Adult and adolescent livestock productive asset transfer programmes to improve mental health, economic stability and family and community relationships in rural South Kivu Province, Democratic Republic of Congo: a protocol of a randomised controlled trial

Anjalee Kohli, Nancy A Perrin, Mitima Mpanano Remy, Mirindi Bacikenge Alfred, Kajabika Binkurhorhwa Arsene, Mwinja Bufole Nadine, Banyewesize Jean Heri, Mitima Murhula Clovis, Nancy Glass, Anjalee Kohli, Nancy A Perrin, Mitima Mpanano Remy, Mirindi Bacikenge Alfred, Kajabika Binkurhorhwa Arsene, Mwinja Bufole Nadine, Banyewesize Jean Heri, Mitima Murhula Clovis, Nancy Glass

Abstract

Introduction: People living in poverty have limited access to traditional financial institutions. Microfinance programmes are designed to meet this gap and show promise in improving income, economic productivity and health. Our Congolese-US community academic research partnership developed two livestock productive asset transfer programmes, Pigs for Peace (PFP) and Rabbits for Resilience (RFR), to address the interlinked health, social and economic well-being of individuals, their families and communities. The community-based randomised controlled trials examine the effectiveness of PFP and RFR to improve health, economic stability, and family and community relationships among male and female adults and adolescents living in 10 rural, postconflict villages of eastern Democratic Republic of Congo.

Methods and analysis: PFP participants include adult permanent residents of rural villages; adolescent participants in RFR include male and female adolescents 10-15 years old living in the selected rural villages. Participants were randomised to intervention or delayed control group. Participants in PFP completed baseline interview prior to intervention and follow-up interview at 6, 12 and 18 months postintervention. In RFR, participants completed baseline interview prior to intervention and follow-up interview at 6, 12 and 18 months postbaseline. The primary outcome of both trials, the change in baseline mental health distress at 18 months in the intervention group (adults, adolescents) compared to control group, is used to calculate sample size.

Ethics and dissemination: The Johns Hopkins Medical Institute Internal Review Board approved this protocol. A committee of respected Congolese educators and community members (due to lack of local ethics review board) approved the study. The findings will provide important information on the potential for community-led sustainable development initiatives to build on traditional livelihood (livestock raising, agriculture) to have a sustained health, economic and social impact on the individual, family and community.

Trial registration number: NCT02008708, NCT02008695.

Keywords: Conflict; Democratic Republic of Congo; MENTAL HEALTH; Microfinance; impact evaluation.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
PFP and RFR intervention and delayed control groups in all 10 participating villages of Walungu and Kabare Territories. PFP, Pigs for Peace; RFR, Rabbits for Resilience.
Figure 2
Figure 2
Timing of follow-up interviews linked to pig and rabbit growth and reproduction. PFP, Pigs for Peace; RFR, Rabbits for Resilience.

