{"id":{"repo_id":"cambridge","oai_identifier":"oai:www.repository.cam.ac.uk:1810/382371"},"canonical_url":"https://search.dev.ndltd.org/etd/cambridge/oai:www.repository.cam.ac.uk:1810/382371","repository":{"repo_id":"cambridge","name":"Cambridge University","base_url":"https://api.repository.cam.ac.uk/server/oai/request"},"display":{"title":"Maternal Exposure to Violence and Child Malnutrition in LMICs: A Cross-Sectional, Population-Based Study in Conflict-Affected Northern Uganda","abstract":"Maternal Exposure to Violence and Child Malnutrition in LMICs: A Cross-Sectional, Population-Based Study in Conflict-Affected Northern Uganda Background: Violence against women by an intimate partner is a serious human rights and public health concern, especially in low-and-middle-income countries (LMICs). Some of the most prevalent rates of intimate partner violence (IPV) are recorded in Sub-Saharan Africa (SSA), and in particular, in conflict-affected settings. IPV can lead to detrimental outcomes not only on maternal health but also on child health, including child growth and nutrition. As some of the most widely cited health outcomes of IPV are simultaneously established risk factors leading to child malnutrition, there is reason to believe that there are biological and/or behavioural pathways relating the two. Previous research has examined the link between IPV and child malnutrition in different areas, yet findings are inconclusive, and the exact context and mechanisms underpinning this link in developing countries remains unclear. Further research is needed to better understand context-specific pathways, particularly in high-risk areas. Aims: This study aims to examine the association between IPV and child malnutrition in three different contexts: a) globally in LMICs, b) regionally in SSA, and c) locally in conflict-affected northern Uganda. At global level, the study aims to 1) systematically review the current literature on maternal exposure to IPV and child malnutrition in LMICs; 2) develop a conceptual framework to better understand socio-ecological pathways linking IPV to child malnutrition in low-resource settings. At regional level, the study aims to 3) conduct a socio-ecological analysis of possible pathways between IPV and child malnutrition using secondary and primary findings from the SSA region. At local level, the study aims to 4) explore the interrelations of intergenerational family violence; 5) examine the association of maternal exposure to IPV and child malnutrition and identify differences in type, accumulation, and severity of violence exposure; and 6) assess mediation and moderation effects between maternal exposure to violence and child malnutrition, with a particular focus on maternal mental health and feeding practices. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, a cross-sectional, population-based household survey was conducted across two districts in Acholiland, northern Uganda – an area severely impacted by over 20 years of conflict. Data was collected in June 2021 with logistical support from Food for the Hungry (FH) International and Gulu University. An interviewer-administered questionnaire was developed for the purpose of this study. Computer-assisted face-to-face interviews were conducted with 478 mothers with children aged 6-23 months. Stringent measures were followed to address ethical, safety, as well as health-related risks in light of the ongoing COVID-19 pandemic. A series of cross-sectional descriptive, regression and mediation analyses were conducted to address the study’s research aims. Results: First, results indicated critical gaps in the literature on maternal exposure to IPV and child malnutrition across LMICs with respect to geographic, conceptual, and methodological shortcomings. Second, the socio-ecological analysis of factors associated with maternal IPV and child malnutrition in SSA highlighted the importance of biopsychosocial mediating pathways between mother and child. Third, in northern Uganda, nearly 90% of ever-partnered mothers aged 18-49 experienced some form of IPV by a former or current partner in their lifetime. Results indicated strong evidence for the intergenerational transmission of family violence, suggesting distinct patterns in the co-occurrence, interrelations, and mediating role of different forms of victimization. Over 40% of children in the sample suffered from either acute malnutrition, chronic malnutrition, or both. Results indicated that particularly maternal exposure to sexual violence was associated with higher odds of malnutrition in children, while a dose-response relationship was indicated between the severity of maternal victimization and malnourishment. Finally, findings suggested maternal depression to moderate and partially mediate the relationship between IPV and child malnutrition. No significant evidence was found for the role of breastfeeding. Outcomes: This study aims to contribute to the limited but growing body of research on victimization and child health in LMICs, particularly in conflict-affected settings. In line with the UN Sustainable Development Goal Agenda, which recognizes the elimination of both IPV and child malnutrition as catalysts towards sustainable development, findings aim to guide researchers, policymakers, and practitioners in designing and implementing interventions, in both development and humanitarian settings. Findings underscore the need to promote adaptive management and integration of not only mental health, but also violence-related interventions into nutrition and public health programmes. Further research is needed on the intersection between maternal victimization, mental health, and child development outcomes in low-resource settings.","abstract_html":"Maternal Exposure to Violence and Child Malnutrition in LMICs: A Cross-Sectional, Population-Based Study in Conflict-Affected Northern Uganda Background: Violence