Lay-worker Delivered Home Visiting Promotes Early Childhood Development and Reduces Violence in Rwanda: A Randomized Pilot.
Barnhart Dale A. Farrar Jordan. Murray Shauna M. Brennan Robert T. Antonaccio Cara M. Sezibera Vincent. Ingabire Charles. Godfroid Kalisa. Bazubagira Stephanie. Uwimana Odette. Kamurase Alex. Wilson Briana. Rawlings Laura B. Yousafzai Aisha. Betancourt Theresa S.
Department of Epidemiology
Published: May 2020
Journal of Child and Family Studies
Vol. 29, No. 7 , p. 1804-1817
Springer International Publishing AG
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New York, NY 10013
Tel: 212-460-1500 800-SPRINGER
Early child development (ECD) programs are increasingly combined with targeted cash transfers for poor households to break intergenerational poverty. However, few evidence-based, scalable, and sustainable ECD programs that complement cash transfer programs exist in in low- and-middle-income countries. We conducted a cluster-randomized pilot study to assess whether Sugira Muryango, a strengths-based home-visiting intervention to promote child development and prevent violence among children aged 6-36 months, could be delivered by community-based lay workers to poor families participating in Rwanda's cash-for-work Vision Umurenge Program (VUP). Data collection occurred among 38 families at baseline, endline, and 6 months after the intervention and included child-level (child engagement, caretaking, and health and development), caregiver-level (family unity and mental health) and household-level (water and sanitation practices and family conflict) outcomes. We compared trajectories of Sugira Muryango families vs. families receiving the cash transfer only over time using mixed-effect models. Sugira Muryango children experienced significantly greater ECD engagement than children in control families and marginally significant reductions in exposure to violent disciplinary methods. Sugira Muryango caregivers reported greater shared decision-making between parents and marginally significant improvements in family unity and anxiety. Conflict within intervention households halved between baseline and follow-up. Satisfaction was high. This randomized pilot demonstrates that Sugira Muryango can be delivered by community-based lay workers, improves access to nurturing care and stimulation among children living in poverty, and may reduce intra-family conflict. A large-scale effectiveness study is underway to assess the intervention's impact on child development and health outcomes. (Author abstract)
poverty; child development; child abuse; prevention programs; community based services; child rearing; parenting skills; community violence; EARLY INTERVENTION PROGRAMS; HOME VISITING PROGRAMS