Association between maternal mental health and child nutritional status in rural Sindh: a cross-sectional study using an e-health clinical model

Objective To assess the association between maternal common mental disorders (CMD), as measured by the Self-Reporting Questionnaire-20 (SRQ-20), and child nutritional outcomes wasting, stunting and underweight in rural Sindh, Pakistan, using an e-health clinical model. Design A cross-sectional observational study was conducted to explore the relationship between maternal mental health and child nutritional status. Data were collected through nurse-facilitated consultations at e-health clinics, with maternal CMD assessed via the WHO-validated SRQ-20 tool and child nutritional status measured using standardised anthropometric indicators (weight-for-height Z-score, height-for-age Z-score, weight-for-age Z-score) based on WHO growth standards. Multivariate logistic regression was applied to determine adjusted associations. Setting Six nurse-assisted e-health clinics operating under the Sehat Kahani telemedicine platform across rural regions of Sindh. Participants A total of 455 mother–child dyads with children aged 6–59 months who visited clinics between April and June 2025. Eligible mothers had resided in the local area for 6 months and were not undergoing treatment for any mental health disorder. Results Stunting affected 62% of children, underweight 46.8% and wasting 43.3%. Maternal CMD was prevalent in 76.9% of participants (SRQ-20 score ≥7). Multivariate logistic regression revealed that children of mothers with CMD were about twice as likely to be stunted (adjusted odds ratio (AOR)=2.006, p=0.006) and nearly 1.6 times more likely to be underweight (AOR=1.688, p=0.05), though CMD showed no link with wasting. Maternal education was protective against stunting (AOR=0.458, p=0.012), while paternal unemployment was linked to increased odds of stunting and underweight. No significant associations were found with environmental factors, water source and toilet facilities. Conclusion Maternal CMD, educational attainment and paternal employment status are key predictors of child nutritional status in rural, low-resource contexts. These findings underscore the need for integrated maternal mental health and child nutrition interventions within digital healthcare delivery models.