordan Farrar6Kalisa Godfroid7Stephanie M. Bazubagira8Laura B. Rawlings9Briana Wilson10Vincent Sezibera11Alex Kamurase12Boston College School of Social WorkBoston College School of Social WorkDepartment of Epidemiology, Harvard School of Public HealthBoston College School of Social WorkBoston College School of Social WorkDepartment of Global Health and Population, Harvard School of Public HealthBoston College School of Social WorkFXB RwandaFXB RwandaThe World BankThe World BankCollege of Medicine and Health Sciences, University of RwandaThe World BankAbstract 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 programmes 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 n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate 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: 0.19, 0.47) and in violent victimisation 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 h (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, 5.30) 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 .http://link.springer.com/article/10.1186/s12889-020-08693-7Home-visitingEarly childhood development (ECD)ViolenceSocial protectionFather engagementPoverty |
| spellingShingle | Theresa S. Betancourt Sarah K. G. Jensen Dale A. Barnhart Robert T. Brennan Shauna M. Murray Aisha K. Yousafzai Jordan Farrar Kalisa Godfroid Stephanie M. Bazubagira Laura B. Rawlings Briana Wilson Vincent Sezibera Alex Kamurase 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 Home-visiting Early childhood development (ECD) Violence Social protection Father engagement Poverty |
| title | Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes |
| title_full | Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes |
| title_fullStr | Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes |
| title_full_unstemmed | Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes |
| title_short | Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes |
| title_sort | promoting parent child relationships and preventing violence via home visiting a pre post cluster randomised trial among rwandan families linked to social protection programmes |
| topic | Home-visiting Early childhood development (ECD) Violence Social protection Father engagement Poverty |
| url | http://link.springer.com/article/10.1186/s12889-020-08693-7 |
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