against women by an intimate partner is a serious human rights and public health concern, especially in low-and-middle-income countries (LMICs). Some of the most prevalent rates of intimate partner violence (IPV) are recorded in Sub-Saharan Africa (SSA), and in particular, in conflict-affected settings. IPV can lead to detrimental outcomes not only on maternal health but also on child health, including child growth and nutrition. As some of the most widely cited health outcomes of IPV are simultaneously established risk factors leading to child malnutrition, there is reason to believe that there are biological and/or behavioural pathways relating the two. Previous research has examined the link between IPV and child malnutrition in different areas, yet findings are inconclusive, and the exact context and mechanisms underpinning this link in developing countries remains unclear. Further research is needed to better understand context-specific pathways, particularly in high-risk areas. Aims: This study aims to examine the association between IPV and child malnutrition in three different contexts: a) globally in LMICs, b) regionally in SSA, and c) locally in conflict-affected northern Uganda. At global level, the study aims to 1) systematically review the current literature on maternal exposure to IPV and child malnutrition in LMICs; 2) develop a conceptual framework to better understand socio-ecological pathways linking IPV to child malnutrition in low-resource settings. At regional level, the study aims to 3) conduct a socio-ecological analysis of possible pathways between IPV and child malnutrition using secondary and primary findings from the SSA region. At local level, the study aims to 4) explore the interrelations of intergenerational family violence; 5) examine the association of maternal exposure to IPV and child malnutrition and identify differences in type, accumulation, and severity of violence exposure; and 6) assess mediation and moderation effects between maternal exposure to violence and child malnutrition, with a particular focus on maternal mental health and feeding practices. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, a cross-sectional, population-based household survey was conducted across two districts in Acholiland, northern Uganda – an area severely impacted by over 20 years of conflict. Data was collected in June 2021 with logistical support from Food for the Hungry (FH) International and Gulu University. An interviewer-administered questionnaire was developed for the purpose of this study. Computer-assisted face-to-face interviews were conducted with 478 mothers with children aged 6-23 months. Stringent measures were followed to address ethical, safety, as well as health-related risks in light of the ongoing COVID-19 pandemic. A series of cross-sectional descriptive, regression and mediation analyses were conducted to address the study’s research aims. Results: First, results indicated critical gaps in the literature on maternal exposure to IPV and child malnutrition across LMICs with respect to geographic, conceptual, and methodological shortcomings. Second, the socio-ecological analysis of factors associated with maternal IPV and child malnutrition in SSA highlighted the importance of biopsychosocial mediating pathways between mother and child. Third, in northern Uganda, nearly 90% of ever-partnered mothers aged 18-49 experienced some form of IPV by a former or current partner in their lifetime. Results indicated strong evidence for the intergenerational transmission of family violence, suggesting distinct patterns in the co-occurrence, interrelations, and mediating role of different forms of victimization. Over 40% of children in the sample suffered from either acute malnutrition, chronic malnutrition, or both. Results indicated that particularly maternal exposure to sexual violence was associated with higher odds of malnutrition in children, while a dose-response relationship was indicated between the severity of maternal victimization and malnourishment. Finally, findings suggested maternal depression to moderate and partially mediate the relationship between IPV and child malnutrition. No significant evidence was found for the role of breastfeeding. Outcomes: This study aims to contribute to the limited but growing body of research on victimization and child health in LMICs, particularly in conflict-affected settings. In line with the UN Sustainable Development Goal Agenda, which recognizes the elimination of both IPV and child malnutrition as catalysts towards sustainable development, findings aim to guide researchers, policymakers, and practitioners in designing and implementing interventions, in both development and humanitarian settings. Findings underscore the need to promote adaptive management and integration of not only mental health, but also violence-related interventions into nutrition and public health programmes. Further research is needed on the intersection between maternal victimization, mental health, and child development outcomes in low-resource settings.","abstract_has_math":false,"creators":["Dewan, Sarika Mira"],"institution":"University of Cambridge","degree_name":"Doctor of Philosophy (PhD)","degree_level":"Doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Eisner, Manuel","Murray, Aja"],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-08-07","date_published":"2024-08-07","updated_at":"2026-07-22T22:24:27Z","subjects":["child malnutrition","conflict-affected settings","cross-sectional mediation analysis","early child development","intergenerational violence","intimate partner violence","Low-and-Middle-Income Countries (LMICs)","maternal mental health","random cluster household survey","socio-ecological framework","Sub-Saharan Africa","violence against children","violence against