Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial

Galvin, Lauren; Verissimo, Cristiana K.; Ambikapathi, Ramya; Gunaratna, Nilupa S.; Rudnicka, Paula; Sunseri, Amy; Jeong, Joshua; O'Malley, Savannah Froese; Yousafzai, Aisha K.; Sando, Mary Mwanyika; Mosha, Dominic; Kumalija, Elfrida; Connolly, Hannah; PrayGod, George; Endyke-Doran, Cara; Kieffer, Mary Pat

doi:10.1016/j.socscimed.2023.115869

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…Specifically in the Rwanda study, the authors speculated that this positive effect on fathers' parenting practices could have been due to the program benefits on joint household decision‐making and sharing of household tasks and childcare between mothers and fathers (Doyle et al., 2018). In a separate study, we report the positive effects of engaging fathers on outcomes relating to fathers' and mothers' gender attitudes and women's empowerment (Galvin et al., 2023), which could have also partly contributed to these positive effects observed on parental stimulation.…”

Section: Discussionmentioning

confidence: 90%

“…Furthermore, we hypothesized that the father‐inclusive bundled intervention would lead to synergistic improvements in ECD and parenting outcomes beyond those achieved by implementing either intervention strategy alone. Elsewhere, we report on the results for other study outcomes, such as the synergistic effect discovered through bundling parenting and engaging fathers on child dietary diversity (under review) and intervention benefits on gender equality and women's empowerment (Galvin et al., 2023).…”

Section: Introductionmentioning

confidence: 99%

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Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster‐randomized controlled trial

Jeong,

Ahun,

Gunaratna

et al. 2023

Child Psychology Psychiatry

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BackgroundMulticomponent interventions are needed to address the various co‐occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes.MethodsWe conducted a 2×2 factorial cluster‐randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard‐of‐care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference‐in‐difference approach with intention‐to‐treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well‐being.ResultsBetween October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (β = .18 [95% CI: 0.01, 0.36]) and receptive language development (β = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (β = .21 [0.04, 0.38]) and availability of home learning materials (β = .25 [0.07–0.43]) and reduced paternal parenting distress (β = −.34 [−0.55, −0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (β = .45 [0.27, 0.63]).ConclusionsJointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster‐randomized controlled trial

Jeong,

Ahun,

Gunaratna

et al. 2023

Child Psychology Psychiatry

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“…Our intervention also leveraged existing touchpoints with caregivers through the health system and community groups, supporting both health workers and CHV to lead discussion around the RCEL content. Similar ECD interventions have also relied on trained community health workers or volunteers, with positive outcomes, given their trusted role in the community (28,31,35,36) . The significant increase in children with inadequate supervision that we observed may be attributed to the natural ageing of children over the course of the study (average age 9 months at baseline, 19 months at endline), leading caregivers to feel more comfortable leaving them in the care of their older siblings.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services

Aidam,

Varela,

Abukari

et al. 2024

Public Health Nutr.

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Objective: This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana. Design: We trained health facility workers and community health volunteers to deliver RCEL counseling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers’ RCEL practices before and after the intervention with a household questionnaire and caregiver-child observations. Setting: The study took place in Sagnarigu, Gushegu, Wa East, and Mamprugu-Moagduri districts from April 2022 to March 2023. Study sites included 79 child welfare clinics (CWCs) at Ghana Health Service facilities and 80 village savings and loan association groups (VSLAs). Participants: We enrolled 211 adult caregivers in the study sites who had children 0–23 months at baseline and were enrolled in a CWC or a VSLA. Results: We observed improvements in RCEL and infant and young child feeding practices, opportunities for early learning (e.g., access to books and playthings) in the home environment, and reductions in parental stress. Conclusions: This study demonstrates the effectiveness of integrating RCEL content into existing nutrition and health services. The findings can be used to develop, enhance, and advocate for policies integrating RCEL into existing services and platforms in Ghana. Future research may explore the relationship between positive changes in caregiver behavior and improvements in child development outcomes as well as strategies for enhancing paternal engagement in care practices, improving child supervision, and ensuring an enabling environment.

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“…For example, a study using data from 122 countries found that gender inequality was significantly correlated with gender disparities in depressive disorders, suggesting women’s mental wellbeing is strongly impacted by inequalities at the societal level ( Yu, 2018 ). To support maternal economic empowerment and mental wellbeing, interventions and public policies in Kenya must therefore adopt gender-transformative approaches that move towards more equitable divisions of caregiving and income-generating activities, such as through the intentional engagement of fathers and community leaders to reflect on and question traditional parenting roles ( Galvin et al, 2023 ; Jeong et al, 2024 ; Slegh et al, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Father involvement is a protective factor for maternal mental health in Western Kenya

McCann,

Freire,

Ramos de Oliveira

et al. 2024

SSM - Mental Health

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Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial

Cited by 11 publications

References 30 publications

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster‐randomized controlled trial

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster‐randomized controlled trial

Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services

Father involvement is a protective factor for maternal mental health in Western Kenya

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