Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia

Objectives: To assess independent and interaction effect of experience of intimate partner violence and depression on risk of child death. Design: Community-based cohort design. Setting: The study was conducted within the demographic surveillance site of Butajira Rural Health Program in south central Ethiopia. Participants: Women (n=561) who gave birth to a live child. Main outcome measures: Exposure status comprising physical, sexual and emotional violence by intimate partner was based on the WHO multi-country questionnaire on violence against women. Depression status was measured using the Composite International Diagnostic Interview. Risk of child death and its association with maternal exposure to violence and/or being depressed was analysed by incidence, rate ratios and interaction. Results: The child death in the cohort was 42.1 (95% CI, 32.7 to 53.5) children per 1000 person years, and maternal depression is associated with child death. The risk of child death increases when maternal depression is combined with physical and emotional violence (RR=4.0; 95% CI, 1.6 to 10.1) and (RR=3.7; 95% CI, 1.3 to 10.4), showing a synergistic interaction. Conclusion: An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.