The intervention

Sugira Muryango comprises 12 modules (see Table 2) that were delivered by trained, supervised CBCs in the families’ homes, unless contraindicated due to illness or privacy concerns, at a pace of about one module per week (average 90-min sessions) between May and August 2018. ​Sugira Muryango ​offers active coaching of caregivers to promote early stimulation, play, nutrition, hygiene, responsive parenting, nonviolent interactions among household members, and engagement of both female and male caregivers. CBCs also help families navigate formal and nonformal resources (e.g. health and nutrition services and social support). Sugira Muryango was originally developed and tested in Rwanda for families affected by HIV/AIDS [14]. During previous pilot studies [15], a version focusing on ECD was developed by integrating United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) Care for Child Development materials [16]. The CBCs were selected from the local community (see Table ​Table11 for selection criteria, training, supervision, and incentives of CBCs). Primary caregivers participated in the modules in interaction with their child (ren); other caregivers and older children were invited to participate. All visits included a 15-min “active play and communication” session where caregivers received live feedback on parent-child interactions. The usual care (UC) group received VUP services and health services as usual from the Rwandan government and its partners. Intervention and UC families received a stipend (RWF 5000 equivalent to 3 k of rice) after each data collection.

The twelve Sugira Muryango modules