Randomised controlled trial of a livestock productive asset transfer programme to improve economic and health outcomes and reduce intimate partner violence in a postconflict setting

Nancy Glass, Nancy A Perrin, Anjalee Kohli, Jacquelyn Campbell, Mitima Mpanano Remy, Nancy Glass, Nancy A Perrin, Anjalee Kohli, Jacquelyn Campbell, Mitima Mpanano Remy

Abstract

Background: Diverse economic empowerment programmes (eg, microcredit, village-led savings and loan, cash and productive asset transfers) for the poor have demonstrated mixed results as vehicles for improved economic stability, health and women's empowerment. However, limited rigorous evaluations exist on the impact of financial and non-financial outcomes of these programmes, especially in conflict-affected areas.

Methods: The team evaluated the effectiveness of an innovative livestock productive asset transfer intervention-Pigs for Peace (PFP)-on economic, health and women's empowerment outcomes with participants in households in 10 villages in Eastern Democratic Republic of Congo. Residual change analysis was used to examine the amount of change from baseline to 18 months between the intervention and delayed control groups, controlling for baseline scores.

Findings: The majority of the 833 household participants were women (84%), 25 years of age or older, married, had on average 3 children and had never attended school. At 18 months postbaseline, the number of participants in the PFP households having outstanding credit/loans was 24.7% lower than households in the control group (p=0.028), and they had an 8.2% greater improvement in subjective health (p=0.026), a 57.1% greater reduction in symptoms of anxiety (p=0.020) and a 5.7% greater improvement in symptoms of post-traumatic stress disorder (p<-0.001). At 18 months postbaseline, partnered women and men reported a reduction in experience and perpetration of all forms of intimate partner violence, although not statistically significant between groups.

Interpretation: The findings support scalability of a livestock productive asset transfer programme in rural and conflict-affected settings where residents have extremely limited access to financial institutions or credit programmes, health or social services and where social norms that sustain gender inequality are strong.

Trial registration number: NCT02008708.

Conflict of interest statement

Competing interests: Pigs for Peace was cofounded and developed by MMR of PAIDEK microfinance, DRC, and NG, Johns Hopkins School of Nursing, USA. MMR supervised the Congolese-based implementation of PFP microfinance. The Hopkins team collaborated with Congolese team on all components of the evaluation, but was not directly involved in data collection. No other authors have any conflict of interest to declare.

Figures

Figure 1
Figure 1
Trial profile.

