Parenting under the triple burden of violence, depression, and poor diet quality: An intergenerational mother–child syndemic in Nepal

Parenting while experiencing intimate partner violence (IPV), depression, and poor diet quality can contribute to child health inequities. Syndemic theory offers a framework to understand how maternal conditions can lead to inequitable child health outcomes, such as diarrheal disease: a risk factor for childhood mortality and stunting. This study uses the 2022 Nepal Demographic and Health Survey to test an intergenerational syndemic model addressing three key questions: (1) Do IPV, depression, and absent 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? The analysis included 2,019 mother-child dyads. Interaction models on additive and multiplicative scales were constructed to predict child diarrhea as a function of maternal syndemic exposures, accounting for complex survey design. The prevalence of single exposure to IPV, depression, and absent dietary iron intake was higher among mothers in poorer households. In disadvantaged households (two lowest household wealth quintiles), children's odds of diarrhea were higher when mothers experienced syndemic vulnerability (IPV, depression, and absent iron intake) on multiplicative (aOR=1.321, 95%CI:1.000, 1.745) and additive scales (B = 0.027, 95%CI:-0.002, 0.055). Household disadvantage may exacerbate the synergistic effects of IPV, depression, and iron deficiency, increasing the likelihood of child diarrhea. Interventions targeting these maternal health adversities in disadvantaged households may reduce the impact on child health.