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Wang W, Zhang H. A Scoping Review of Parenting Programs for Preventing Violence Against Children in Low- and Middle-Income Countries. TRAUMA, VIOLENCE & ABUSE 2024; 25:2173-2188. [PMID: 37947081 DOI: 10.1177/15248380231207887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Violence against children affects their well-being globally, with a greater burden in low-and middle-income countries (LMICs). This scoping review aimed to summarize the available evidence on parenting programs for reducing violence against children in LMICs and identify knowledge gaps in this area. Six English databases and gray literature were systematically searched to identify studies in LMICs that examined the efficacy of parenting programs to prevent violence against children, before April 15, 2023. A total of 4,183 independent studies were identified, of which 31 met the inclusion criteria. The majority were conducted in Africa and Asia, delivered by trained local community/childcare workers and lay workers, and targeted younger children aged <10 years. Although the core modules varied in terms of number of group sessions and age of the children, the majority emphasized the importance of building a positive relationship with children and nonviolent discipline strategies. The vast majority demonstrated intervention efficacy in reducing general maltreatment and physical and emotional abuse, and improving positive parenting. Ineffective programs for violence tended to be characterized by self-designed programs, small sample sizes, and low corporal punishment levels in the baseline assessment. In conclusion, parenting programs are promising for preventing and reducing the risk factors for violence in LMICs. Future intervention studies should expand to low-income countries outside Eastern Africa with more trials targeting older children, utilizing direct observational assessments, designing core modules relevant to child neglect, involving more male caregivers, and conducting long-term follow-up assessments.
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Prina E, Bano B, Singh R, Albanese E, Trujillo D, Dedios Sanguineti MC, Sorsdahl K, Luitel NP, Garman EC, Purgato M, Barbui C, Jordans MJD, Lund C. Effectiveness of combining prevention psychological interventions with interventions that address the social determinants of mental health in low and middle-income countries: protocol of a systematic review and meta-analysis. BMJ Open 2024; 14:e083261. [PMID: 38760028 PMCID: PMC11103201 DOI: 10.1136/bmjopen-2023-083261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Common mental health conditions (CMHCs), including depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries (LMICs). Preventive strategies combining psychological interventions with interventions addressing the social determinants of mental health may represent a key strategy for effectively preventing CMHCs. However, no systematic reviews have evaluated the effectiveness of these combined intervention strategies for preventing CMHCs. METHODS AND ANALYSIS This systematic review will include randomised controlled trials (RCTs) focused on the effectiveness of interventions that combine preventive psychological interventions with interventions that address the social determinants of mental health in LMICs. Primary outcome is the frequency of depression, anxiety or PTSD at postintervention as determined by a formal diagnostic tool or any other standardised criteria. We will search Epistemonikos, Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Global Index Medicus, ClinicalTrials.gov (Ctgov), International Clinical Trials Registry Platform (ICTRP). Two reviewers will independently extract the data and evaluate the risk of bias of included studies using the Cochrane risk of bias tool 2. Random-effects meta-analyses will be performed, and certainty of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION This study uses data from published studies; therefore, ethical review is not required. Findings will be presented in a published manuscript. TRIAL REGISTRATION NUMBER CRD42023451072.
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Affiliation(s)
- Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Beatrice Bano
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Faculty of Biomedical Sciences, Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Rakesh Singh
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Bagmati, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emiliano Albanese
- Faculty of Biomedical Sciences, Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Psychiatry, University of Geneva, Geneve, Switzerland
| | | | | | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Bagmati, Nepal
| | - Emily C Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Mark J D Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Rudgard WE, Obiesie S, Desmond C, Casale M, Cluver L. Assessing the cost-effectiveness of economic strengthening and parenting support for preventing violence against adolescents in Mpumalanga Province, South Africa: An economic modelling study using non-randomised data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001666. [PMID: 37590179 PMCID: PMC10434898 DOI: 10.1371/journal.pgph.0001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.
