Maternal exposure to intimate partner violence and its association with diarrhoea prevalence and treatment among children under five in Nepal

Diarrhoeal disease remains a critical public health concern, and a leading cause of death among children under the age of five. Increasingly, studies are also showing a relationship between child diarrhoea and maternal exposure to intimate partner violence (IPV). This study assessed the relationship between maternal experience of different forms of IPV and child diarrhoea prevalence and treatment-seeking in Nepal. Study participants included children under five years whose mothers were asked about IPV exposure in the 2022 Nepal Demographic and Health Survey (n = 1,959). The main outcomes were: (1) Diarrhoea prevalence in the last two weeks, and (2) Diarrhoea treatment. Main exposures assessed were last twelve months maternal experience of physical, sexual, emotional IPV, and controlling behaviours. Multivariable Poisson regression with robust standard errors were used to estimate adjusted prevalence ratios and 95% CI. Diarrhoea prevalence was 8.9%, with treatment sought for 56.6% of cases. Children whose mothers were exposed to sexual IPV (aPR: 1.94 95% CI: 1.17–3.21), emotional IPV (aPR: 1.87; 95% CI: 1.17-3.00), controlling behaviour (aPR: 1.64; 95% CI: 1.14–2.35), or any form of IPV (aPR: 1.71; 95% CI: 1.19–2.45) had higher diarrhoea prevalence in the last 2 weeks. Maternal exposure to emotional IPV (aPR: 0.32; 95% CI: 0.15–0.70) was associated with lower prevalence of seeking treatment. In sex-stratified analyses, male children whose mothers experienced emotional IPV (aPR: 1.91; 95% CI: 1.01–3.63) or controlling behaviour (aPR: 1.68; 95% CI: 1.08–2.62), and female children whose mothers experienced any form of IPV (aPR: 1.68; 95% CI: 1.06–2.66) had significantly higher diarrhoea prevalence. Conversely, maternal exposure to emotional IPV was associated with significantly lower treatment-seeking among female children only (aPR: 0.09; 95% CI: 0.02–0.35). Maternal exposure to IPV was associated with a higher prevalence of diarrhoea and lower treatment-seeking behaviour, with key differences by child sex, underscoring the need for gender-sensitive, integrated maternal and child health interventions that address IPV.