Childhood stunting contributes to substantial global disease and economic burden (~US$2.1 billion per day). The purpose of this study was to investigate key psychosocial factors that may increase the risk for stunting. Within this observational study, 162 mothers living in rural Tanzania completed a cross-sectional quantitative survey measuring parental substance use, intimate partner violence (IPV) and mothers’ mental health (i.e., depression/anxiety). One month after survey completion, children’s height and weight were measured in triplicate to assess for childhood stunting. Sequential mediation revealed that parental alcohol use (b = 0.03, SE = 0.02, 95% CI [0.003, 0.08]) and alcohol-related consequences (b = 0.07, SE = 0.05, 95% CI [0.02, 0.20]) predicted greater IPV, which, in turn, was associated with elevated maternal mental health problems and ultimately childhood stunting. This study helps to clarify the pathways through which psychosocial risk factors confer heightened risk for childhood undernutrition. Going forward, this knowledge may also help to inform preventative interventions intended to reduce childhood stunting.
AboagyeRGAhinkorahBOTenganCL, et al. (2022) Partner alcohol consumption and intimate partner violence against women in sexual unions in sub-Saharan Africa. PLoS One17: e0278196. https://doi.org/10.1371/journal.pone.0278196
2.
AlhusenJLFrohmanNPurcellG (2015) Intimate partner violence and suicidal ideation in pregnant women. Archives of Women’s Mental Health18: 573–578. https://doi.org/10.1007/s00737-015-0515-2
3.
BacchusLJColombiniMContreras UrbinaM, et al. (2017) Exploring opportunities for coordinated responses to intimate partner violence and child maltreatment in low and middle income countries: a scoping review. Psychology Health & Medicine22: 135–165. https://doi.org/10.1080/13548506.2016.1274410
4.
BarnettWNhapiRZarHJ, et al. (2022) Intimate partner violence and growth outcomes through infancy: A longitudinal investigation of multiple mediators in a South African birth cohort. Maternal and Child Nutrition18: e13281. https://doi.org/10.1111/mcn.13281
5.
BeleteHYimerTMDawsonD, et al. (2024) Alcohol use and alcohol use disorders in sub-Saharan Africa: A systematic review and meta-analysis. Addiction119: 1527–1540. https://doi.org/10.1111/add.16514
6.
BeydounHABeydounMAKaufmanJS, et al. (2012) Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine75: 959–975. https://doi.org/10.1016/j.socscimed.2012.04.025
7.
BintabaraDKibusiSM (2018) Intimate partner violence victimization increases the risk of under-five morbidity: A stratified multilevel analysis of pooled Tanzania Demographic Health Surveys, 2010-2016. PLoS One13: e0201814. https://doi.org/10.1371/journal.pone.0201814
8.
CaulfieldLERichardSARiveraJA, et al. (eds) (2006) Stunting, wasting, and micronutrient deficiency disorders. In: JamisonDTBremanJGMeashamAR, et al. (eds), Disease Control Priorities in Developing Countries, 2nd edn. (pp. 551–567). Oxford University Press.
9.
ChaiJFinkGKaayaS, et al. (2016) Association between intimate partner violence and poor child growth: Results from 42 demographic and health surveys. Bulletin of the World Health Organization94: 331–339. https://doi.org/10.2471/BLT.15.152462
10.
ChoiAWLoBCLoRT, et al. (2021) Intimate Partner Violence Victimization, social support, and resilience: Effects on the anxiety levels of young mothers. Journal of Interpersonal Violence36: n12299–n12323. https://doi.org/10.1177/0886260519888532
11.
ChzhenYHowarthCMainG (2022) Deprivation and intra-family conflict: Children as agents in the family stress model. Journal of Marriage and Family84: 121–140. https://doi.org/10.1111/jomf.12791
12.
DerogatisLRLipmanRSRickelsK, et al. (1974) The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behavioral Sciences19(1): 1–15.
13.
DevriesKMMakJYBacchusLJ, et al. (2013) Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies. PLoS Medicine10: e1001439. https://doi.org/10.1371/journal.pmed.1001439
14.
FawziMCSAndrewsKGFinkG, et al. (2019) Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries. BMJ Global Health4: e001144. https://doi.org/10.1136/bmjgh-2018-001144
15.
FritzMSMackinnonDP (2007) Required sample size to detect the mediated effect. Psychological Science18: 233–239.
16.
GaoYZhaoSZhouY, et al. (2025) Maternal experiences of multiple forms of intimate partner violence and associations with undernutrition among children under 5: Evidence from 36 low- and middle-income countries based on demographic and health surveys. BMJ Global Health10(4): e017114
17.
García-MorenoCJansenHEllsbergM, et al. (2005) WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women. World health organization, 204, p.18.
18.
GillerKEDelauneTSilvaJV, et al. (2021) Small farms and development in sub-Saharan Africa: Farming for food, for income or for lack of better options?Food Security13: 1431–1454.
19.
GreeneMCKaneJCTolWA (2017) Alcohol use and intimate partner violence among women and their partners in sub-Saharan Africa. Global Mental Health4: e13. https://doi.org/10.1017/gmh.2017.9
20.
HeinzAJBeckAMeyer-LindenbergA, et al. (2011) Cognitive and neurobiological mechanisms of alcohol-related aggression. Nature Reviews Neuroscience12: 400–413. https://doi.org/10.1038/nrn3042
21.
HernandezDCMarshallAMineoC (2014) Maternal depression mediates the association between intimate partner violence and food insecurity. Journal of Women’s Health23: 29–37. https://doi.org/10.1089/jwh.2012.4224
22.
