Abstract: The Longitudinal Impact of an Evidence-Based Multiple Family Group Intervention (Amaka Amasanyufu), on Child Behavioral Outcomes in Uganda: The SMART Africa Uganda Study (2016-2021) (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

Schedule:

Saturday, January 15, 2022

Marquis BR Salon 9, ML 2 (Marriott Marquis Washington, DC)

* noted as presenting author

Mary McKay, PhD, Dean and Professor, Washington University in Saint Louis, St Louis, MO

Rachel Brathwaite, PhD, Postdoctoral Fellow, Washington University in Saint Louis, St. Louis, MO

Fred Ssewamala, PhD, William E. Gordon Distinguished Professor, Washington University in Saint Louis, St. Louis, MO

Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Torsten B. Neilands, PhD, Professor, University of California, San Francisco, CA

Phionah Namatovu, MPH, Research Coordinator, International Center for Child Health and Development, Uganda

Joshua Kiyingi, MSTAT, Doctoral Student, Washington University in St. Louis, St. Louis, MO

Lily Zmachinski, MSW student, Washington University in Saint Louis, MO

Josephine Nabayinda, Msc, Doctoral student, Washington University in Saint Louis, Saint Louis, MO

Keng-Yen Huang, PhD, MPH, Associate Professor of Population Health and Child and Adolescent Psychiatry and Associated Faculty of Global Public Health, New York University, New York, NY

Apollo Kivumbi, MPH, Project Coordinator, International Center for Child Health and Development, Masaka, Uganda

Christopher Ddamulira, BA, Data Analyst, International Center for Child Health and Development, Masaka, Uganda

Arvin Bhana, PhD, Chief Specialist Scientist, South African Medical Research Council, Durban, South Africa

Abel Mwebembezi, M.S., Executive Director, Reach the Youth Uganda, Kampala, Uganda

Inge Petersen, Professor, University of KwaZulu-Natal, Durban, South Africa

Kimberly Hoagwood, PhD, Researcher, New York University

ABSTRACT

We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu (Happy Families) designed to reduce disruptive behavioral disorders (DBDs) among school-going children residing in low-resourced communities in Uganda by strengthening parenting skills, parental discipline, family communication, within-family support, and positive child interactions.

Methods

We used longitudinal data from the SMART Africa-Uganda study (2017-2021), from 26 public primary schools in 5 districts in the greater Masaka region. Schools were randomized to: 1) Control condition (receiving usual care that comprises of distribution of generalized literature on psychosocial functioning—produced by the Uganda Ministry of Health), 10 schools; 2) intervention condition delivered via parent peers (MFG-PP), 8 schools or; 3) intervention condition delivered via community healthcare workers (MFG-CHW), 8 schools. At baseline, 8- and 16-weeks post-intervention initiation, caregivers completed the Iowa Conners Scale which measured Oppositional Defiant Disorder (ODD) and the Impairment Rating Scale to evaluate children’s overall impairment and impaired functioning with peers, siblings and parents; impaired academic progress, self-esteem and family functioning. Three-level linear mixed models were fitted to each continuous outcome. Models comprised fixed categorical effects for study condition, time and their interaction, a random intercept for school, and unstructured correlations among subjects’ repeated measures. Pairwise comparisons of post-baseline group means within each time point were performed using Sidak’s adjustment for multiple comparisons. Only children who screened positive for DBDs were analysed.

Results

A total of 636 children screened positive for DBDs (Control condition: n=243; MFG-PP: n=194; MFG-CHWs: n=199). At 8 weeks, children in the MFG-PP condition reported significantly lower mean scores for overall impairment compared to children in the control condition while children in the MFG-CHWs condition performed better on ODD. At 16 weeks, children in both the MFG-CHWs and MFG-PP condition reported significantly lower mean scores on ODD and total impairment, than children in the control condition.

Conclusion

The Amaka Amasanyufu MFG intervention was more effective in reducing ODD, and impairment functioning than usual care. Wholistically, this intervention may help reduce the burden of DBDs among children in resource-limited settings, and improve family functioning.

Trial registration: ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.