As part of the culmination of the SMART Africa study, the 5th Annual Conference on Child Behavioral Health in Sub-Saharan Africa was held virtually on April 21-22, 2021 and focused on “South to South Collaboration to Strengthen Child and Adolescent Mental Health in Sub-Saharan Africa (SSA): Lessons Learned from SMART Africa Center.” The two-day conference featured keynote remarks by NIMH Director Joshua Gordon, Vikram Patel from Harvard Medical School, Cornelius Williams Director of the Child Protection Programme at UNICEF, Florence Baingana, Regional Adviser for Mental Health, WHO Regional Office for Africa, and Chiara Servili from the WHO Department of Mental Health and Substance Abuse (MSD). Keynote speakers discussed behavioral health and global research priorities moving forward. Attendees were also privileged to hear from NIH Program Officers Holly Rosen-Campbell and Geetha Bansal, as well as Washington University leaders Chancellor Andrew Martin, Vice Provost of Interdisciplinary Initiatives Mary McKay, and Kurt Dirks, Vice Chancellor for International Affairs. 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. Conference 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.
During the conference, the SMART Africa teams shared some preliminary findings in three separate panel discussions 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 elevated symptoms of behavioral challenges. 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.
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 (n=179 families) 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. For additional details, please see our poster abstracts found here.