HossainMChoudhuryNAdib Binte AbdullahK, et al. (2017) Evidence-based approaches to childhood stunting in low and middle income countries: A systematic review. Archives of Disease in Childhood102: 903–909. https://doi.org/10.1136/archdischild-2016-311050
23.
JainSAhsanSRobbZ, et al. (2024) The cost of inaction: A global tool to inform nutrition policy and investment decisions on global nutrition targets. Health Policy and Planning39: 819–830.
24.
KassieGAAsgedomYS (2025) Childhood stunting severity level and associated factors among under-five children in Tanzania: A multi-level ordinal logistic regression analysis using 2022 Tanzanian demographic and health survey. BMC Pediatrics25: 129. https://doi.org/10.1186/s12887-025-05490-2
25.
KeynejadRCDuaTBarbuiC, et al. (2018) WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A systematic review of evidence from low and middle-income countries. Evidence-Based Mental Health21: 30–34. https://doi.org/10.1136/eb-2017-102750
26.
LevendoskyAAMartinez-TorteyaCBallingerAL, et al. (2024) The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy. Archives of Women’s Mental Health27: 285–292. https://doi.org/10.1007/s00737-023-01399-w
27.
Lin-RoarkIHChurchATMcCubbinLD (2015) Battered women’s evaluations of their intimate partners as a possible mediator between abuse and self-esteem. Journal of Family Violence30: 201–214. https://doi.org/10.1007/s10896-014-9661-y
28.
LobatoGMoraesCLDiasAS, et al. (2012) Alcohol misuse among partners: A potential effect modifier in the relationship between physical intimate partner violence and postpartum depression. Social Psychiatry and Psychiatric Epidemiology47: 427–438. https://doi.org/10.1007/s00127-011-0346-z
29.
MacKinnonDPLockwoodCMHoffmanJM, et al. (2002) A comparison of methods to test mediation and other intervening variable effects. Psychological Methods7: 83–104. https://doi.org/10.1037/1082-989X.7.1.83
30.
MacKinnonDRKisbu-SakaryaYGottschallAC (2013) Developments in mediation analysis. In: LittleTD (ed.), The Oxford Handbook of Quantitative Methods: Statistical Analysis, vol. 2. Oxford Library of Psychology. Oxford University Press, pp.338–360.
31.
MandalSKHookerLVallyH, et al. (2018) Partner violence and postnatal mental health: Cross-sectional analysis of factors associated with depression and anxiety in new mothers. Australian Journal of Primary Health24: 434–440. https://doi.org/10.1071/PY17174
32.
McCloskeyLABoonzaierFSteinbrennerSY, et al. (2016) Determinants of intimate partner violence in sub-Saharan Africa: A review of prevention and intervention programs. Partner Abuse7: 277–315.
33.
MeyerSRVahediLBhatt CarrenoS, et al. (2025) Gender-based violence and child nutrition in fragile settings: exploring intersections and opportunities for evidence generation. BMJ Nutrition, Prevention & Health8(1): 283–289. https://doi.org/10.1136/bmjnph-2023-000682
NaingLWinnTRusliB (2006) Practical issues in calculating the sample size for prevalence studies. Archives of Orofacial Sciences1: 9–14.
36.
National Bureau of Statistics (2019) Tanzania Mainland Household Budget Survey 2017–18: key indicators report. National Bureau of Statistics.
37.
NeamahHHSudfeldCMcCoyDC, et al. (2018) Intimate partner violence, depression, and child growth and development. Pediatrics142(1): e20173457.
38.
NgochoJSMinjaLMMwambaRN, et al. (2022) Prevalence and predictors of depression among women attending antenatal care in Moshi, Tanzania: A cross-sectional study. BMC Pregnancy and Childbirth22: 594. https://doi.org/10.1186/s12884-022-04917-3
39.
PeerNLombardCSteynK, et al. (2014) Rising alcohol consumption and a high prevalence of problem drinking in black men and women in Cape Town: The CRIBSA study. Journal of Epidemiology and Community Health68: 446–452. https://doi.org/10.1136/jech-2013-202985
RodríguezMValentineJMSonJB, et al. (2009) Intimate partner violence and barriers to mental health care for ethnically diverse populations of women. Trauma Violence & Abuse10: 358–374.
42.
SaundersJBAaslandOGBaborTF, et al. (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption—II. Addiction88: 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
43.
StatonCAZhaoDGinalisEE, et al. (2020) Alcohol availability, cost, age of first drink, and its association with at-risk alcohol use in Moshi, Tanzania. Alcoholism Clinical and Experimental Research44: 2266–2274. https://doi.org/10.1111/acer.14457
44.
SummersCHWinbergS (2006) Interactions between the neural regulation of stress and aggression. Journal of Experimental Biology209: 4581–4589. https://doi.org/10.1242/jeb.02565
45.
United Nations Children’s Fund (UNICEF), World Health Organization (WHO), International Bank for Reconstruction and Development/The World Bank (2023) Levels and Trends in Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2023 Edition. UNICEF and WHO.
46.
VahediLOrjuela-GrimmMChanPMP, et al. (2025) Intimate partner violence and reduced dietary iron and vitamin A intake: A population analysis of nationally representative data from eight low- and middle-income countries. Public Health Nutrition28: e87.
47.
ValladaresEPeñaREllsbergM, et al. (2009) Neuroendocrine response to violence during pregnancy–impact on duration of pregnancy and fetal growth. Acta Obstetricia et Gynecologica Scandinavica88: 818–823. https://doi.org/10.1080/00016340903015321
48.
World Health Organization (2023) Levels and Trends in Child Malnutrition Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the, 2023 Edition. World Health Organization.
