Association between poor mental health in mothers and child stunting: a population-based cross-sectional study in Rwanda

BMJ Open. 2025 Oct 13;15(10):e101117. doi: 10.1136/bmjopen-2025-101117.

ABSTRACT

OBJECTIVE: Child undernutrition is linked to substantial national economic and health losses in low- and middle-income countries, including Rwanda. Although the causal and contextual factors contributing to chronic malnutrition in children in Rwanda have been explored, the role of the mothers’ mental health has not been fully investigated. This study aims to determine the prevalence of major depressive disorders, generalised anxiety and suicide risk among mothers in Rwanda and to explore their association with child stunting.

DESIGN: This study used a cross-sectional, population-based design.

SETTING AND PARTICIPANTS: Participants included children aged 1-36 months (n=601) and their mothers (n=601) in Rwanda’s Northern Province. Mothers’ mental health was assessed using four modules from the Mini International Neuropsychiatric Interview, based on the Diagnostic and Statistical Manual of Mental Disorders. Child anthropometric measurements followed WHO guidelines.

PRIMARY AND SECONDARY OUTCOMES: The primary outcome of the study was child stunting that was defined as a height-for-age Z (HAZ) score <-2 SD according to WHO growth standards.

RESULTS: Among the 601 mothers assessed, generalised anxiety disorder had the highest prevalence (36.6%), followed by recurrent major depressive disorder (27.3%), current major depressive disorder (22.7%) and current suicide risk (18.2%). Among the children, 27.1% were stunted, with prevalence rising from 9.8% in infants (1-12 months) to 39.9% in toddlers (25-36 months). Current major depressive disorders in mothers were associated with child stunting (adjusted OR 1.67; 95% CI 1.06 to 2.61). Affected children had lower HAZ scores (-1.68 ± 1.36 vs -1.30 ± 1.09; p = 0.004), and excess relative risk (ERR) analysis confirmed depression as a significant risk factor (ERR: 1.56; p = 0.005).

CONCLUSIONS: Mental health disorders in mothers, especially depression, showed a significant association with child stunting. Addressing mental health disorders in mothers is essential for improving child nutritional outcomes.

PMID:41083297 | DOI:10.1136/bmjopen-2025-101117