April 2021 | ICHAD & SMART Africa Monthly Monitor

Greetings from the ICHAD and SMART Africa Teams!

As the implementation of the SMART Africa studies near completion at the end of this month, we wanted to take this opportunity to showcase the many accomplishments of our SMART Africa teams in Uganda, Kenya and Ghana as well as share some notes of gratitude that our team has received from study participants.

We encourage those of you who were not able to attend our 5th Annual Conference on Child Behavioral Health to view the conference recordings here and visit our poster gallery here to learn about the latest research findings.

The ICHAD and SMART Africa Teams

SMART Africa's 5th Annual Conference on Child Behavioral Health in Sub-Saharan Africa

The SMART Africa Uganda team discusses preliminary study findings while community stakeholders gather in Masaka and direct questions to panelists

Many thanks to all who participated in our 5th Annual Conference on Child Behavioral Health in Sub-Saharan Africa, held virtually on April 21-22, 2021. The packed two-day agenda featured keynote remarks by NIMH Director Joshua Gordon, Vikram Patel from Harvard Medical School, Cornelius Williams from UNICEF, and Florence Baingana and Chiara Servili from WHO. They all discussed behavioral health and global research priorities moving forward. We were privileged to hear from NIH Program Officers Holly Rosen-Campbell and Geetha Bansal, as well as Washington University leaders Chancellor Andrew Martin, Brown School Dean Mary McKay, and Kurt Dirks, Vice Chancellor for International Affairs. SMART Africa study teams also had opportunities to discuss their findings in three separate panel discussions (see Study Spotlight below).

Key themes and takeaways included the need to strengthen our existing South to South collaborations by working with both local government, stakeholders and engaging multilateral agencies such as UNICEF and WHO. Speakers also touched on the importance of implementation science and taking a life course approach, that takes into account an individual or cohort’s life experiences when developing interventions. Finally, panelists pointed to the need to continue to grow the research pipeline and invest in early career researchers. The below feedback highlights how attendees and speakers alike appreciated various aspects of this virtual conference.

Research Study Spotlight

SMART Africa - Whether called “Familia Pamoja” (Kenya), “Dang-Malgu” (Ghana) or “Amaka Amasanyufu” (Uganda), early results point to a success by any name!

Schools across the Masaka region show their appreciation for the SMART Africa study with posters and hand-written notes

During our annual conference held earlier this month, the SMART Africa teams shared some preliminary findings examining the impact of the multiple family group (MFG) intervention for children ages 8-13 with behavioral difficulties.

The Uganda scale-up study team utilized data from over 2,400 caregivers to examine the short term impact of the MFG intervention (at 8 and 16 weeks), comparing outcomes across three study conditions (control, MFG delivered by parent peers, and MFG delivered by community health workers). Results indicate that at baseline, 6% of children exhibited symptoms of disruptive behavioral disorders, with 6% and 2% exhibiting oppositional defiant disorder and conduct disorder respectively. Less parental supervision, widowhood, and large family size were identified as risk factors for behavioral disorders. At both 8 and 16 weeks, children receiving the MFG intervention demonstrated significant reductions in behavioral challenges compared to the control condition, indicating that MFG is an effective intervention for addressing disruptive behaviors in low-resource settings. In a separate analysis, compared to other family-based interventions, the MFG intervention had a much lower per-participant cost, though few comparisons are available in the literature. For additional details, please see our poster abstracts found here.

The team in Ghana, one of our capacity building sites, implemented the study in three schools using a similar study design to the scale-up study. In the two treatment arms, 60 families received MFG sessions delivered by School Health and Education Program coordinators and 60 received MFG sessions delivered by parent peers. The team is still analyzing data, but testimonies from families point to improved emotional and social well-being among children receiving the MFG intervention.

The SMART Africa Kenya team also implemented the study in three schools to test the MFG intervention delivered by parent peers as facilitators versus community health workers. As with the Ghana team, the SMART Africa Kenya data is still being cleaned and analyzed, yet initial feedback has been positive, showing the promise of the intervention in improving children’s behavior as well as the benefits of engaging community stakeholders at all points of the study intervention.

Stay tuned for publications from all three sites. In addition, the teams are exploring ways to continue to move this research forward through continued South to South collaborations.

It Takes a Village!

Many thanks to everyone that has contributed to this important study. We want to extend our gratitude to the team for all your hard work and dedication to the study over the last five years!

Newly Published Work

Working with economically vulnerable women engaged in sex work: Collaborating with community stakeholders in Southern Uganda

Global Public Health

Nabunya, P.; Kiyingi, J.; Witte, SS; Sensoy Bahar, O.; Jennings Mayo-Wilson L.; Tozan, Y.; Nabayinda. J.; Mwebembezi, A.; Tumwesige, W.; Mukasa, B.; Namirembe, R.; Kagaayi, J.; Nakigudde, J.; McKay, M. M.; & Ssewamala, F. M.

Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda

In Press in Social Science & Medicine

Cavazos-Rehg, P.A.; Byansi, W.; Doroshenko, C.; Neilands, T.; Anako, N.; Sensoy Bahar, O.; Kasson, E.; Nabunya, P.; Mellins, C.A.; & Ssewamala, F.M.

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SMART Africa Center

sites.wustl.edu/smartafrica | smartafricacenter@gmail.com

International Center for Child Health and Development (ICHAD)

ichad.wustl.edu | ichad@wustl.edu

Brown School, Washington University in St. Louis

Campus Box 1196, One Brookings Drive, St. Louis, MO 63130