women"],"languages":["eng"],"rights":[],"rights_urls":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/b412460b-854a-4667-8b45-aada88ebf5ee/download","http://purl.org/NET/rdflicense/allrightsreserved"],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.17863/CAM.117207","outbound_label":"DOI","outbound_source":"dc:identifier.doi"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Eisner, Manuel","Murray, Aja"]},{"key":"dc:contributor.sponsor","label":"Sponsor","values":["Heinrich Boell Foundation, Institute of Criminology"]},{"key":"dc:creator","label":"Author","values":["Dewan, Sarika Mira"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.issued","label":"Date","values":["2024-08-07"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cambridge"]},{"key":"dc:relation.isreferencedby.uri","label":"Dc Relation Isreferencedby URI","values":["https://www.repository.cam.ac.uk/handle/1810/382371"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["child malnutrition","conflict-affected settings","cross-sectional mediation analysis","early child development","intergenerational violence","intimate partner violence","Low-and-Middle-Income Countries (LMICs)","maternal mental health","random cluster household survey","socio-ecological framework","Sub-Saharan Africa","violence against children","violence against women"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/b412460b-854a-4667-8b45-aada88ebf5ee/download","http://purl.org/NET/rdflicense/allrightsreserved"]},{"key":"dc:rights.embargodate","label":"Dc Rights Embargodate","values":["2026-04-14"]},{"key":"dc:rights.embargotype","label":"Dc Rights Embargotype","values":["embargo"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.doi","label":"DOI","values":["https://doi.org/10.17863/CAM.117207"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/81540007-e438-4da6-833d-3ff3b386ceda/download"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Maternal Exposure to Violence and Child Malnutrition in LMICs: A Cross-Sectional, Population-Based Study in Conflict-Affected Northern Uganda Background: Violence against women by an intimate partner is a serious human rights and public health concern, especially in low-and-middle-income countries (LMICs). Some of the most prevalent rates of intimate partner violence (IPV) are recorded in Sub-Saharan Africa (SSA), and in particular, in conflict-affected settings. IPV can lead to detrimental outcomes not only on maternal health but also on child health, including child growth and nutrition. As some of the most widely cited health outcomes of IPV are simultaneously established risk factors leading to child malnutrition, there is reason to believe that there are biological and/or behavioural pathways relating the two. Previous research has examined the link between IPV and child malnutrition in different areas, yet findings are inconclusive, and the exact context and mechanisms underpinning this link in developing countries remains unclear. Further research is needed to better understand context-specific pathways, particularly in high-risk areas. Aims: This study aims to examine the association between IPV and child malnutrition in three different contexts: a) globally in LMICs, b) regionally in SSA, and c) locally in conflict-affected northern Uganda. At global level, the study aims to 1) systematically review the current literature on maternal exposure to IPV and child malnutrition in LMICs; 2) develop a conceptual framework to better understand socio-ecological pathways linking IPV to child malnutrition in low-resource settings. At regional level, the study aims to 3) conduct a socio-ecological analysis of possible pathways between IPV and child malnutrition using secondary and primary findings from the SSA region. At local level, the study aims to 4) explore the interrelations of intergenerational family violence; 5) examine the association of maternal exposure to IPV and child malnutrition and identify differences in type, accumulation, and severity of violence exposure; and 6) assess mediation and moderation effects between maternal exposure to violence and child malnutrition, with a particular focus on maternal mental health and feeding practices. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, a cross-sectional, population-based household survey was conducted across two districts in Acholiland, northern Uganda – an area severely impacted by over 20 years of conflict. Data was collected in June 2021 with logistical support from Food for the Hungry (FH) International and Gulu University. An interviewer-administered questionnaire was developed for the purpose of this study. Computer-assisted face-to-face interviews were conducted with 478 mothers with children aged 6-23 months. Stringent measures were followed to address ethical, safety, as well as health-related risks in light of the ongoing COVID-19 pandemic. A series of cross-sectional descriptive, regression and mediation analyses were conducted to address the study’s research aims. Results: First, results indicated critical gaps in the literature on maternal exposure to IPV and child malnutrition across LMICs with respect to geographic, conceptual, and methodological shortcomings. Second, the socio-ecological analysis of factors associated with maternal IPV and child malnutrition in SSA highlighted the importance of biopsychosocial mediating pathways between mother and child. Third, in northern Uganda, nearly 90% of ever-partnered mothers aged 18-49 experienced some form of IPV by a former or current partner in their lifetime. Results indicated strong evidence for the intergenerational transmission of family violence, suggesting distinct patterns in the co-occurrence, interrelations, and mediating role of different forms of victimization. Over 40% of children in the sample suffered from either acute malnutrition, chronic malnutrition, or both. Results indicated that particularly maternal exposure to sexual violence was associated with higher odds of