{
  "abstract": "Introduction Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union.Methods Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model.Results 123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (−65%; 95% CI 51% to 74%), emotional abuse (−59%; 95% CI 48% to 68%) and approval of corporal punishment (−55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (−48%; 95% CI 34% to 58%). Caregiver depressive symptoms (−25%; 95% CI 8% to 48%), parenting stress (−46%; 95% CI 41% to 52%), adolescent depressive symptoms (−22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (−43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports.Conclusion In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.",
  "authors": [
    {
      "affiliations": [
        "Department of Social Policy and Intervention, University of Oxford, Oxford, UK",
        "Department of Psychiatry and Mental Health, University of Cape Town, Western Cape, South Africa"
      ],
      "name": "Lucie Cluver"
    },
    {
      "affiliations": [
        "Centre for Social Science Research, University of Cape Town, Rondebosch, Western Cape, South Africa",
        "Department of Psychology, University of Cape Town, Western Cape, South Africa"
      ],
      "name": "Catherine L Ward"
    },
    {
      "affiliations": [
        "Department of Statistical Sciences, University of Cape Town, Western Cape, South Africa",
        "Nuffield Department of Primary Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Francesca Little"
    },
    {
      "affiliations": [
        "Department of Social Policy and Intervention, University of Oxford, Oxford, UK"
      ],
      "name": "Inge Vallance"
    },
    {
      "affiliations": [
        "Centre for Social Science Research, University of Cape Town, Rondebosch, Western Cape, South Africa"
      ],
      "name": "Genevieve Haupt Ronnie"
    },
    {
      "affiliations": [
        "Wolfson Centre for Young People’s Mental Health, Cardiff University, Cardiff, Wales, UK",
        "Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK"
      ],
      "name": "Yulia Shenderovich"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Cape Town, Western Cape, South Africa",
        "Department of Nursing and Public Health, University of Fort Hare, East London, South Africa"
      ],
      "name": "Hlengiwe Gwebu"
    },
    {
      "affiliations": [
        "Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany",
        "Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa"
      ],
      "name": "Kufre Joseph Okop"
    },
    {
      "affiliations": [
        "Department of Social Policy and Intervention, University of Oxford, Oxford, UK"
      ],
      "name": "Frances Gardner"
    },
    {
      "affiliations": [
        "Clowns Without Borders South Africa, Pietermaritzburg, South Africa"
      ],
      "name": "Lindokuhle L Ngcobo"
    },
    {
      "affiliations": [
        "Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa",
        "School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK"
      ],
      "name": "Mark Tomlinson"
    },
    {
      "affiliations": [
        "Catholic Relief Services USA, Baltimore, Maryland, USA",
        "Room to Read, San Francisco, California, USA"
      ],
      "name": "Daniel Oliver"
    },
    {
      "affiliations": [
        "Institute of Population Research, Peking University, Beijing, Beijing, China"
      ],
      "name": "Zuyi Fang"
    },
    {
      "affiliations": [
        "Centre for Social Science Research, University of Cape Town, Rondebosch, Western Cape, South Africa"
      ],
      "name": "Natalie Davidson"
    },
    {
      "affiliations": [
        "Department of Social Policy and Intervention, University of Oxford, Oxford, UK"
      ],
      "name": "Roselinde Janowski"
    },
    {
      "affiliations": [
        "Department of Statistical Sciences, University of Cape Town, Western Cape, South Africa",
        "Center for Neurogenomics and Cognitive Research, Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Heiletjé Van Zyl"
    },
    {
      "affiliations": [
        "Clowns Without Borders South Africa, Pietermaritzburg, South Africa"
      ],