References

    1. United Nations. Transforming our world: the 2030 agenda for sustainable development. United Nations, 2015.
    1. Langer A, Meleis A, Knaul FM et al. . Women and health: the key for sustainable development. Lancet 2015;386:1165–210. 10.1016/S0140-6736(15)60497-4
    1. Overseas Development Institute. The definition of extreme poverty has just changed—here's what you need to know 2015. (accessed 24 Apr 2016).
    1. Korth M, Stewart R, van Rooyen C et al. . Microfinance: development intervention or just another bank? J Agrar Change 2012;12:575–86. 10.1111/j.1471–0366.2012.00375.x
    1. UN Economic Commission for Africa. Microfinance in Africa: combining the best practices of traditional and modern microfinance approaches towards poverty eradication, 2000:1–16.
    1. Helmore K, Chidiac S, Hendricks L. Microfinance in Africa: state-of-the-sector report: bringing financial services to Africa's poor. CARE.
    1. de Haan L, Lakwo A. Rethinking the impact of microfinance in Africa: ‘Business Change’ or social emancipation. Eur J Dev Res 2010;22:529–45. 10.1057/ejdr.2010.32
    1. van Rooyen C, Stewart R, de Wet T. The impact of microfinance in Sub-Saharan Africa: a systematic review of the evidence. World Dev 2012;40:2249–62. 10.1016/j.worlddev.2012.03.012
    1. Banerjee A, Duflo E, Goldberg N et al. . A multifaceted program causes lasting progress for the very poor: evidence from six countries. Science 2015;348:1260799 10.1126/science.1260799
    1. Ssewamala FM, Han CK, Neilands TB et al. . Effect of economic assets on sexual risk-taking intentions among orphaned adolescents in Uganda. Am J Public Health 2010;100:483–8. 10.2105/AJPH.2008.158840
    1. Ismayilova L, Ssewamala FM, Karimli L. Family support as a mediator of change in sexual risk-taking attitudes among orphaned adolescents in rural Uganda. J Adolesc Health 2012;50:228–35. 10.1016/j.jadohealth.2011.06.008
    1. Doocy S, Teferra S, Norell D et al. . Credit program outcomes: coping capacity and nutritional status in the food insecure context of Ethiopia. Soc Sci Med 2005;60:2371–82. 10.1016/j.socscimed.2004.10.025
    1. Glass N, Perrin NA, Kohli A et al. . Livestock/animal assets buffer the impact of conflict-related traumatic events on mental health symptoms for rural women. PLoS ONE 2014;9:e111708 10.1371/journal.pone.0111708
    1. Wakoko F. Microfinance and women's empowerment in Uganda: a socioeconomic approach. Ohio State University, 2004.
    1. Kim J, Ferrari G, Abramsky T et al. . Assessing the incremental effects of combining economic and health interventions: the IMAGE in South Africa. Bull World Health Organ 2009;87:824–32.
    1. Pronyk PM, Hargreaves JR, Kim JC et al. . Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 2006;368:1973–83. 10.1016/S0140-6736(06)69744-4
    1. Gupta J, Falb KL, Lehmann H et al. . Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Cote d'Ivoire: a randomized controlled pilot study. BMC Int Health Hum Rights 2013;13:46 10.1186/1472-698X-13-46
    1. Hossain M, Zimmerman C, Kiss L et al. . Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d'Ivoire. BMC Public Health 2014;14:339 10.1186/1471-2458-14-339
    1. Kafle K, Winter-Nelson A, Goldsmith P. Does 25 cents more per day make a difference? The impact of livestock transfer and development in rural Zambia. Food Policy 2016;63:62–72. 10.1016/j.foodpol.2016.07.001
    1. Wakabi W. The Democratic Republic of the Congo in crisis. Lancet 2008;372:2011–12.
    1. Coghlan B, Ngoy P, Mulumba F et al. . Update on mortality in the Democratic Republic of Congo: results from a third nationwide survey. Disaster Med Public Health Prep 2009;3:88–96. 10.1097/DMP.0b013e3181a6e952
    1. Veling W, Hall BJ, Joosse P. The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo. J Anxiety Disord 2013;27:225–30. 10.1016/j.janxdis.2013.01.007
    1. McIvor Murray S, Robinette KL, Bolton P et al. . Stigma among survivors of sexual violence in Congo: scale development and psychometrics. J Interpers Violence 2015;1–24.
    1. Christian M, Safari O, Ramazani P et al. . Sexual and gender based violence against men in the Democratic Republic of Congo: effects on survivors, their families and the community. Med Confl Surviv 2011;27:227–46. 10.1080/13623699.2011.645144
    1. Omba Kalonda JC. Sexual violence in the Democratic Republic of Congo: impact on public health? Les violences sexuelles en République Démocratique du Congo: Quelles conséquences sur le plan de santé publique? Med Trop 2008;68:576–8.
    1. Cox TP. Farming the battlefield: the meanings of war, cattle and soil in South Kivu, Democratic Republic of the Congo. Disasters 2012;36:233–48. 10.1111/j.1467-7717.2011.01257.x
    1. Glass N, Ramazani P, Tosha M et al. . A Congolese-US participatory action research partnership to rebuild the lives of rape survivors and their families in eastern Democratic Republic of Congo. Glob Public Health 2012;7:184–95. 10.1080/17441692.2011.594449
