Combining parenting and economic strengthening programmes to reduce violence againstchildren in rural Tanzania: a cluster randomised controlled trial with predominantly malecaregivers

Introduction: Parenting programmes may reduce risk of violence against children and improve child wellbeing. However, additional economic support may be necessary in highly-deprived rural communities in sub-Saharan Africa. Furthermore, delivering programmes within farmer groups may increase male caregiver recruitment and engagement. Methods: A parallel cluster randomised controlled trial examined the combined and separate effects of parenting and economic strengthening programmes on reducing violence against children ages 0 to 18 years in farming communities in Tanzania (N=248 families; 63% male caregivers). Eight villages were randomly assigned to four conditions (2:2:2:2): 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 were child maltreatment and parenting behaviour. Secondary outcomes included corporal punishment endorsement, parenting stress, parent/child depression, child behaviour, economic wellbeing, and child development (ClinicalTrials.gov: NCT02633319). Results: 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 reported reduced endorsement of corporal punishment (Dw=-0.43, 95%CI [-0.79,0.07]) and fewer 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 fewer child behaviour problems (Dw=-0.47, 95%CI [-0.84,-0.11]). Parents in agribusiness-only villages reported fewer 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. Conclusion: Parent training may be the active ingredient in reducing maltreatment in farmer groups with majority male caregivers, while agribusiness training programmes may have unintended negative consequences on children when delivered alone. Locating parenting support in existing farmer groups can engage a much higher proportions of fathers than stand-alone programmes.