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Affiliation(s)
- William E. Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Sopuruchukwu Obiesie
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Chris Desmond
- School of Economics and Finance, University of Witwatersrand, Johannesburg, South Africa
| | - Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Jeong J, McCann JK, Alsager A, Bhojani A, Andrew N, Joseph J, Ahun MN, Kabati M, Joachim D. Formative research to inform the future design of a multicomponent fatherhood intervention to improve early child development in Mwanza, Tanzania. Soc Sci Med 2023; 331:116072. [PMID: 37459822 PMCID: PMC10753856 DOI: 10.1016/j.socscimed.2023.116072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
Fathers can influence child development through various pathways, such as via their caregiving behaviors, marital relationships, and their psychosocial wellbeing. However, few parenting interventions have been designed to target these multiple dimensions among fathers with young children in low- and middle-income countries. In June 2022, we conducted qualitative formative research to explore the perceptions surrounding fatherhood and the underlying barriers and enablers to engaged fathering in Mwanza, Tanzania. We completed individual in-depth interviews with 29 fathers and 23 mothers of children under aged 2 years along with 5 community leaders and 3 community health workers. We also completed 10 focus group discussions: 4 with fathers, 2 with mothers, and 4 mixed groups that combined both fathers and mothers. In total, the sample included 120 respondents stratified from across 4 study communities. Data were analyzed using thematic content analysis. Respondents highlighted that poor couples' relationships (e.g., limited male partner support, male dominance in decision-making) and fathers' mental health problems (e.g., parenting stress) were major priorities affecting fathers. Father involvement in parenting, childcare, and household activities were generally low. These dimensions of fatherhood were interlinked (e.g., poor paternal mental health constrained marital relationships and parenting). A constellation of determinants impacted engaged fathering. Common barriers included poverty, restrictive gender attitudes and norms, men's limited time at home, and inadequate knowledge about caregiving. Key enablers included mutual respect in marital relationships and men's desires to show their love for their families. Our results highlight the cultural relevance and the need for multicomponent strategies that jointly target fathers' caregiving, marital relationships, and psychosocial wellbeing for enhancing nurturing care and promoting early child development in Tanzania. Study findings can be used to inform the design of a future father-inclusive, gender-transformative parenting intervention for engaging and supporting fathers with young children in the local cultural context.
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Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Juliet K McCann
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alya Alsager
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alina Bhojani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ngusa Andrew
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | | | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kabati
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | - Damas Joachim
- Tanzania Home Economics Organization, Mwanza, Tanzania
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Jocson RM, Alampay LP, Lachman JM, Maramba DHA, Melgar ME, Ward CL, Madrid BJ, Gardner F. Pre-post Mixed Methods Study of a Parent and Teen Support Intervention to Prevent Violence Against Adolescents in the Philippines. J Adolesc Health 2023; 73:102-109. [PMID: 37086250 DOI: 10.1016/j.jadohealth.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE This study examines the feasibility of a culturally adapted parenting intervention (MaPa Teens) within the national cash transfer system to reduce violence against adolescents, the first such program in the Philippines. METHODS Thirty caregiver-adolescent dyads who were beneficiaries of a government conditional cash transfer program participated in a pilot of a locally adapted version of the Parenting for Lifelong Health for Parents and Teens program. Primary outcomes of reducing child maltreatment and associated risk factors were evaluated using a single-group, pre-post design. Focus group discussions explored the perceptions of participants and facilitators regarding program acceptability and feasibility. RESULTS Significant and moderate reductions were reported in overall child maltreatment and physical abuse (caregiver and adolescent reports) and in emotional abuse (adolescent report). There were significant reductions in neglect, attitudes supporting punishment, parenting stress, parental and adolescent depressive symptoms, parent-child relationship problems, and significant improvement in parental efficacy in managing child behavior. Adolescents reported reduced behavior problems, risk behavior, and witnessing of family violence. Participants valued learning skills using a collaborative approach, sustained their engagement between sessions through text messages and phone calls, and appreciated the close interaction with caring and skilled facilitators. Program areas of improvement included addressing barriers to attendance, increasing adolescent engagement, and revising the sexual health module. DISCUSSION The study provides preliminary support for the effectiveness and feasibility of the program in reducing violence against Filipino adolescents. Findings suggest potential adaptations of the program, and that investment in more rigorous testing using a randomized controlled trial would be worthwhile.
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Affiliation(s)
- Rosanne M Jocson
- National Institute of Education, Nanyang Technological University, Singapore, Singapore.
| | - Liane Peña Alampay
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Jamie M Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | | | - Marika E Melgar
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Catherine L Ward
- Department of Psychology and Safety and Violence Initiative, University of Cape Town, Rondebosch, South Africa
| | - Bernadette J Madrid
- Child Protection Unit, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Brathwaite R, Mutumba M, Nanteza J, Filiatreau LM, Migadde H, Namatovu P, Nabisere B, Mugisha J, Mwebembezi A, Ssewamala FM. Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46486. [PMID: 37314844 PMCID: PMC10337321 DOI: 10.2196/46486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. OBJECTIVE We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda's fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. METHODS This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). RESULTS Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. CONCLUSIONS Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. TRIAL REGISTRATION ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46486.
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Affiliation(s)
- Rachel Brathwaite
- Brown School, Washington University in St. Louis, St Louis, MO, United States
| | - Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Herbert Migadde
- International Center for Child Health and Development, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
| | - Betina Nabisere
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St Louis, MO, United States
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Stern E, Alemann C, Delgado GAF, Vásquez AE. Lessons learned from implementing the parenting Program P in Bolivia to prevent family violence. EVALUATION AND PROGRAM PLANNING 2023; 97:102207. [PMID: 36587432 DOI: 10.1016/j.evalprogplan.2022.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/20/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
Parenting programs are an increasingly used strategy to prevent family violence and promote gender equality in the household. Yet, there is limited understanding of the processes and pathways to change through such programs, especially from the Global South. This paper presents key findings of a qualitative evaluation of the parenting 'Program P', which was implemented in El Alto, Bolivia. The study complements and aims to provide additional insights to an experimental evaluation of this program, which found limited impact on the intended objectives, including a reduction in violence against children and women and more gender equitable attitudes among parents. Thirty-six qualitative interviews and 6 focus groups were conducted with men and women that attended Program P, and facilitators of the program. Findings were analyzed thematically and organized around key successes and challenges of the program including motivations and ability to engage with the program, opportunities for supportive group-based processes, addressing hegemonic gender and social norms, and learning and applying skills as a platform to change behaviours. We use these findings to offer implications for more effective design and implementation of gender transformative, parenting programs in Bolivia and globally.
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Affiliation(s)
- Erin Stern
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1E 7HT, UK.
