Combining Economic Strengthening and Parenting Programmes to Reduce Violence Against Children in Rural Tanzania: A Cluster Randomised Controlled Trial

Abstract

Background: Parenting programmes may reduce risk of violence against children and improve child wellbeing. However, additional economic support may be necessary in highly-deprived low-income countries. Methods: A parallel cluster randomised controlled trial examined the combined and separate effects of parenting and economic strengthening on reducing violence against children ages 0 to 18 years in impoverished farming communities in Tanzania (N =248 families). Eight villages were randomly assigned to four conditions (2:2:2:2 ratio): 1) 12-session parenting programme (N =60); 2) agribusiness training (N =56); 3) parenting and agribusiness combined (N =72); 4) control (N =60). Parent-report, child-report, and early childhood observation assessments were conducted at baseline, mid-treatment, and post-treatment. Primary outcomes included child maltreatment, parenting behaviour, and corporal punishment endorsement. Secondary outcomes included parenting stress, parent/child depression, child behaviour, economic wellbeing, and child development (ClinicalTrials.gov: NCT02633319). Assessors were blind to allocation status at baseline; the data analyst was also blind to allocation until after initial intention-to-treat analyses. Findings: At post-treatment, parents and children receiving the combined interventions reported less maltreatment (parents: IRR=0.40, 95%CI [0.24,0.65]; children: IRR=0.40, 95%CI [0.17,0.92]). Parents also reported reduced endorsement of corporal punishment (Dw =-0.43, 95%CI [-0.79,0.07]), and less child behaviour problems (Dw =-0.41, 95%CI [-0.77,-0.05]). Parents in parenting-only villages reported less abuse (IRR=0.36, 95%CI [0.21,0.63]) and less child behaviour problems (Dw =-0.47, 95%CI [-0.84,-0.11]). Parents in agribusiness-only villages reported less child behaviour problems (Dw =-0.43, 95%CI [-0.77,-0.08]) and greater household wealth (Dw =0.57, 95%CI [0.08,1.06]). However, children in agribusiness-only villages reported increased physical abuse (IRR=2.26, 95%CI [1.00,5.12]) and less positive parenting (Dw =-0.50, 95%CI [-0.91,-0.10]). There were no other adverse effects. Interpretation: Results suggest that the parenting component may be the active ingredient in reducing maltreatment, and that agribusiness training programmes may have unintended negative consequences on children when delivered alone. Trial Registration: (ClinicalTrials.gov: NCT02633319; Pan African Clinical Trials: PACTR201610001267268). Funding Statement: The Skilful Parenting and Agribusiness Child Abuse Prevention Study (SPACAPS) was supported by the UBS Optimus Foundation (Grant: 7849.09), the Netherlands Ministry of Foreign Affairs, and the Complexity in Health Improvement Programme of the Medical Research Council MRC UK (Grant: MC_UU_12017/14). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval was received from the Tanzania Lake Zone Institutional Review Board (03.09.2015) and the University of Oxford Social Sciences and Humanities Interdivisional Research Ethics Committee (SSD/CUREC1A/14-SSH_C2_15_023).