Association between maternal mental health and child nutritional status in rural Sindh: a cross-sectional study using an e-health clinical model

BMJ Paediatr Open. 2025 Nov 30;9(1):e003972. doi: 10.1136/bmjpo-2025-003972.

ABSTRACT

OBJECTIVE: To assess the association between maternal common mental disorders (CMD), as measured by the Self-Reporting Questionnaire-20 (SRQ-20), and child nutritional outcomes wasting, stunting and underweight in rural Sindh, Pakistan, using an e-health clinical model.

DESIGN: A cross-sectional observational study was conducted to explore the relationship between maternal mental health and child nutritional status. Data were collected through nurse-facilitated consultations at e-health clinics, with maternal CMD assessed via the WHO-validated SRQ-20 tool and child nutritional status measured using standardised anthropometric indicators (weight-for-height Z-score, height-for-age Z-score, weight-for-age Z-score) based on WHO growth standards. Multivariate logistic regression was applied to determine adjusted associations.

SETTING: Six nurse-assisted e-health clinics operating under the Sehat Kahani telemedicine platform across rural regions of Sindh.

PARTICIPANTS: A total of 455 mother-child dyads with children aged 6-59 months who visited clinics between April and June 2025. Eligible mothers had resided in the local area for 6 months and were not undergoing treatment for any mental health disorder.

RESULTS: Stunting affected 62% of children, underweight 46.8% and wasting 43.3%. Maternal CMD was prevalent in 76.9% of participants (SRQ-20 score ≥7). Multivariate logistic regression revealed that children of mothers with CMD were about twice as likely to be stunted (adjusted odds ratio (AOR)=2.006, p=0.006) and nearly 1.6 times more likely to be underweight (AOR=1.688, p=0.05), though CMD showed no link with wasting. Maternal education was protective against stunting (AOR=0.458, p=0.012), while paternal unemployment was linked to increased odds of stunting and underweight. No significant associations were found with environmental factors, water source and toilet facilities.

CONCLUSION: Maternal CMD, educational attainment and paternal employment status are key predictors of child nutritional status in rural, low-resource contexts. These findings underscore the need for integrated maternal mental health and child nutrition interventions within digital healthcare delivery models.

PMID:41326038 | DOI:10.1136/bmjpo-2025-003972