Mental health outcomes of offspring exposed to parental intimate partner violence in Rwanda.

BACKGROUND: Children who witness parental intimate partner violence (IPV) are more likely to develop mental health issues compared to those who do not witness such violence. OBJECTIVE: The main objective of this study is to assess the association between parental intimate partner violence and child mental health outcomes. METHODOLOGY: This cross-sectional study involved 548 participants divided into two groups: parents (N = 304) and offspring (N = 244). The participants were recruited from Mageragere Sector in the City of Kigali (urban), as well as Mbazi and Ruhashya sectors in Huye District (rural). To assess the difference about mental difficulties reported by the offspring, a Mann-Whitney U test was employed to compare the responses of parents and their children on mental health outcomes. Additionally, multiple linear regression analysis was conducted to explore the association between parental intimate partner violence (IPV) and the mental health outcomes of their offspring. RESULTS: The results highlighted significant levels of mental and emotional challenges in children, as reported by both parents and the children themselves. Depression and youth conduct problems were more prevalent among the children compared to their parents, whereas anxiety and irritability were more commonly reported by parents than by their children. Intimate partner violence showed to be a predictor of irritability and anxiety symptoms in offspring. In terms of irritability, depression, and youth conduct problems they were identified as predictors of anxiety symptoms. Particularly, anxiety and irritability were revealed to predict youth conduct problems. CONCLUSION: The study indicates that parental intimate partner violence (IPV) has an impact on the mental well-being of their offspring. Furthermore, it was observed that there is not only a correlation between IPV and poor mental health outcomes, but also a connection between different mental conditions, implying that children exposed to IPV are more prone to experiencing a range of mental issues. As a result, intervention programs should place emphasis on addressing the mental disorders of both parents and children.

Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system.

Early childhood development (ECD) programmes are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. This study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention to improve ECD outcomes through positive parent-child relationships. Cost-effectiveness analysis of ECD interventions is challenging given their potential to have multiple benefits. We propose a cost-effectiveness method using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions. The trial intervention cost US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems. The cost-effectiveness analysis suggests that while SM generated a relatively small impact on markers of early development, it did so efficiently. The observed improvements in cognitive development per home-visit are similar to other home-visiting interventions of longer duration. SM by focusing on the family had benefits beyond ECD, including reductions in violence against children and intermate partner violence, further analysis is needed to include these returns in the economic evaluation.

Perceptions of the Intervention Utility and Effectiveness in Supporting and Reintegrating Youths Born of Genocidal Rape in Rwanda.

Background: Birth through genocidal rape has a detrimental impact on the health of the offspring; however, there is scarce literature that focuses on efforts to support and reintegrate people born of this crime due to the lack of needs assessments that can inform policies and interventions. Objective: This study sought to explore perceptions of the intervention utility and effectiveness in supporting and reintegrating offspring born of the 1994 genocidal rape against the Tutsi in Rwanda. Methods: A purposive sample of 16 dyads of non-partnered mothers raped in the 1994 genocide against the Tutsi and their offspring participated in semi-structured qualitative interviews. The transcribed interview verbatims were uploaded to NVivo 12 and analyzed inductively using thematic analysis. Results: The analysis resulted in several subthemes that were grouped into four main themes based on research questions. These themes included the reconstruction of a positive image (ie, hardworking, contribution to the community, supporting vulnerable people, etc.), the benefits of collaborating with peers in a similar situation (ie, a sense of belonging, self-acceptance, relieving distress and emotional pain, etc.), the support obtained from Survivors Fund Rwanda (ie, psychosocial support, financial support for school fees, support to get a job), and the intervention and strategies needed (ie, continuous psychosocial support, catch-up learning programs, accompaniment support, advocacy to get a job, supporting the parents, etc.). Conclusion: Our results highlight how the youth born of genocidal rape are reconstructing a positive image and self-advocacy, their perception of obtained support, and the recommended intervention. These findings will help in initiating or strengthening interventions targeting this population, especially strategies to support and reintegrate them.

Family Violence Reduction Within a Parenting Intervention in Rwanda: A Mixed-Methods Study.