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Mutumba M, Bhattacharya S, Ssewamala FM. Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey. Glob Public Health 2022; 17:2826-2840. [PMID: 35167776 DOI: 10.1080/17441692.2022.2037149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Fred M Ssewamala
- Brown School of Social Work, University of Washington at St. Louis, St. Louis, MO, USA
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Mutumba M, Ssewamala F, Namirembe R, Sensoy Bahar O, Nabunya P, Neilands T, Tozan Y, Namuwonge F, Nattabi J, Acayo Laker P, Mukasa B, Mwebembezi A. A Multilevel Integrated Intervention to Reduce the Impact of HIV Stigma on HIV Treatment Outcomes Among Adolescents Living With HIV in Uganda: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40101. [PMID: 36197706 PMCID: PMC9582915 DOI: 10.2196/40101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND HIV stigma remains a formidable barrier to HIV treatment adherence among school-attending adolescents living with HIV, owing to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support, and food insecurity. Thus, this protocol paper presents an evidence-informed multilevel intervention that will simultaneously address family- and school-related barriers to HIV treatment adherence and care engagement among adolescents living with HIV attending boarding schools in Uganda. OBJECTIVE The proposed intervention-Multilevel Suubi (MSuubi)-has the following objectives: examine the impact of M-Suubi on HIV viral suppression (primary outcome) and adherence to HIV treatment, including keeping appointments, pharmacy refills, pill counts, and retention in care; examine the effect of M-Suubi on HIV stigma (internalized, anticipated, and enacted), with secondary analyses to explore hypothesized mechanisms of change (eg, depression) and intervention mediation; assess the cost and cost-effectiveness of each intervention condition; and qualitatively examine participants' experiences with HIV stigma, HIV treatment adherence, and intervention and educators' attitudes toward adolescents living with HIV and experiences with group-based HIV stigma reduction for educators, and program or policy implementation after training. METHODS MSuubi is a 5-year multilevel mixed methods randomized controlled trial targeting adolescents living with HIV aged 10 to 17 years enrolled in a primary or secondary school with a boarding section. This longitudinal study will use a 3-arm cluster randomized design across 42 HIV clinics in southwestern Uganda. Participants will be randomized at the clinic level to 1 of the 3 study conditions (n=14 schools; n=280 students per study arm). These include the bolstered usual care (consisting of the literature on antiretroviral therapy adherence promotion and stigma reduction), multiple family groups for HIV stigma reduction plus family economic empowerment (MFG-HIVSR plus FEE), and Group-based HIV stigma reduction for educators (GED-HIVSR). Adolescents randomized to the GED-HIVSR treatment arm will also receive the MFG-HIVSR plus FEE treatment. MSuubi will be provided for 20 months, with assessments at baseline and 12, 24, and 36 months. RESULTS This study was funded in September 2021. Participant screening and recruitment began in April 2022, with 158 dyads enrolled as of May 2022. Dissemination of the main study findings is anticipated in 2025. CONCLUSIONS MSuubi will assess the effects of a combined intervention (family-based economic empowerment, financial literacy education, and school-based HIV stigma) on HIV stigma among adolescents living with HIV in Uganda. The results will expand our understanding of effective intervention strategies for reducing stigma among HIV-infected and noninfected populations in Uganda and improving HIV treatment outcomes among adolescents living with HIV in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40101.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Fred Ssewamala
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Rashida Namirembe
- International Center for Child Health and Development, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Torsten Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Yesim Tozan
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Jennifer Nattabi
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Penina Acayo Laker
- Sam Fox School of Design and Visual Arts, Washington University in St Louis, St Louis, MO, United States
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11
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Wight D, Sekiwunga R, Namutebi C, Zalwango F, Siu GE. A Ugandan Parenting Programme to Prevent Gender-Based Violence: Description and Formative Evaluation. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:448-464. [PMID: 35431527 PMCID: PMC7612614 DOI: 10.1177/10497315211056246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: To develop a culturally-sensitive intervention for the early prevention of gender-based violence (GBV) in Uganda. Methods: Programme design followed the 6SQuID model of intervention development and multi-sectorial advice. A formative evaluation was conducted in two communities with six groups and 138 participants. Findings: Four familial predictors of GBV were identified as potentially malleable: poor parent-child attachment, harsh parenting, inequitable gendered socialization and parental conflict. A community-based parenting programme was developed to address them. Its programme theory incorporates Attachment Theory, the concept that positive behavioural control develops emotional control, and Social Learning Theory. Its rationale, structure and content are presented using the TIDieR checklist. A formative evaluation showed the programme to be widely acceptable, culturally appropriate, and perceived to be effective, but also identified challenges. Conclusion: The careful development of this community-based parenting programme shows promise for the early prevention of GBV.
