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Background: Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty‐impacted communities in sub‐Saharan Africa. Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school‐going children residing in low‐resource communities in Uganda. Methods: We used longitudinal data from the SMART Africa‐Uganda study (2016–2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka‐parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka‐community), 8 schools. All the participants were blinded. At baseline, 8‐ and 16‐weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children's overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self‐esteem, and family functioning. Three‐level linear mixed‐effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak's adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed. Results: Six hundred and thirty‐six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka‐parents: n = 194; Amaka‐community: n = 199). At 8 weeks, Amaka‐parents' children had significantly lower mean scores for overall impairment compared to controls, (mean difference: −0.71, p =.001), while Amaka‐community children performed better on ODD (mean difference: −0.84, p =.016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups. Conclusions: The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka‐community or Amaka‐parents has the potential to reduce negative behavioral health outcomes among young people in resource‐limited settings and improve family functioning. Trial registration: ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017. [ABSTRACT FROM AUTHOR]

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Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33–41; Research in Nursing and Health, 2016, 39(4), 229–243). Yet, there is limited research on the impact of evidence‐based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa‐Uganda study (2016–2022), a cluster randomized clinical trial testing an evidence‐based family‐strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8–13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post‐intervention completion. The intervention effectiveness was evaluated via a three‐level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent–peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges. [ABSTRACT FROM AUTHOR]