References

    1. World Bank. Agriculture and Rural Development Indicators, 2014.
    1. Helmore K, Chidiac S, Hendricks L. Microfinance in Africa: State-of-the-sector report: Bringing fInancial services to Africa's poor: CARE, 2009. .
    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. von Bastelaer T. Does social capital facilitate the poor's access to credit? A review of the microeconomic literature. Social Capital Initiative Working Paper World Bank, 2000.
    1. Patel RB. Microfinance: untapped potential for global health. J Health Care Poor Underserved 2014;25:1718–22. 10.1353/hpu.2014.0169
    1. World Bank. 2005. Dying for change : Poor people's experience of health and ill-health. Washington, DC: World Bank. .
    1. Leatherman S, Metcalfe M, Geissler K et al. . Integrating microfinance and health strategies: examining the evidence to inform policy and practice. Health Policy Plan 2012;27:85–101. 10.1093/heapol/czr014
    1. Kim JC, Watts CH, Hargreaves JR et al. . Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa. Am J Public Health 2007;97:1794–802. 10.2105/AJPH.2006.095521
    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. UN Economic Commission for Africa. Microfinance in Africa: combining the best practices of traditional and modern microfinance approaches towards poverty eradication, 2000.
    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, 2013:1–8.
    1. Kariuki J, Njuki J, Mburu S et al. . Women, lifestock ownership and food security. In: Njuki J, Sangiga PC, eds. Women, livestock ownership and markets: bridging the gender gap in Eastern and Southern Africa. New York: Routledge, 2013:95–110.
    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. Erulkar AS, Muthengi E. Evaluation of Berhane Hewan: a program to delay child marriage in rural Ethiopia. Int Perspect Sex Reprod Health 2009;35:6–14. 10.1363/ifpp.35.006.09
    1. Ssewamala FM, Neilands TB, Waldfogel J et al. . The Impact of a Comprehensive Microfinance Intervention on Depression Levels of AIDS-Orphaned Children in Uganda. J Adolesc Health 2012;50:346–52. 10.1016/j.jadohealth.2011.08.008
    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. USAID. Ending extreme poverty in fragile contexts: Getting to Zero: a USAID discussion series, 2014.
    1. Luckman R, Ahmed I, Muggah R et al. . Conflict and poverty in sub-Saharan Africa: an assessment of the issues and evidence. IDS Working Paper UK, 2001.
    1. United Nations Development Program. Human Development Report 2015: Work for Human Development New York, 2015.
    1. Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP), ICF International. Democratic Republic of Congo Demographic and Health Survey 2013–14: key findings. Rockville, MD, USA: MPSMRM, MSP et ICF International, 2014.
    1. Coghlan B, Brennan RJ, Ngoy P et al. . Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet 2006;367:44–51. 10.1016/S0140-6736(06)67923-3
    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. Johnson K, Scott J, Rughita B et al. . Association of sexual violence and human rights violations with physical and mental health in territories of the eastern Democratic Republic of Congo. JAMA 2010;304:553–62. 10.1001/jama.2010.1086
    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. Ware J, Kosinski M, Dewey J et al. . How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Boston: QualyMetric, 2001.
    1. Betancourt TS, Bass J, Borisova I et al. . Assessing local instrument reliability and validity: a field-based example from northern Uganda. Soc Psychiatry Psychiatr Epidemiol 2009;44:685–92. 10.1007/s00127-008-0475-1
    1. Bauer DJ, Preacher KJ, Gil KM. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations. Psychol Methods 2006;11:142–63. 10.1037/1082-989X.11.2.142
    1. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide (v.3). Washington DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development, 2007.
    1. Swindale A, Bilinsky P. Household Dietary Diversity Score (HDDS) for measurement of household food access: indicator guide (v.2). Washington DC: FHI 360/FANTA, 2006.
    1. Mollica RF, McDonald LS, Massagli MP et al. , 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) and The Harvard Trauma Questionnaire (HTQ), 2004.
    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. Straus MA. Measuring intrafamily conflict and violence: the conflict tactic (CT) scales. New Brunswick, NJ, USA: Transactions Publishers, 1990:29–47.
    1. Straus MA. Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. J Marriage Fam 1979;41:75–88. 10.2307/351733
    1. Holzemer WL, Uys LR, Chirwa ML et al. . Validation of the HIV/AIDS Stigma Instrument—PLWA (HASI-P). AIDS care 2007;19:1002–12. 10.1080/09540120701245999
    1. Williams DR, Yan Y, Jackson JS et al. . Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 1997;2:335–51. 10.1177/135910539700200305
    1. Spirito A, Stark LJ, Williams CA. Development of a brief checklist to assess coping in pediatric patients. J Pediatr Psychol 1988;13:555–74. 10.1093/jpepsy/13.4.555
    1. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press, 1965.
    1. Doucette A, Bickman R. Life satisfaction/hopefulness scale: youth version. Nashville, TN: Vanderbilt University, 2000.
    1. Bryant BK. An index of empathy for children and adolescents. Child Dev 1982;53:413–25. 10.2307/1128984

Source: PubMed

3
Prenumerera