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This cluster-randomised trial evaluates whether families living in extreme poverty (\n                      <jats:italic>Ubudehe<\/jats:italic>\n                      1, the poorest category in the Government of Rwanda\u2019s wealth ranking) who receive\n                      <jats:italic>Sugira Muryango<\/jats:italic>\n                      in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programmes operating in the village clusters; 198 clusters met all enrolment criteria.\n                      <jats:italic>Sugira Muryango<\/jats:italic>\n                      was delivered to\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u2009541 families in 100 treatment clusters with children aged 6\u201336\u2009months living in extreme poverty. We assessed changes in outcomes in intervention and\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u2009508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Families receiving\n                      <jats:italic>Sugira Muryango<\/jats:italic>\n                      improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u20090.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u20090.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR\u2009=\u20090.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR\u2009=\u20090.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24\u2009h (Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u20090.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR\u2009=\u20094.43, 95% CI: 1.95, 10.10) and fever (OR\u2009=\u20093.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR\u2009=\u20093.39, 95% CI: 2.16, 5.30) compared with UC. Finally,\n                      <jats:italic>Sugira Muryango<\/jats:italic>\n                      was associated with decreased caregiver depression and anxiety (OR\u2009=\u20090.58, 95% CI: 0.38, 0.88).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Sugira Muryango<\/jats:italic>\n                      led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov number\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02510313\">NCT02510313<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-020-08693-7","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T01:03:16Z","timestamp":1588726996000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes"],"prefix":"10.1186","volume":"20","author":[{"given":"Theresa S.","family":"Betancourt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K. 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