      "name": "Anna Booij"
    },
    {
      "affiliations": [
        "Clowns Without Borders South Africa, Pietermartzburg, South Africa"
      ],
      "name": "Nyasha Manjengenja"
    },
    {
      "affiliations": [
        "Clowns Without Borders South Africa, Pietermaritzburg, South Africa"
      ],
      "name": "Sibongile Tsoanyane"
    },
    {
      "affiliations": [
        "University of Lubumbashi, Lubumbashi, Katanga, The Democratic Republic of the Congo"
      ],
      "name": "Muhubiri Kabuyaya"
    },
    {
      "affiliations": [
        "Centre for Social Science Research, University of Cape Town, Rondebosch, Western Cape, South Africa"
      ],
      "name": "Mukondi Nethavhakone"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Cape Town, Rondebosch, Western Cape, South Africa"
      ],
      "name": "Tendai Mutembedza"
    },
    {
      "affiliations": [
        "Pact Tanzania, Dar es Salaam, United Republic of Tanzania"
      ],
      "name": "Alison Koler"
    },
    {
      "affiliations": [
        "Pact Tanzania, Dar es Salaam, United Republic of Tanzania"
      ],
      "name": "Amon Exavery"
    },
    {
      "affiliations": [
        "mothers2mothers, Mbombela, Western Cape, South Africa"
      ],
      "name": "Anne Schley"
    },
    {
      "affiliations": [
        "Catholic Relief Services, Kinshasa, The Democratic Republic of the Congo"
      ],
      "name": "Charles Bibuya"
    },
    {
      "affiliations": [
        "Strategic Information, Pact Eswatini, Mbabane, Hhohho, Eswatini"
      ],
      "name": "Daisy Kisyombe"
    },
    {
      "affiliations": [
        "Pact Tanzania, Dar es Salaam, United Republic of Tanzania"
      ],
      "name": "Esther Nydetabura"
    },
    {
      "affiliations": [
        "Catholic Relief Services Zimbabwe, Harare, Zimbabwe",
        "FHI 360, Harare, Zimbabwe"
      ],
      "name": "Farai Charasika"
    },
    {
      "affiliations": [
        "Catholic Relief Services Zimbabwe, Harare, Zimbabwe"
      ],
      "name": "Gideon Mavise"
    },
    {
      "affiliations": [
        "Catholic Relief Services, Kinshasa, The Democratic Republic of the Congo"
      ],
      "name": "Henry Mbuyi"
    },
    {
      "affiliations": [
        "Pact Zambia, Lusaka, Zambia"
      ],
      "name": "Jack Ngangula"
    },
    {
      "affiliations": [
        "Stepping Stones International, Gaborone, Botswana",
        "Trauma Aid Netherlands, Amsterdam, The Netherlands"
      ],
      "name": "Jeldau Rieff"
    },
    {
      "affiliations": [
        "National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania"
      ],
      "name": "Joyce Wamoyi"
    },
    {
      "affiliations": [
        "Stepping Stones International, Gaborone, Botswana"
      ],
      "name": "Lisa Jamu"
    },
    {
      "affiliations": [
        "Stepping Stones International, Gaborone, Botswana"
      ],
      "name": "Nomsa Monare"
    },
    {
      "affiliations": [
        "Catholic Relief Services Zimbabwe, Harare, Zimbabwe"
      ],
      "name": "Richard Savo"
    },
    {
      "affiliations": [
        "Agency for Research and Development Initiative, Juba, Central Equatoria, South Sudan"
      ],
      "name": "Samuel Bojo"
    },
    {
      "affiliations": [
        "Stepping Stones International, Gaborone, Botswana"
      ],
      "name": "Styn Jamu"
    },
    {
      "affiliations": [
        "Pact Zambia, Lusaka, Zambia"
      ],
      "name": "Thomas Kipingili"
    },
    {
      "affiliations": [
        "Clowns Without Borders South Africa, Pietermaritzburg, South Africa"
      ],
      "name": "Vengai MacGerald Mujuru"
    },
    {
      "affiliations": [
        "Department of Social Policy and Intervention, University of Oxford, Oxford, UK",
        "Centre for Social Science Research, University of Cape Town, Rondebosch, Western Cape, South Africa"
      ],
      "name": "Jamie Lachman"
    }
  ],
  "title": "Are parenting programmes effective at scale? Associations with violence against adolescent girls, parenting and mental health in real-world delivery across eight African countries: a meta-analysis of pre-post surveys",
  "uid": "881a3ce9-90f4-513c-ba1f-e34decbfadd7"
}