BACKGROUND AND OBJECTIVES: A mixed-methods study of mechanisms of change through which a home-visiting-based early childhood development intervention, Sugira Muryango ("strong family"), reduced violent discipline and intimate partner violence in Rwanda. METHODS: The cluster-randomized trial of Sugira Muryango enrolled socioeconomically vulnerable families with children aged 6 to 36 months in rural Rwanda. We interviewed 18 female caregivers early in the intervention, and 21 female caregivers and 11 male intimate partners were interviewed after the intervention. Coded interviews identify risk factors for violence and mechanisms of intervention-related change in violence. Quantitative analyses included 931 caregivers (52.6% female) who lived with an intimate partner to examine risk factors for violence, intervention effects, and mechanisms of violence reduction. RESULTS: The qualitative data identified daily hardships and alcohol problems as risk factors for violent discipline and intimate partner violence. Through Sugira Muryango, caregivers learned that strong relationships between partners and engagement of male caregivers in child care has positive impacts on children's development. Techniques taught by community lay workers improved communication, promoted positive parent-child interactions, and reduced intimate partner violence and violent discipline. Quantitative analyses also found that daily hardships predict violent discipline and intimate partner violence. Sugira Muryango reduced violent discipline, increased father engagement, and increased female caregiving warmth. Moreover, pre- to postintervention change in caregiving warmth was associated with reduced use of violent discipline among female caregivers and marginally associated with reduced female victimization. CONCLUSIONS: Violence reduction can be integrated into early child development programs to reduce violent discipline and intimate partner violence.

Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda - towards a blueprint for promoting mental health care services in low- and middle-income countries?

BACKGROUND: In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda. METHODS: This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14-65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007-2008 Genocide Survivors Census. RESULTS: Of 19,110 general survey participants, most were female (n = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) (p < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% (n = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services. CONCLUSIONS: Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services.

The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey.

Despite mounting evidence indicating an increased risk of long-term mental disorders in Rwanda's general population, little is still known about the national prevalence of mental disorders among victims of intimate partner violence (IPV) in a post-conflict setting. The aim of this study was to compare the prevalence of mental disorders among IPV exposed and non-exposed individuals in Rwanda. This was a cross-sectional study based on secondary data from the 2018 Rwanda Mental Health Survey. The sample consisted 20,381 participants selected nationwide, from 7,124 households (age range: 14-65 years), of which 3,759 Rwandans were exposed to IPV (18.4%) and 16,622 were non-exposed to IPV (81.6%). Participants were screened for IPV exposure and common mental disorders, and data was analyzed using the SPSS version 25 software. The results showed that the rate of any mental disorder was substantially higher in the group exposed to IPV than the non-exposed, at 32.4% and 11.7% respectively. These results highlight that among Rwandans diagnosed with severe mental disorders, participants with a history of IPV exposure present with increased odds of mental disorders prevalence and severity. Therefore, people seeking mental health care should also be screened for their IPV exposure and offered appropriate interventions.

Prevalence and correlates of depression among rural and urban Rwandan mothers and their daughters 26 years after the 1994 genocide against the Tutsi.

Background: In the past 26 years since the genocide against the Tutsi, mental illness continues to be the greatest challenges facing the Rwandan population. In the context of the 1994 genocide against Tutsi, there are three different survival status within Rwandan women. Those who were targeted by the genocide referred to as 'survivors', those who were in the country during the genocide but were not targeted referred to as 'non-targeted', and those who were outside the country referred to as '1959 returnees'. All these groups experienced the traumatic events differently. The literature shows that traumatic stress exposure is associated with depression. Objectives: To demonstrate differences in trauma exposure in a sample of mothers and daughters according to their genocide survival status. To examine differences in depression prevalence between these three groups of mothers and daughters as a function of their genocide survival status and place of residence. To examine the relationship between major depression, survival status, place of residence, and trauma exposure in sample of mothers and daughters, including the relationship between mothers' depression and daughters' depression. Methods: A sample of 309 dyads of mothers and daughters was recruited. Data were collected using the Mini International Neuropsychiatric Interview, Life Events Questionnaire and the Social Demographics Questionnaire. Data were analysed using descriptive statistics, chi-square test, logistic regression, and one-way ANOVA. Results: There is a significant difference in trauma exposure in three survival categories of mothers and daughters. A 23% of mothers and 18.4% of daughters met criteria for major depression, with urban participants twice as likely to meet criteria as participants from rural areas. Depression was associated with trauma exposure and place of residence in mothers' and daughters' samples. Maternal depression was associated with depression in daughters. Conclusions: Family support counselling services and research to identify factors of intergenerational depression are needed.

Antecedentes: En los últimos 26 años, desde el genocidio contra los tutsi, la enfermedad mental continúa siendo uno de los grandes retos que enfrenta la población de Ruanda. En el contexto del genocidio de 1994 contra los tutsi, existen tres categorías de sobrevivencia diferentes entre las mujeres de Ruanda. Aquellas que fueron objetivo del genocidio se denominaron 'supervivientes'; las que estuvieron en el país durante el genocidio, pero no fueron objetivo de este, se les denominó como 'no objetivo'; y las que estuvieron fuera del país fueron denominados como los 'repatriados de 1959'. Todos estos grupos experimentaron los eventos traumáticos de manera diferente. La literatura muestra que la exposición al estrés traumático está asociada con la depresión.Objetivos: Demostrar las diferencias en la exposición a trauma en una muestra de madres e hijas según su estado de supervivencia al genocidio. Examinar las diferencias en la prevalencia de la depresión entre estos tres grupos de madres e hijas en función de su estado de supervivencia al genocidio y el lugar de residencia. Examinar la relación entre la depresión mayor, el estado de supervivencia, el lugar de residencia, y la exposición al trauma en una muestra de madres e hijas, incluyendo la relación entre la depresión de las madres y la depresión de las hijas.Métodos: Se reclutó una muestra de 309 díadas de madres e hijas. Los datos fueron recopilados utilizando los cuestionarios MINI Entrevista Neuropsiquiátrica Internacional, el Cuestionario de Sucesos Vitales y el Cuestionario Demográfico Social. Los datos fueron analizados utilizando la estadística descriptiva, la prueba de chi cuadrado, la prueba de regresión logística y la prueba de ANOVA unifactorial.Resultados: Hay una diferencia significativa en la exposición al trauma en las tres categorías de madres e hijas sobrevivientes. El 23% de las madres y el 18,4% de las hijas cumplieron los criterios de depresión mayor, teniendo las participantes de zonas urbanas el doble de probabilidades de cumplir con tales criterios en comparación con las participantes de las áreas rurales. La depresión estuvo asociada a la exposición al trauma y al lugar de residencia en las muestras de madres e hijas. La depresión materna se asoció a la depresión en las hijas.Conclusiones: Se necesitan servicios de asesoramiento y apoyo familiar, así como investigación para identificar los factores relacionados a la depresión intergeneracional.

Intimate partner violence as a predictor of antenatal care services utilization in Rwanda.

BACKGROUND: Although compelling evidence shows that exposure to intimate partner violence (IPV) during pregnancy is detrimental to both physical and mental health of the victims and their fetuses, studies on negative impact of IPV on antenatal care (ANC) services utilization are scarce. METHODS: The aim of the current study was to determine the impact of IPV exposure on ANC services utilization indicators such as (i) initiation of care within the first 3 months of pregnancy, (ii) receipt of at least four ANC visits and (iii) receipt of care from skilled providers among reproductive age women in Rwanda. This study used the data from the 2014-15 Rwanda Demographic and Health Survey. Multiple logistic regression was used to estimate the effects of physical and sexual IPV on the ANC services utilization indicators. RESULTS: Among married women living with their partners with at least one child aged 5 years or under (N = 5116), 17% of them reported physical violence, 22.8% reported psychological violence and 9.2% reported sexual violence. We found that there was a significant negative relationship between physical IPV and both early ANC and sufficient ANC. Women who had experienced physical violence by their partners during the preceding 12 months were less likely to receive more than four ANC visits, (O.R = 0.61, CI = 0.417-0.908) and they were less likely to attend the first ANC visits within the first 3 months (O.R = 0.656, CI = 0.445-0.967). CONCLUSION: In this study, the prevalence of IPV still remains high and there is evidence that it does have significant impact on ANC. Therefore, the results provide support for continued efforts to reduce intimate partner violence, through the improvement of screening for IPV during ANC visits.

