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. 2021 Oct 9:24:101593.
doi: 10.1016/j.pmedr.2021.101593. eCollection 2021 Dec.

Preventing maltreatment in institutional care: A cluster-randomized controlled trial in East Africa

Tobias Hecker  1   2 , Getrude Mkinga  1   2 , Anette Kirika  1 , Mabula Nkuba  2   3 , Justin Preston  2   4 , Katharin Hermenau  2   5
Affiliations

Preventing maltreatment in institutional care: A cluster-randomized controlled trial in East Africa

Tobias Hecker et al. Prev Med Rep. .

Abstract

An increasing number of orphans in low- and middle-income countries are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. To prevent maltreatment, we tested the effectiveness and feasibility of the intervention Interaction Competencies with Children - for Caregivers (ICC-C). In a two-arm cluster-randomized controlled trial, 203 caregivers (65.5% female, Mage = 36.63 years, SDage = 12.26) and 356 children (46.1% female, Mage = 9.43 years, SDage = 1.93) from 24 orphanages in Dar es salaam (Tanzania) participated from August to October 2018 (Baseline) and March to April 2019 (Follow-Up). Orphanages were assigned to the intervention or waitlist-group. Caregivers in the intervention group received the ICC-C intervention to prevent maltreatment through focusing on non-violent caregiving strategies. The primary outcome was the change in self-reported maltreatment by caregivers (Conflict Tactics Scale). Trial registration: ClinicalTrials.gov, NCT03594617, 20 July 2018. Participation in the intervention resulted in a significant reduction in reported maltreatment (f2 = 0.153), a decrease of positive attitudes toward violent discipline (f2 = 0.248), and an increased level of childcare knowledge (f2 = 0.220) in the caregiver sample, each indicating a moderate effect. Caregivers' training participation did not predict reduced maltreatment reported by children. Aspects of feasibility, including motivation to participate, acceptability, and integration of the new strategies were evaluated positively. The study promises initial effectiveness and feasibility of efforts to improve the situation of children in institutional care settings in resource-poor countries by offering training to care providers.

Keywords: Caregiver training; Childcare quality; Maltreatment; Orphans; Residential childcare.

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Conflict of interest statement

We declare that none of the authors have competing financial or non-financial interests. The study was funded by the Young Researchers’ Fund of Bielefeld University.

Figures

Fig. 1
Fig. 1
Participant flow chart. Modified from CONSORT 2010.
Fig. 2
Fig. 2
Primary and secondary outcomes: Change from baseline to follow-up in the primary outcome measure maltreatment by caregivers (caregivers’ report) as well as the secondary outcome measures positive attitude toward violence and childcare knowledge in each of the orphanages (separated by allocation to intervention and wait-list condition). Across all variables a clear picture emerges: the values in all orphanages in the intervention condition are mostly similar and support our hypotheses, whereas the values in the orphanages in the control conditions do not show a uniform pattern.
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