Description of study variables.

Background
Despite the significant public health burden of maternal mental health disorders in sub-Saharan Africa (SSA), limited data are available on their effects on early childhood development (ECD), nutritional status, and child health in the region.
Aims
This study investigated the association between maternal mental health and ECD, nutritional status, and common childhood illnesses, while controlling for biological, social, financial, and health-related factors and/or confounders.
Method
As part of the Innovative Partnership for Universal and Sustainable Healthcare (i-PUSH) program evaluation study, initiated in November 2019, a cohort of low-income rural families, including pregnant women or women of childbearing age with children under five, was recruited for this study. A total of 24 villages were randomly selected from a list of villages near two health facilities. Following a census to identify eligible households, 10 households per village were randomly selected. Data collection included maternal mental health, assessed using Centre for Epidemiological Studies Depression (CES-D) scale, ECD, nutritional status (anthropometric measurements), and common childhood illnesses, their symptoms, and healthcare utilization. This study presents a cross-sectional analysis of the data drawn from endline survey of 299 target mothers and 315 children.
Results
The majority of the mothers were aged between 25 and 34 years. The mean age of children was 3.2 years, with 53% being male. The overall maternal mental health score, as measured by the CES-D scale, was 28. Children of mothers with higher CES-D scores exhibited poorer ECD domains, lower nutritional status indicators, and increased incidence of ill-health in the previous two weeks, in both unadjusted and adjusted analyses. Individual, parental, and household factors—including maternal age, household wealth index, and decision-making regarding child healthcare—were significantly associated with children’s development, nutrition status, and health outcomes.
Conclusion
Children of mothers with low mental health scores demonstrated suboptimal developmental outcomes, nutritional status, and overall well-being, particularly for those from impoverished households. These findings suggest that improving the socioeconomic conditions of low-income households is essential for promoting children’s development, nutritional status, and well-being. Longitudinal studies are needed to further investigate the impact of maternal mental health on child development, nutrition, and health outcomes, considering additional factors across the maternal, newborn, and child health continuum.
Trial registration for the parent and nested study
ClinicalTrials.gov (NCT04068571), AEA Registry (AEARCTR-0006089) and PACTR (PACTR202204635504887).

背景
尽管撒哈拉以南非洲（sub-Saharan Africa, SSA）地区的孕产妇精神健康疾病造成了沉重的公共卫生负担，但目前针对该类疾病对该地区儿童早期发展（early childhood development, ECD）、营养状况与儿童健康的影响，相关数据仍较为匮乏。
研究目的
本研究旨在探讨孕产妇精神健康与儿童早期发展、营养状况及常见儿童疾病之间的关联，并控制生物学、社会、经济及健康相关因素与/或混杂变量的影响。
研究方法
本研究作为2019年11月启动的全民与可持续医疗创新伙伴关系（Innovative Partnership for Universal and Sustainable Healthcare, i-PUSH）项目评估研究的一部分，招募了低收入农村家庭队列，涵盖孕妇或育有5岁以下子女的育龄女性。研究从两家医疗机构周边的村庄名单中随机抽取24个村落；经人口普查确认符合条件的家庭后，每个村落随机选取10户家庭。数据收集内容包括：采用流行病学研究中心抑郁量表（Centre for Epidemiological Studies Depression (CES-D) scale）评估孕产妇精神健康状况、儿童早期发展水平、营养状况（人体测量指标）、常见儿童疾病及其症状，以及医疗服务利用情况。本研究针对该项目终线调查的299名目标母亲与315名儿童的数据开展横断面分析。
研究结果
研究对象中，多数母亲年龄介于25至34岁之间；儿童平均年龄为3.2岁，其中53%为男性。采用CES-D量表测得的孕产妇整体精神健康平均得分为28分。在未校正与校正后的分析中，CES-D得分更高的母亲所育子女，其儿童早期发展各维度表现更差、营养状况指标更低，且过去两周内患病风险更高。个体、父母及家庭层面因素——包括母亲年龄、家庭财富指数、儿童医疗决策话语权——均与儿童的发展、营养状况及健康结局显著相关。
研究结论
母亲精神健康得分较低的儿童，其发育结局、营养状况与整体福祉均未达最优水平，这一现象在贫困家庭儿童中尤为显著。本研究结果提示，改善低收入家庭的社会经济条件，对促进儿童发展、营养状况与福祉至关重要。未来需开展纵向研究，进一步探讨孕产妇精神健康对儿童发育、营养及健康结局的影响，并纳入孕产妇、新生儿与儿童健康连续照护体系中的更多相关因素。
临床试验注册
本研究及嵌套子研究的临床试验注册信息：ClinicalTrials.gov（NCT04068571）、AEA注册库（AEARCTR-0006089）及PACTR注册库（PACTR202204635504887）。