Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study

**Background:** Malnutrition is a leading cause of child mortality and developmental impairment globally. In Bangladesh, despite declining trends, stunting (41%), wasting (16%), and underweight (36%) remain high (BDHS 2011). Maternal common mental disorders (CMDs), including anxiety, depression, and somatic symptoms, are prevalent in developing countries and may impair a mother's ability to care for her child, potentially affecting child nutrition. This study aimed to assess the association between maternal mental health and child nutritional status in an urban slum in Bangladesh, where data are scarce.

**Methods:** A community-based cross-sectional study was conducted from September to November 2013 in Kamrangichar, an urban slum in Dhaka, Bangladesh. A total of 264 mother-child pairs were recruited from 12 administrative areas (mohallas). Mothers were interviewed using a structured questionnaire that included the Self-Reporting Questionnaire-20 (SRQ-20; cut-off ≥7 for CMD), Household Food Insecurity Access Scale (HFIAS), and Kuppuswamy's socioeconomic status scale. Anthropometric measurements of children (weight, length/height) were taken following standard WHO procedures. Child nutritional status was assessed using WHO Anthro software to calculate height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ) Z-scores; stunting, wasting, and underweight were defined as Z-scores < -2 SD. Child feeding practice, hygiene practice (spot-check observation), preventive care service use, and child illness (diarrhea, ARI within 30 days) were also assessed. Bivariate analyses (chi-squared, Fisher's exact, Mann-Whitney U, Spearman correlation) and multivariable logistic regression were performed.

**Key Results:** The prevalence of maternal CMD was 46.2% (122/264). Child stunting, wasting, and underweight prevalence were 44.3%, 18.2%, and 33.7%, respectively. Maternal CMD was significantly associated with poorer child feeding practice (p<0.001), poorer hygiene practice (p<0.001), poorer preventive care service use (p=0.016), and higher prevalence of diarrheal disease in children (54.4% vs. 38.6%, p=0.049). Poor child feeding practice was associated with wasting (p=0.004) and underweight (p<0.001) but not stunting. In bivariate analysis, maternal CMD was associated with wasting (p=0.005) and underweight (p<0.001) but not stunting (p=0.085). After multivariable adjustment, maternal CMD remained significantly associated with child wasting (aOR = 2.25, 95% CI = 1.15–4.43). The association with underweight was attenuated and no longer statistically significant (aOR = 1.77, 95% CI = 0.94–3.33). No significant association was found between maternal CMD and stunting (aOR = 1.46, 95% CI = 0.84–2.54).

**Clinical Implications:** Maternal CMD is highly prevalent (46.2%) in this urban slum population and is independently associated with child wasting, an indicator of acute malnutrition. The findings suggest that poor maternal mental health may impair childcare practices (feeding, hygiene, preventive care), which in turn may contribute to child undernutrition. Integrating mental health screening and interventions into child nutrition programs could improve child nutritional outcomes. However, the cross-sectional design precludes causal inference, and reverse causality (poor child health worsening maternal mental health) is possible. The study was conducted in 2013 in a single urban slum, limiting generalizability. Further research using longitudinal designs and structural equation modeling is needed to elucidate the complex pathways linking maternal mental health and child nutrition.