| Issue/Objective |
Parenting while navigating multiple health and social challenges, such as intimate partner violence (IPV), depression, and malnutrition, contributes to poor child health outcomes. Syndemic theory provides a framework for understanding how these intersecting inequalities exacerbate maternal health disparities, which, in turn, negatively affect child health outcomes like diarrheal disease-a key risk factor for child mortality and stunting, particularly in low- and middle-income countries (LMICs).This study leverages the 2022 Nepal Demographic and Health Survey to test an intergenerational syndemic model involving three key questions: (1) Do IPV, depression, and inadequate dietary iron intake co-occur among mothers? (2) Does the probability of child diarrhea increase with concurrent maternal exposures to these three factors? (3) Are these relationships stronger in disadvantaged households? |
| Methodology/Approach |
The analysis included 2,019 mother-child (under 5 years) dyads. Multivariable interaction models on additive and multiplicative scales were constructed to predict child diarrhea as a function of IPV, depression, and dietary iron intake, accounting for complex survey design. Models were also stratified by household wealth to assess the potential role of contextual factors. Predicted probabilities of child diarrheal disease were computed at different combinations of maternal health and social disparities to assess harmful synergies. |
| Results |
The prevalence of single exposure to IPV, depression, and inadequate dietary iron intake was higher among mothers in poorer households. Only in disadvantaged households was children's risk of diarrhea significantly higher when mothers experienced syndemic vulnerability (co-occurrence of IPV, depression, and inadequate iron intake). The model predicted probability of child diarrhea rose from 7.5% (P=0.000) to 53.5% (P=0.045) among mothers exposed to all three challenges, compared to none. |
| Discussion/Conclusion |
These findings suggest that household disadvantage may magnify the negative effects of IPV, depression, and iron deficiency, increasing the likelihood of child diarrhea. Interventions targeting these maternal health challenges in disadvantaged households could help reduce their impact on child health. The findings support a proportionate universalism approach to addressing this maternal-child syndemic in Nepal. Mothers experiencing the triple burden of violence, depression, and malnutrition in disadvantaged households could be identified and provided tailored supports within the wider system of antenatal care in Nepal. |
| Presenters and affiliations |
Luissa Vahedi Sick Kids Centre for Global Child Health; University of Toronto |