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Affiliation(s)
- Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard Sekiwunga
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Carol Namutebi
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | | | - Godfrey E. Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
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12
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Meinck F, Orkin M, Cluver L. Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis. BMC Med 2021; 19:263. [PMID: 34758838 PMCID: PMC8580740 DOI: 10.1186/s12916-021-02137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets ("accelerators") within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. METHODS Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. RESULTS Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. CONCLUSION Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
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Affiliation(s)
- Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD UK
- OPTENTIA, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Orkin
- MRC-Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Lachman JM, Alampay LP, Jocson RM, Alinea C, Madrid B, Ward C, Hutchings J, Mamauag BL, Garilao MAVFV, Gardner F. Effectiveness of a parenting programme to reduce violence in a cash transfer system in the Philippines: RCT with follow-up. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 17:100279. [PMID: 34734199 PMCID: PMC8501762 DOI: 10.1016/j.lanwpc.2021.100279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023]
Abstract
Background Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiveness of a locally adapted parenting programme delivered as part of a government CCT system to low-income families with children aged two to six years in Metro Manila, Philippines. Methods Participants were randomly assigned (1:1) to either a 12-session group-based parenting programme or treatment-as-usual services (N = 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments in January-February 2018 and 12-month follow-up in January-February 2019. All assessments were parent-report (ClinicalTrials.gov: NCT03205449). Findings One-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0.50 [-0.86, -0.13]), emotional abuse (d = -0.59 [-0.95; -0.22]), physical abuse (IRR = 0.51 [0.27; 0.74]), and neglect (IRR = 0.52 [0.18; 0.85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at one-year follow-up. Interpretation Findings suggest that a culturally adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries. Funding This research was supported by UBS Optimus Foundation and UNICEF Philippines, and by the Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK and Chief Scientist Office (Grant: MC_UU_00022/1 and CSO SPHSU16, MC_UU_00022/3 and CSO SPHSU18).
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Affiliation(s)
- Jamie M Lachman
- University of Oxford, Centre for Evidence-Based Interventions, Department of Social Policy and Intervention, Wellington Square, Oxford, OX1 2ER, United Kingdom.,University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, +44 (0) 141 353 6508
| | - Liane Peña Alampay
- Ateneo de Manila University, Department of Psychology, 3/F Leong Hall, Quezon City, 1108, Philippines
| | - Rosanne M Jocson
- Ateneo de Manila University, Department of Psychology, 3/F Leong Hall, Quezon City, 1108, Philippines
| | - Cecilia Alinea
- Philippine Ambulatory Pediatric Association, Unit 1409 Balagtas Royal Mansions, 168 Balagtas St., Pasay City, 1300, Philippines
| | - Bernadette Madrid
- Child Protection Unit, Philippine General Hospital, University of the Philippines, Taft Avenue, Manila, Philippines
| | - Catherine Ward
- Department of Psychology, University of Cape Town, Rondebosch 7701, South Africa
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Department of Psychology, Bangor University, Nantlle Building, Normal Site, Bangor, Gwynedd LL57 2PX, United Kingdom
| | - Bernice Landoy Mamauag
- Division of Social Sciences, College of Arts and Sciences, University of Philippines Visayas
| | | | - Frances Gardner
- University of Oxford, Centre for Evidence-Based Interventions, Department of Social Policy and Intervention, Wellington Square, Oxford, OX1 2ER, United Kingdom
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Moos B, Williams D, Bolon I, Mupfasoni D, Abela-Ridder B, Ruiz de Castaneda R. A scoping review of current practices on community engagement in rural East Africa: Recommendations for snakebite envenoming. Toxicon X 2021; 11:100073. [PMID: 34381992 PMCID: PMC8334718 DOI: 10.1016/j.toxcx.2021.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/01/2022] Open
Abstract
