Evaluation of the Sugira Muryango early childhood intervention

The context

The first 3 years of life are critical for long-term human development and life outcomes. Over 80 per cent of the brain is formed by that age, and 75% of the food consumed goes into its development. In this context, it’s not surprising that many countries have invested in Early Childhood Development interventions. One example in Rwanda is the Sugira Muryango intervention, created by the FXB International, the Boston College School of Social Work, and the University of Rwanda. Sugira Muryango was designed to support playful parenting, father engagement, improved nutrition, care seeking, and family functioning. The initial version of the program was rolled out in 2018, and has since been scaled up to three additional districts in 2021.

Boston College (BC) designed the evaluation of the Sugira Muryango scale-up as a hybrid type II implementation-effectiveness study with two objectives:

1. Evaluating the effects of the intervention on caregiver behaviors, and on child health and development,
2. Gaining insights on the dissemination and implementation processes of the program.

The quantitative part of the study involved 540 randomly selected households in three districts (Nyanza, Rubavu, and Ngoma), as well as 200 community-based child and family protection volunteers (IZUs), and 370 members of the collaborative. Households were split across 86 treatment and 102 control villages. The qualitative part consisted of semi-structured interviews with 60 IZUs from treatment sectors and 75 members of Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) in Rwanda. Laterite was the data collection partner for the evaluation of the Sugira Muryango intervention and provided technical and research support throughout.

This case study focuses on the quantitative data collection with households.

The quantitative data collection

Data collection was planned for three points in time: baseline in May 2021, midline in September 2021 and endline in November 2022. To conduct fieldwork, we selected 7 field coordinators and 39 enumerators divided into 2 different teams: the household survey team and the child assessment team.

The household survey team conducted data collection with caregivers, deploying survey instruments consisting of modules aimed at measuring the following aspects: health status and health service access, child development, home environment, mother-child interaction, child discipline, alcohol use, measures of father engagement in childcare, and shared decision making in the home. The child assessment team conducted data collection at a central location using the Malawi Development Assessment Tool and child anthropometric measurements. Children who participated in the evaluation were aged 0-2 years old at baseline and 1.5-3.5 years old at endline.

Throughout this project, our field team took measures to ensure the safety and wellbeing of respondents, especially given the sensitive nature of some questions asked in the survey. We had a protocol in place to flag reports of immediate risk of harm, for example in cases of suicidal thoughts, intimate partner violence, or malnutrition, to the program implementers for appropriate follow up.

Outcome

Tracking individuals over long periods of time inevitably leads to attrition. This is especially noticeable in rural Rwanda, where families often migrate for work. We succeeded in keeping levels of attrition low across rounds of data collection. At endline, 1.5 years after baseline, we were able to track and interview 93.3% of households and 93% of children that were surveyed at baseline. We further checked for potential bias due to this attrition, but concluded that it was random.

The secret for keeping attrition low across rounds of data collection is well-organized field preparation. Before each round of data collection, our teams contacted all respondents by phone to inform them of our upcoming visit and establish rapport. If the respondent was unavailable, we took comprehensive efforts to track the household starting from the last known location.