Family Strengthening Intervention (Sugira Muryango) Associated with Improved Caregiver Mental Health and Reduced Family Violence and in Rwanda

Background: Mental health problems are common among vulnerable populations. Risk factors associated with poor mental health include poverty, job insecurity, stress, chaotic living environments, and exposure to violence. Mental health problems are particularly prevalent among parents of young children and can impact parents’ ability to attend to children’s needs and engage in positive interactions. Above and beyond direct effects of parental mental health on child outcomes, parental mental health is likely to both mediate and moderate effects of parent focused interventions to promote early childhood development.

Methods: We use data collected as part of a cluster randomized trial (n=1049 households) testing the impact of a home visiting parenting intervention, Sugira Muryango (Strengthen the Family), in Rwanda. The trial is linked to the Rwandan national social protection program, thus reaching the poorest households with children aged 6-36 months. Sugira Muryango is delivered by trained lay workers and integrates promotion of early childhood development with violence prevention. The curriculum is delivered via active coaching in the family’s home and covers responsive parenting as well as active education and problem solving to promote family functioning, reduce conflict and violence in the home, increase father engagement, improve family health and hygiene.

Results: Results comparing baseline with postintervention outcomes suggest that using lay workers as home visitors, participation in Sugira Muryango is associated improvements in caregiver behaviors related to responsive parenting and family health, as well as improve child developmental outcomes. Sugira Muryango, for example, was associated with increased stimulation and positive parenting, improved child health and development outcomes, improved caregiver mental health (depression and anxiety), and reduced family violence including intimate partner violence and harsh discipline.

In these analyses we further explore the extent to which improved caregiver mental health, reduced family violence, improved caregiver emotion regulation, and increased positive parenting mediate positive effect of Sugira Muryango on children’s developmental outcomes.

Conclusions and Implications: A lay worker delivered intervention led to improvements in a broad range of child and caregiver outcomes. Understanding the mechanisms by which early parenting programs like Sugira Muryango improve child development outcomes is important for optimization and scale up of programs to reach and support vulnerable families at large.