This paper confirms presence of a significant relationship between maternal CMD and childhood malnutrition in Zimbabwe. There is a paucity of studies that assessed maternal CMD in Zimbabwe with a majority of studies mainly disease specific for example CMDs among HIV infected mothers (30). We found a high burden of maternal CMDs in Zimbabwe in our study population (29.5%). This finding is in keeping with a study conducted in two rural districts in Zimbabwe which reported maternal depression prevalence of 21% in Chipinge and 34% in Mutasa district (18) .Much higher prevalence of maternal mental health outcomes were reported in studies conducted in Rwanda (51.6%), and Nigeria (40.7%) (25, 32). However, the high prevalence in these reviewed studies may be attributed to selection bias as a result of interviewing inpatients, health facility clients, and mothers of children with known morbidity as well as a difference in the validity and specificity of the tools used in assessing for the maternal CMDs.
A systematic review of studies conducted in 17 low to middle-income countries in Africa, Asia, and the Americas found a significant association between maternal CMD and stunting (33). The review also highlighted the most significant factors influencing the relationship, including shorter periods of breastfeeding, poor maternal instincts, and diminished caregiving. Similarly, a study conducted in Madagascar revealed that maternal CMD was a risk factor for stunting (34). The study argued that maternal CMD influenced household dietary diversity, resulting in the children being fed a poor diet, which is a known risk factor for stunting. Another study conducted in the Americas, which followed mothers for the first 48 months of their child’s life, found a strong association between maternal CMD and underweight and stunting in children (14). This finding supports the results of our study, which also found a significant association between maternal CMD and child wasting and underweight.
We did not find an association between maternal CMD and children who were overweight. A Bangladeshi study found that mother with CMD was less likely to perceive their children as overweight or obese (35). This highlights the lack of attention child overweight and obesity is given in low-income countries. Policies and public health interventions in low-income countries have mostly focused on under-nutrition thus mothers may not be affected by over-nutrition (35, 36). This is further strengthened by our finding whereby CMD were significantly higher among mothers of children who experienced frequent appetite loss. In contrast a study conducted in USA found mothers presenting with common mental disorders to more likely have overweight children attributing such to poor watching of diet and children being exposed to more takeaway as opposed to home cooked meals (37)
The presence of a partner was associated with a decreased odds of maternal CMDs, with one study arguing that this is because spousal support generates a better life satisfaction which in turn improves maternal health outcomes (32). A study in Sub-Saharan Africa that assessed the effect of spousal support on maternal burnout, depression and anxiety reported that perceived spousal support reduced both burnout and depression (38). In Japan, it was found that unmet spousal support needs increased the odds of maternal depression among both working mothers and stay at home mothers (39). These studies are in support with our findings whereby mothers with either a deceased spouse, divorced or separated had increased odds of CMDs.
Household income exerts additional pressure on mothers as they are usually in charge of children. A systematic review conducted among several LMICs concluded that mothers, often left to find food and clothing within poor settings, are more likely to experience maternal CMDs (9). Similarly, a study in Brazil reported that socioeconomic factors were associated with both maternal CMD and malnutrition in children (40). Household income has also been found to be linked to distance from health facilities, distance from water sources, and access to protected water sources. Our study revealed a significant association between maternal CMDs and household income, as well as access to clean water sources. A study conducted in India suggests that the increased odds of maternal CMD resulting from distance and access to clean water sources are due to an increased workload on the mother as well as an increased disease burden within the household (41).
Despite these findings, this study has identified some limitations. For instance, the study only assessed CMD once, and as chronic malnutrition in children may require a historical assessment, the study does not account for the chronic nature of malnutrition outcomes. Moreover, this study measures maternal CMDs among children aged 6 months and above and compared these findings to chronic outcomes such as childhood stunting and wasting, which may discount the chronic nature of the