Community empowerment and engagement is one of the four strategic aims highlighted in the WHO strategy to prevent and control snakebite envenoming. Inappropriate health-seeking behaviours contribute to adverse outcomes, and community engagement is key in driving behavioural change. WHO has highlighted East Africa as a geographical area of concern for snakebite envenoming. The overall aim of the project is to develop a community engagement toolkit for snakebite envenoming and other NTDs. The objective of this scoping review was to identify current practices in recent community engagement in rural East Africa; the applicability of these results to snakebite envenoming are discussed. PubMed, Web of Science, PsycINFO and Google Scholar were searched from 1 January 2017 to 3 September 2020. Search terms were used to identify publications which related to rural communities and health or disease, for both humans and animals. After reviewing the full papers for all geographical areas, 112 publications were included, 30 of which were conducted in East Africa. Papers included nine different countries and covered a broad range of health topics; notably, water, sanitation and hygiene, nutrition, and maternal and child health. Only one publication considered animal health. The most common form of engagement was in the context of a group meeting, lecture, presentation, discussion or question and answer session (63.3%). A variety of locations within the community were used to engage with people, the most common being an individual's household (23.3%). Communication factors was the key influencer for engagement, both positively and negatively. Key barriers to engagement include local languages and health beliefs, literacy levels, mobile phone ownership and the level of mobile Internet coverage, burden of agricultural work and weather conditions. This study provides an extensive overview of recent public health community engagement in East Africa, which will serve as a useful resource for any group seeking to plan an intervention in remote and rural areas in East Africa. Furthermore, it serves as a guide to help tailor community engagement to snakebite envenoming.
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Affiliation(s)
- Bethany Moos
- Hedena Health, 207 London Road, Headington, Oxford, UK
| | - David Williams
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, CH-1202, Geneva, Switzerland
| | - Denise Mupfasoni
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Rafael Ruiz de Castaneda
- Division of Tropical and Humanitarian Medicine & Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Jensen SK, Placencio-Castro M, Murray SM, Brennan RT, Goshev S, Farrar J, Yousafzai A, Rawlings LB, Wilson B, Habyarimana E, Sezibera V, Betancourt TS. Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda. BMJ Glob Health 2021; 6:bmjgh-2020-003508. [PMID: 33514591 PMCID: PMC7849888 DOI: 10.1136/bmjgh-2020-003508] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah Kg Jensen
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Matias Placencio-Castro
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shauna M Murray
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Robert T Brennan
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA.,Women's Study Research Center, Brandeis University, Waltham, Massachusetts, USA
| | - Simo Goshev
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jordan Farrar
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Briana Wilson
- The World Bank, Washington, District of Columbia, USA
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Jeong J. Redesigning and delivering inclusive parenting interventions for fathers. LANCET GLOBAL HEALTH 2021; 9:e596. [PMID: 33865470 DOI: 10.1016/s2214-109x(21)00037-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, MA, USA.
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Shanley JR, Armistead LP, Musyimi C, Nyamai D, Ishiekwene M, Mutiso V, Ndetei D. Engaging community voices to assess Kenya's strengths and limitations to support a child maltreatment prevention program. CHILD ABUSE & NEGLECT 2021; 111:104772. [PMID: 33158583 PMCID: PMC7855883 DOI: 10.1016/j.chiabu.2020.104772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/09/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Preventing child maltreatment is a global mission of numerous international organizations, with parent support programs as the critical prevention strategy. In Kenya, 70 % of children are at risk of experiencing abuse and neglect, most often by their parents. Yet, there is a lack of evidence-based parent support programs, and a limited understanding of Kenya's capacity and infrastructures (e.g., policies, funding, service agencies) to support and sustain such programs. OBJECTIVE The purpose of this study was to assess systematically Kenya's strengths and limitations to implement a parent support program using a mixed-methods study design. PARTICIPANTS AND METHODS Twenty-one community stakeholders from Kenya completed the World Health Organization's (WHO) Readiness Assessment for the Prevention of Child Maltreatment to understand Kenya's preparedness to undertake a prevention program. In addition, 91 participants (e.g., parents, community health workers, community leaders) took part in focus group discussions or individual interviews to understand existing support networks around parenting programs. RESULTS Kenya's overall 'readiness' score was comparable to the other countries that completed the WHO survey. The survey results revealed Kenya's strengths and limitations across the ten readiness dimensions. Several themes emerged from the focus groups and interviews, including the diverse sources of support for parents, specific programs available for parents, and gaps in services offered. CONCLUSIONS The results document ways to build upon Kenyan's existing strengths to facilitate implementation of an evidence-based prevention program. These results also highlight the significant need to understand local context when adapting parenting programs for low/middle income countries (LMICs).
