Citation

Stark L, Seff I, Asghar K, Roth D, Bakamore T, MacRae M, Fanton D'Andon C, Falb KL. BMJ Glob. Health 2018; 3(5): e000824.

Affiliation

International Rescue Committee, New York City, New York, USA.

Copyright

(Copyright © 2018, BMJ Publishing Group)

DOI

10.1136/bmjgh-2018-000824

PMID

30398222

PMCID

PMC6203064

Abstract

INTRODUCTION: Parenting programmes are increasingly popular for reducing children's exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls' exposure to violence (sexual and others) and caregivers' gender attitudes and parenting behaviours.

METHODS: In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10-14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls' self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted.

RESULTS: At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes.

CONCLUSION: While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls' violence exposure in humanitarian settings. TRIAL REGISTRATION NUMBER: NCT02384642.

Language: en

Keywords

child health; cluster randomised trial; prevention strategies; public health