malnutrition in children, while a dose-response relationship was indicated between the severity of maternal victimization and malnourishment. Finally, findings suggested maternal depression to moderate and partially mediate the relationship between IPV and child malnutrition. No significant evidence was found for the role of breastfeeding. Outcomes: This study aims to contribute to the limited but growing body of research on victimization and child health in LMICs, particularly in conflict-affected settings. In line with the UN Sustainable Development Goal Agenda, which recognizes the elimination of both IPV and child malnutrition as catalysts towards sustainable development, findings aim to guide researchers, policymakers, and practitioners in designing and implementing interventions, in both development and humanitarian settings. Findings underscore the need to promote adaptive management and integration of not only mental health, but also violence-related interventions into nutrition and public health programmes. 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Some of the most prevalent rates of intimate partner violence (IPV) are recorded in Sub-Saharan Africa (SSA), and in particular, in conflict-affected settings. IPV can lead to detrimental outcomes not only on maternal health but also on child health, including child growth and nutrition. As some of the most widely cited health outcomes of IPV are simultaneously established risk factors leading to child malnutrition, there is reason to believe that there are biological and/or behavioural pathways relating the two. Previous research has examined the link between IPV and child malnutrition in different areas, yet findings are inconclusive, and the exact context and mechanisms underpinning this link in developing countries remains unclear. Further research is needed to better understand context-specific pathways, particularly in high-risk areas. Aims: This study aims to examine the association between IPV and child malnutrition in three different contexts: a) globally in LMICs, b) regionally in SSA, and c) locally in conflict-affected northern Uganda. At global level, the study aims to 1) systematically review the current literature on maternal exposure to IPV and child malnutrition in LMICs; 2) develop a conceptual framework to better understand socio-ecological pathways linking IPV to child malnutrition in low-resource settings. At regional level, the study aims to 3) conduct a socio-ecological analysis of possible pathways between IPV and child malnutrition using secondary and primary findings from the SSA region. At local level, the study aims to 4) explore the interrelations of intergenerational family violence; 5) examine the association of maternal exposure to IPV and child malnutrition and identify differences in type, accumulation, and severity of violence exposure; and 6) assess mediation and moderation effects between maternal exposure to violence and child malnutrition, with a particular focus on maternal mental health and feeding practices. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, a cross-sectional, population-based household survey was conducted across two districts in Acholiland, northern Uganda – an area severely impacted by over 20 years of conflict. Data was collected in June 2021 with logistical support from Food for the Hungry (FH) International and Gulu University. An interviewer-administered questionnaire was developed for the purpose of this study. Computer-assisted face-to-face interviews were conducted with 478 mothers with children aged 6-23 months. Stringent measures were followed to address ethical, safety, as well as health-related risks in light of the ongoing COVID-19 pandemic. A series of cross-sectional descriptive, regression and mediation analyses were conducted to address the study’s research aims. Results: First, results indicated critical gaps in the literature on maternal exposure to IPV and child malnutrition across LMICs with respect to geographic, conceptual, and methodological shortcomings. Second, the socio-ecological analysis of factors associated with maternal IPV and child malnutrition in SSA highlighted the importance of biopsychosocial mediating pathways between mother and child. Third, in northern Uganda, nearly 90% of ever-partnered mothers aged 18-49 experienced some form of IPV by a former or current partner in their lifetime. Results indicated strong evidence for the intergenerational transmission of family violence, suggesting distinct patterns in the co-occurrence, interrelations, and mediating role of different forms of victimization. Over 40% of children in the sample suffered from either acute malnutrition, chronic malnutrition, or both. Results indicated that particularly maternal exposure to sexual violence was associated with higher odds of malnutrition in children, while a dose-response relationship was indicated between the severity of maternal victimization and malnourishment. Finally, findings suggested maternal depression to moderate and partially mediate the relationship between IPV and child malnutrition. No significant evidence was found for the role of breastfeeding. Outcomes: This study aims to contribute to the limited but growing body of research on victimization and child health in LMICs, particularly in conflict-affected settings. In line with the UN Sustainable Development Goal Agenda, which recognizes the elimination of both IPV and child malnutrition as catalysts towards sustainable development, findings aim to guide researchers, policymakers, and practitioners in designing and implementing interventions, in both development and humanitarian settings. Findings underscore the need to promote adaptive management and integration of not only mental health, but also violence-related interventions into nutrition and public health programmes. 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