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Affiliation(s)
| | - Lisa P Armistead
- Georgia State University, 140 Decatur St., Atlanta, GA 30303, USA.
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, PO Box 48423-00100, Nairobi, Kenya.
| | - Darius Nyamai
- Africa Mental Health Research and Training Foundation, PO Box 48423-00100, Nairobi, Kenya.
| | | | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, PO Box 48423-00100, Nairobi, Kenya.
| | - David Ndetei
- Africa Mental Health Research and Training Foundation, PO Box 48423-00100, Nairobi, Kenya; The University of Nairobi, PO Box 30197-00100, Nairobi, Kenya.
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Wilke NG, Howard AH, Goldman P. Rapid return of children in residential care to family as a result of COVID-19: Scope, challenges, and recommendations. CHILD ABUSE & NEGLECT 2020; 110:104712. [PMID: 32921445 PMCID: PMC7473257 DOI: 10.1016/j.chiabu.2020.104712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND As a result of the COVID-19 pandemic, some governments have mandated that residential care providers rapidly return children and youth to family. OBJECTIVE The goal of the present study was to better understand the scope and characteristics of rapid return, and to provide data-informed recommendations for service providers working with this population. PARTICIPANTS AND SETTING Representatives from 67 non-government organizations (NGOs) providing residential care that were government-mandated to rapidly return children and youth to family completed a brief online survey. They collectively serve 12,494 children in 14 nations. METHODS Using a mixed methods design, results examined 1) characteristics of the rapid return mandate, 2) preparation received by children and families, 3) support services provided since the return, and 4) primary concerns for children and families. RESULTS Data revealed that rapid return was characterized by compressed timelines that did not allow for adequate child and family assessment and preparation. However, all respondents indicated they believed at least some families would be able to remain intact safely with appropriate support. Primary concerns for children and families related to unresolved antecedents to separation, lack of economic capacity, limited monitoring, and lack of access to education. CONCLUSIONS Based on the findings, 9 recommendations were made for service providers working with children and families that have been rapidly reunified as a result of the COVID-19 pandemic.
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Affiliation(s)
| | | | - Philip Goldman
- Maestral International, Suite 2850, 150 South Fifth Street, Minneapolis, MN 55402, USA.
