RT Journal Article
SR Electronic
T1 Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e003508
DO 10.1136/bmjgh-2020-003508
VO 6
IS 1
A1 Sarah KG Jensen
A1 Matias Placencio-Castro
A1 Shauna M Murray
A1 Robert T Brennan
A1 Simo Goshev
A1 Jordan Farrar
A1 Aisha Yousafzai
A1 Laura B Rawlings
A1 Briana Wilson
A1 Emmanuel Habyarimana
A1 Vincent Sezibera
A1 Theresa S Betancourt
YR 2021
UL http://gh.bmj.com/content/6/1/e003508.abstract
AB Introduction Families 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).Methods Families 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.Results A 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.Conclusion Social protection programmes provide a means to deliver ECD intervention.Trial registration number NCT02510313.