{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T17:20:45Z","timestamp":1794504045087,"version":"4.9.1"},"reference-count":46,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T00:00:00Z","timestamp":1611792000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2020,12,23]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Families living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda\u2019s social protection system to promote ECD and reduce violence compared with usual care (UC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Families with children aged 6\u201336 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95%\u2009CI 0.065 to 0.260), communication (d=0.081, 95%\u2009CI 0.005 to 0.156), problem solving (d=0.101, 95%\u2009CI 0.002 to 0.179) and personal-social development (d=0.096, 95%\u2009CI \u22120.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95%\u2009CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95%\u2009CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95%\u2009CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Social protection programmes provide a means to deliver ECD intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02510313\">NCT02510313<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2020-003508","type":"journal-article","created":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T11:16:07Z","timestamp":1611918967000},"page":"e003508","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda"],"prefix":"10.1136","volume":"6","clinical-trial-number":[{"clinical-trial-number":"nct02510313","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02510313","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Sarah KG","family":"Jensen","sequence":"first","affiliation":[{"name":"School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Placencio-Castro","sequence":"additional","affiliation":[{"name":"Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shauna M","family":"Murray","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert T","family":"Brennan","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA"},{"name":"Women's Study Research Center, Brandeis University, Waltham, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simo","family":"Goshev","sequence":"additional","affiliation":[{"name":"Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Farrar","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Yousafzai","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B","family":"Rawlings","sequence":"additional","affiliation":[{"name":"The World Bank, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briana","family":"Wilson","sequence":"additional","affiliation":[{"name":"The World Bank, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Habyarimana","sequence":"additional","affiliation":[{"name":"FXB Rwanda, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Sezibera","sequence":"additional","affiliation":[{"name":"Center for Mental Health, University of Rwanda, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa S","family":"Betancourt","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston 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