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Cluver LD, Rudgard WE, Toska E, Zhou S, Campeau L, Shenderovich Y, Orkin M, Desmond C, Butchart A, Taylor H, Meinck F, Sherr L. Violence prevention accelerators for children and adolescents in South Africa: A path analysis using two pooled cohorts. PLoS Med 2020; 17:e1003383. [PMID: 33166288 PMCID: PMC7652294 DOI: 10.1371/journal.pmed.1003383] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The INSPIRE framework was developed by 10 global agencies as the first global package for preventing and responding to violence against children. The framework includes seven complementary strategies. Delivering all seven strategies is a challenge in resource-limited contexts. Consequently, governments are requesting additional evidence to inform which 'accelerator' provisions can simultaneously reduce multiple types of violence against children. METHODS AND FINDINGS We pooled data from two prospective South African adolescent cohorts including Young Carers (2010-2012) and Mzantsi Wakho (2014-2017). The combined sample size was 5,034 adolescents. Each cohort measured six self-reported violence outcomes (sexual abuse, transactional sexual exploitation, physical abuse, emotional abuse, community violence victimisation, and youth lawbreaking) and seven self-reported INSPIRE-aligned protective factors (positive parenting, parental monitoring and supervision, food security at home, basic economic security at home, free schooling, free school meals, and abuse response services). Associations between hypothesised protective factors and violence outcomes were estimated jointly in a sex-stratified multivariate path model, controlling for baseline outcomes and socio-demographics and correcting for multiple-hypothesis testing using the Benjamini-Hochberg procedure. We calculated adjusted probability estimates conditional on the presence of no, one, or all protective factors significantly associated with reduced odds of at least three forms of violence in the path model. Adjusted risk differences (ARDs) and adjusted risk ratios (ARRs) with 95% confidence intervals (CIs) were also calculated. The sample mean age was 13.54 years, and 56.62% were female. There was 4% loss to follow-up. Positive parenting, parental monitoring and supervision, and food security at home were each associated with lower odds of three or more violence outcomes (p < 0.05). For girls, the adjusted probability of violence outcomes was estimated to be lower if all three of these factors were present, as compared to none of them: sexual abuse, 5.38% and 1.64% (ARD: -3.74% points, 95% CI -5.31 to -2.16, p < 0.001); transactional sexual exploitation, 10.07% and 4.84% (ARD: -5.23% points, 95% CI -7.26 to -3.20, p < 0.001); physical abuse, 38.58% and 23.85% (ARD: -14.72% points, 95% CI -19.11 to -10.33, p < 0.001); emotional abuse, 25.39% and 12.98% (ARD: -12.41% points, 95% CI -16.00 to -8.83, p < 0.001); community violence victimisation, 36.25% and 28.37% (ARD: -7.87% points, 95% CI -11.98 to -3.76, p < 0.001); and youth lawbreaking, 18.90% and 11.61% (ARD: -7.30% points, 95% CI -10.50 to -4.09, p < 0.001). For boys, the adjusted probability of violence outcomes was also estimated to be lower if all three factors were present, as compared to none of them: sexual abuse, 2.39% to 1.80% (ARD: -0.59% points, 95% CI -2.24 to 1.05, p = 0.482); transactional sexual exploitation, 6.97% to 4.55% (ARD: -2.42% points, 95% CI -4.77 to -0.08, p = 0.043); physical abuse from 37.19% to 25.44% (ARD: -11.74% points, 95% CI -16.91 to -6.58, p < 0.001); emotional abuse from 23.72% to 10.72% (ARD: -13.00% points, 95% CI -17.04 to -8.95, p < 0.001); community violence victimisation from 41.28% to 35.41% (ARD: -5.87% points, 95% CI -10.98 to -0.75, p = 0.025); and youth lawbreaking from 22.44% to 14.98% (ARD -7.46% points, 95% CI -11.57 to -3.35, p < 0.001). Key limitations were risk of residual confounding and not having information on protective factors related to all seven INSPIRE strategies. CONCLUSION In this cohort study, we found that positive and supervisory caregiving and food security at home are associated with reduced risk of multiple forms of violence against children. The presence of all three of these factors may be linked to greater risk reduction as compared to the presence of one or none of these factors. Policies promoting action on positive and supervisory caregiving and food security at home are likely to support further efficiencies in the delivery of INSPIRE.
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Affiliation(s)
- Lucie D. Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - William E. Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Department of Statistics and AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa
| | | | - Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Mark Orkin
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Medical Research Council Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alexander Butchart
- Violence Prevention Unit, Social Determinant of Health, Healthier Populations Division, World Health Organization, Switzerland
| | - Howard Taylor
- Global Partnership to End Violence Against Children, New York, New York, United States of America
| | - Franziska Meinck
- OPTENTIA Faculty of Health Sciences, North-West University, South Africa
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global Health, University College London, United Kingdom
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