    1. Zozo R, Chiuri WL, Katunga Musale D et al. . Report of a participatory rural appraisal (PRA) in the groupements of Miti-Mulungu and Tubimbi, South Kivu/DR Congo. Working Document no 211 Nairobi, Kenya: Centro Internacional de Agricultura Tropical (CIAT), 2010:32.
    1. Maass BL, Musale DK, Chiuri WL et al. . Challenges and opportunities for smallholder livestock production in post-conflict South Kivu, eastern DR Congo. Trop Anim Health Prod 2012;44:1221–32. 10.1007/s11250-011-0061-5
    1. Kandala NB, Madungu TP, Emina JBO et al. . Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter? BMC Public Health 2011;11:261 10.1186/1471-2458-11-261
    1. Rossi L, Hoerz T, Thouvenat V et al. . Evaluation of health, nutrition and food security programmes in a complex emergency: the case of Congo as an example of a chronic post-conflict situation. Public Health Nutr 2005;9:551–6.
    1. Kohli A, Kuehnast K, Rubenstein LS. The health sector and gender-based violence in a time of war. Peace USIo. Peace Brief, 2010:1–4.
    1. Kohli A, Perrin NA, Mpanano RM et al. . Risk for family rejection and associated mental health outcomes amongst conflict-affected adult women living in rural eastern Democratic Republic of Congo. Health Care Women Int 2014;35:789–807. 10.1080/07399332.2014.903953
    1. Slegh H, Barker G, Levtov R. Gender relations, sexual and gender-based violence and the effects of conflict on women and men in North Kivu, eastern Democratic Republic of Congo: results from the International Men and Gender Equality Survey (IMAGES). Washington, DC and Capetown, South Africa: Promundo-US and Sonke Gender Justice, 2014.
    1. Cox TP. The land as casualty: soil, cattle and the future in South Kivu, DRC. University College London, 2008.
    1. Garcia-Moreno C, Jansen HA, Ellsberg M et al. . WHO Multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses. Geneva: World Health Organization, 2005.
    1. Mollica RF, Harvard Program in Refugee Trauma. Measuring Trauma, Measuring Torture: Instructions and Guidance on the Utilization of the Harvard Program in Refugee Trauma's Versions of The Hopkins Symptom Checklist-25 (HSCL-25) & the Harvard Trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma, 2004.
    1. Kohli A, Tosha M, Ramazani P et al. . Family and community rejection and a Congolese led mediation intervention to reintegrate rejected survivors of sexual violence in eastern Democratic Republic of Congo. Health Care Women Int 2012;34:736–56. 10.1080/07399332.2012.721418
    1. Mollica RF, Cardozo BL, Osofsky HJ et al. . Mental health in complex emergencies. Lancet 2004;364:2058–67. 10.1016/S0140-6736(04)17519-3
    1. Mollica RF, Donelan K, Tor S et al. . The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps. JAMA 1993;270:581–6. 10.1001/jama.1993.03510050047025
    1. Onyut LP, Neuner F, Ertl V et al. . Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement—an epidemiological study. Confl Health 2009;3:6 10.1186/1752-1505-3-6
    1. Roberts B, Damundu EY, Lomoro O et al. . Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry 2009;9:7 10.1186/1471-244X-9-7
    1. Roberts B, Felix Ocaka K, Browne J et al. . Alcohol disorder amongst forcibly displaced persons in northern Uganda. Addict Behav 2011;36:870–3. 10.1016/j.addbeh.2011.03.006
    1. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res 1999;8:3–16.
    1. Rubin MD. Multiple imputations for nonresponse in surveys. New York: John Wiley, 1987.
    1. Njuki J, Sangiga PC. Gender and livestock: key issues, challenges and opportunities. In: Njuki J, Sangiga PC, eds. Women, livestock ownership and markets: bridging the gender gap in Eastern and Southern Africa. New York: Routledge, 2013.
    1. Mupawaenda AC, Chawatama S, Muvavirirwa P. Gender issues in livestock production: a case study of Zimbabwe. Trop Anim Health Prod 2009;41:1017–21. 10.1007/s11250-008-9268-5
    1. Bass JK, Annan J, McIvor Murray S et al. . Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med 2013;368:2182–91. 10.1056/NEJMoa1211853
    1. Kohli A, Makambo MT, Ramazani P et al. . A Congolese community-based health program for survivors of sexual violence. Confl Health 2012;6:6 10.1186/1752-1505-6-6
    1. Kelly JT, Betancourt TS, Mukwege D et al. . Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study. Confl Health 2011;5:25 10.1186/1752-1505-5-25
    1. World Health Organization. Mental Health Atlas 2011—Democratic Republic of the Congo. Mental Health Atlas 2011. World Health Organization, 2011.
    1. Roberts B, Browne J. A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries. Glob Public Health 2011;6:814–29. 10.1080/17441692.2010.511625
    1. Ministeère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité (MPSMRM), Ministeère de la Santé Publique (MSP), ICF International. Democratic Republic of Congo Demographic and Health Survey 2013–14: key findings. Rockville, Maryland, USA: MPSMRM, MSP et ICF International, 2014.
    1. Kohli A, Perrin NA, Remy MM et al. . Family and community driven response to intimate partner violence in post-conflict settings. Soc Sci Med 2015;146:6–84.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj