The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: analysis of a cluster randomized trial from the SMART Africa-Uganda scale-up study (2016-2022).

Autor: Brathwaite R; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Ssewamala FM; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Sensoy Bahar O; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., McKay MM; Brown School, Washington University in St. Louis, St. Louis, MO, USA., Neilands TB; Division of Prevention Science, University of California, San Francisco, CA, USA., Namatovu P; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Kiyingi J; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Zmachinski L; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Nabayinda J; Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA., Huang KY; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.; Department of Population Health, New York University School of Medicine, New York, NY, USA., Kivumbi A; Reach the Youth-Uganda, Kampala, Uganda., Bhana A; South African Medical Research Council, Cape Town, South Africa.; University of KwaZulu-Natal, Durban, South Africa., Mwebembezi A; Reach the Youth-Uganda, Kampala, Uganda., Petersen I; University of KwaZulu-Natal, Durban, South Africa., Hoagwood K; Department of Child and Adolescent Psychiatry at the School of Medicine, New York University, New York, NY, USA.
Jazyk: angličtina
Zdroj: Journal of child psychology and psychiatry, and allied disciplines [J Child Psychol Psychiatry] 2022 Nov; Vol. 63 (11), pp. 1252-1260. Date of Electronic Publication: 2022 Jan 06.
DOI: 10.1111/jcpp.13566
Abstrakt: Background: Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty-impacted communities in sub-Saharan Africa. Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school-going children residing in low-resource communities in Uganda.
Methods: We used longitudinal data from the SMART Africa-Uganda study (2016-2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka-parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka-community), 8 schools. All the participants were blinded. At baseline, 8- and 16-weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children's overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self-esteem, and family functioning. Three-level linear mixed-effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak's adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed.
Results: Six hundred and thirty-six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka-parents: n = 194; Amaka-community: n = 199). At 8 weeks, Amaka-parents' children had significantly lower mean scores for overall impairment compared to controls, (mean difference: -0.71, p = .001), while Amaka-community children performed better on ODD (mean difference: -0.84, p = .016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups.
Conclusions: The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka-community or Amaka-parents has the potential to reduce negative behavioral health outcomes among young people in resource-limited settings and improve family functioning.
Trial Registration: ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.
(© 2021 Association for Child and Adolescent Mental Health.)
Databáze: MEDLINE
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