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. 2020 May 6;20(1):621. doi: 10.1186/s12889-020-08693-7.


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: number NCT02510313.

Keywords: Early childhood development (ECD); Father engagement; Home-visiting; Poverty; Social protection; Violence.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aggression / psychology
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Caregivers / psychology
  • Child Development
  • Child, Preschool
  • Cluster Analysis
  • Depression / epidemiology
  • Depression / psychology
  • Fathers / psychology*
  • Female
  • House Calls*
  • Humans
  • Infant
  • Male
  • Parent-Child Relations*
  • Poverty / psychology*
  • Program Evaluation
  • Public Policy*
  • Rwanda / epidemiology
  • Surveys and Questionnaires
  • Violence / prevention & control*
  • Violence / psychology

Associated data