Gender Differences in Traumatic Experiences and Posttraumatic Stress Symptoms After the Rwandan Genocide Against the Tutsi.

The effects of the 1994 Rwandan Genocide against the Tutsi are widespread and long-lasting, but little is known about how posttraumatic consequences differ regarding gender. In the present study, we estimated the associations between trauma exposure and posttraumatic stress symptoms (PTSS) in a Rwandan community sample and examined whether the associations differed by gender. The sample comprised 498 adults (75.2% women) living in Rwanda's Huye District in 2011. We used a validated self-report checklist to assess the eight most frequent traumatic experiences during the Genocide. The PTSD Checklist-Civilian version (PCL-C) was used to assess PTSS. Associations between trauma exposure and PTSS were estimated using structural equation modeling (SEM), with additional SEMs stratified by gender. The prevalence of exposure to each traumatic event ranged from 15.1% to 64.5%, with more severe PTSS among individuals who reported personal physical injury, ß = .76, 95% CI [0.54, 0.98]; witnessing sexual/physical violence against a loved one, ß = .51, 95% CI [0.20, 0.81]; a close relative/friend's death, ß = .54, 95% CI [0.24, 0.83]; property destruction, ß = .35, 95% CI [0.048, 0.51]; or a family member's death due to illness, ß = .21, 95% CI [0.00, 0.41]. Men who saw people killed and women who witnessed sexual/physical violence against a close family member reported elevated PTSS. The psychiatric impact of the Rwandan Genocide continues into the 21st century. Increased attention should be paid to the long-term and demographic patterns of distress and disorder, especially in the absence of widespread clinical mental health services.

Adherence to childhood religious affiliation and suicide intentions in women exposed to the violence of the 1994 Genocide against the Tutsi in Rwanda.

PURPOSE: To examine the association between adherence to childhood religious affiliations and serious suicide intentions in 371 women exposed to the 1994 Genocide against the Tutsi in Rwanda. METHODS: Participants were randomly sampled in 2011 from households in the Southern Province of Rwanda. Trained interviewers gathered information on socio-economic background, genocide-related trauma exposure, Major Depressive Episode (MDE) and suicide intentions (assessed with the Mini International Neuropsychiatric Interview), and Posttraumatic Stress Disorder (PTSD) (assessed with the PTSD Checklist-Civilian version). RESULTS: In this predominantly Christian sample, 62.8% (233/371) had adhered to their childhood religious affiliation. Adherence was associated with lower odds of serious suicide intentions (OR 0.321, 95% CI 0.13-0.78, P < 0.01) independent of socio-economic factors, court-designated victim status, trauma exposure, MDE, and PTSD; that association held following consideration of specific denomination. CONCLUSION: Women who adhere to their childhood religious affiliation may be less likely to have serious suicide intentions following major catastrophes. Whether that association is attributable to stronger connections with lost and remaining family and friends, or greater faith in the church as a facilitator of reconciliation and coping, requires further study.

Prevalence and correlates of depression during the COVID-19 pandemic and the major role of stigmatization in low- and middle-income countries: A multinational cross-sectional study.

OBJECTIVES: Currently, there is little data on the mental health consequences of the COVID-19 pandemic in low- and middle-income countries (LMICs). This study aims to examine the pooled and separate prevalence and determinants of depression during the pandemic in samples from four LMICs. METHODS: Participants (N= 1267, 40.9% women) were recruited from the Democratic Republic of the Congo (DRC), Haiti, Rwanda, and Togo. They completed an online cross-sectional survey on sociodemographics, exposure and stigmatization related to COVID-19, the Hopkins Symptom Checklist depression subscale, and the Connor-Davidson Resilience Scale-2. RESULTS: The pooled prevalence for depression symptoms was 24.3% (95% CI: 22.08-26.79%), with significant differences across countries. Younger age, gender (women), and high levels of exposure and stigmatization related to COVIID-19, and resilience were associated with depression in the pooled data. There were significant variations at the country level. Stigmatization (but not exposure to COVID-19 and resilience) was a strong predictor among the four countries. CONCLUSIONS: The prevalence of depression symptoms in the LMICs are similar to those reported in China and in most high-income countries during the pandemic. The findings emphasize the need for implementing non-fear-based education programs during epidemics to reduce stigmatization.

Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda.

INTRODUCTION: 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's social protection system to promote ECD and reduce violence compared with usual care (UC). METHODS: Families with children aged 6-36 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. RESULTS: 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% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI -0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth. CONCLUSION: Social protection programmes provide a means to deliver ECD intervention. TRIAL REGISTRATION NUMBER: NCT02510313.

Intergenerational impacts of trauma and hardship through parenting.

BACKGROUND: Millions of people worldwide experience severe trauma in their lifetime. Trauma has immediate and long-term effects on emotional wellbeing. Moreover, the experiences of one generation may influence subsequent generations via social and biological pathways. Poor mental health and emotion dysregulation associated with trauma may affect parenting behaviours, which may have long-lasting effects on children's development. METHODS: We use longitudinal data from a unique sample of 732 caregivers of children aged 6-36 months living in extremely poor rural households in Rwanda to examine associations of caregiver lifetime trauma, recent daily hardships, mental health, and emotion dysregulation with parenting behaviours reflecting parental acceptance and rejection of their offspring. RESULTS: Cumulative trauma exposure (ß = .234, p < .001) and recent daily hardships (ß = .323, p < .001) are associated with higher levels of internalising symptoms. Trauma (ß = .257, p < .001) and daily hardships (ß = .323, p < 0.001) are also associated with post-traumatic stress disorder (PTSD) symptoms. Internalising symptoms predict more rejection (ß = .177, p = .001), but show no association with acceptance. Caregiver PTSD symptoms predict more rejection (ß = .277, p < .001) and less acceptance (ß = -.190, p = .003). Both internalising symptoms (ß = .557, p < .001) and PTSD symptoms (ß = .606, p < .001) are strongly associated with poor emotion regulation. Indirect effects suggest that caregiver trauma and hardships affect parenting indirectly via elevated caregiver internalising symptoms and PTSD and that some of these effects are accounted for by emotion dysregulation. CONCLUSIONS: Caregiver internalising and PTSD symptoms are important mechanisms through which caregiver trauma and hardship affect parenting behaviours. Emotion dysregulation is a shared mechanism linking caregivers' mental health problems with parenting behaviours that reflect acceptance and rejection of the child. Emotion regulation is indicated as a key target for prevention of adverse effects of caregiver trauma on mental health and child wellbeing.

Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study.

OBJECTIVE: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. METHODS: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. RESULTS: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x2 = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (ß = 0.06, p = .005), stigmatization related to COVID-19 (ß = 0.03, p < .001), and resilience (ß = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (ß = 0.02, p < .00; ß = 0.05, p = .013; ß = 0.03, p = .021; ß = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). CONCLUSIONS: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.

Parenting and parental burnout in Africa.

A recent initiative known as the International Investigation of Parental Burnout, sought to study the prevalence of parental burnout in over 40 countries globally using the Parental Burnout Assessment (PBA) instrument. Four countries investigated here provide a first insight into parental burnout in Africa, based on a pooled dataset of 738 parents (48.8% mothers) sampled from Burundi (n = 187; 25.3%), Cameroon (n = 208; 28.2%), Rwanda (n = 240; 32.5%), and Togo (n = 103; 14%). As a first step, we tested the content validity of the PBA that was developed and validated in Western countries. Second, we tested the relations between the PBA and several sociodemographic characteristics such as age, gender, and level of education. The results provide evidence that the concept of parental burnout makes sense for African parents, and that the PBA can be considered as a psychometrically sound instrument to measure it. However, the results also point to the need for further exploration of the nature of parental burnout in Africa. As in previous studies, low correlations between parental burnout and the sociodemographic characteristics were found. Finally, the current results suggest the existence of parenting subcultures across the four participating countries that would be interesting to document.

Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes.

BACKGROUND: Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty (Ubudehe 1, the poorest category in the Government of Rwanda's wealth ranking) who receive Sugira Muryango 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). METHODS: 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. Sugira Muryango was delivered to n = 541 families in 100 treatment clusters with children aged 6-36 months living in extreme poverty. We assessed changes in outcomes in intervention and n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering. RESULTS: Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen's d = 0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen's d = 0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR = 0.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR = 0.49, 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 h (Cohen's d = 0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR = 4.43, 95% CI: 1.95, 10.10) and fever (OR = 3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR = 3.39, 95% CI: 2.16, 5.30) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR = 0.58, 95% CI: 0.38, 0.88). CONCLUSIONS: Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02510313.

Reduction of PTSD in South African University Students Using Transcendental Meditation Practice.

A study was conducted on South African college students using the Transcendental Meditation technique to reduce posttraumatic stress disorder. Students meeting the criteria for possible posttraumatic stress disorder were included. Thirty-four students at the experimental university in South Africa clinically diagnosed with posttraumatic stress disorder were instructed in and practiced the Transcendental Meditation technique twice daily compared to 34 diagnosed posttraumatic stress disorder comparison students at the comparison university. The multivariate effect was significant for both the posttraumatic stress disorder symptomatology and depression. Results were significantly associated with regularity of practice. The study replicates recent findings and offers an alternative educational treatment for higher education.

PTSD prevalence among resident mothers and their offspring in Rwanda 25 years after the 1994 genocide against the Tutsi.

BACKGROUND: The 1994 Genocide against the Tutsi was a major traumatic event affecting nearly all Rwandans. Significant psychological sequels continue to occur in the population 25 years after, with a high prevalence of posttraumatic stress disorder (PTSD) found in women. Three groups are typically designated with regard to the Genocide against the Tutsi: those who were targeted and categorized as genocide "survivors," those who were in the country during the genocide and were the "non-targeted" group, and those who were outside of the country, referred to as the "1959 returnees." Each group experienced various traumatic events during and in the aftermath of the genocide. Offspring of the designated groups, currently exhibit symptoms of PTSD disregarding of being born in the years following the genocide. A number of studies have described the prevalence of PTSD in the general adult population. There is a lack of research comparing the prevalence of PTSD in women and their offspring among these three target groups, therefore, this study aimed to bridge the gap. METHODS: We conducted a comparative cross-sectional study with a sample of 432 mothers and 432 children in three categories: genocide survivors, in country non-targeted and 1959 returnees. Participant ages for children were between 14 to 22 years and for mothers, between the ages of 32 to 87 years. The UCLA-PTSD DSM-5, PTSD Check list-5 and Life events Checklist-5 were translated from English to Kinyarwanda and were used to assess exposure to trauma and the prevalence of PTSD symptoms in Rwandan mothers and their offspring. RESULTS: Key Results yield a PTSD rate of 18.8, 6.2, 5.2% within survivors, in country non-targeted, and returnees respectively with an average PTSD rate of 43.8% for parents, and 16.5% for offspring. CONCLUSION: PTSD among the mothers' groups and their offspring have been found, specifically in the offspring of genocide survivors. Considering these adolescents were not born at the time of the 1994 Genocide against the Tutsi, the results suggest future studies should explore the precipitating factors contributing to the PTSD symptoms within this specific group.

Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial.

BACKGROUND: Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent-child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services. METHODS: Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7-17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. TRIAL REGISTRATION: NCT01509573, 'Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1. RESULTS: At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (ß = -.246; p = .009) and parent report (ß = -.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting. CONCLUSIONS: Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators.

Risk and protective factors for suicidal ideation and behaviour in Rwandan children.

BACKGROUND: Suicide is a leading cause of death for young people. Children living in sub-Saharan Africa, where HIV rates are disproportionately high, may be at increased risk. AIMS: To identify predictors, including HIV status, of suicidal ideation and behaviour in Rwandan children aged 10-17. METHOD: Matched case-control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers. RESULTS: Over 20% of HIV-positive and affected children engaged in suicidal behaviour in the previous 6 months, compared with 13% of unaffected children. Children were at increased risk if they met criteria for depression, were at high-risk for conduct disorder, reported poor parenting or had caregivers with mental health problems. CONCLUSIONS: Policies and programmes that address mental health concerns and support positive parenting may prevent suicidal ideation and behaviour in children at increased risk related to HIV.