Browsing by Author "Chirwa, Esnat"

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    Impact of witnessing abuse of their mother and childhood trauma on men’s perpetration of intimate partner violence in the cross-sectional UN multi-country study on men and violence in Asia and the Pacific
    (Elsevier, 2025-01) Jewkes, Rachel; Shai, Nwabisa; Chirwa, Esnat; Naved, Ruchira Tabassum; Abrahams, Naeema; Ramsoomar, Leane; Dekel, Bianca; Gibbs, Andrew; Nothling, Jani; Willan, Samantha
    Trauma exposure and witnessing intimate partner violence (IPV) in childhood are recognised risk factors for IPV. Using the UN Multi-country Study on Men and Violence in Asia and the Pacific dataset, we describe the pathways through which they influence adult IPV perpetration. Methods: In nine sites, from six countries, data were collected in a two-stage, randomly-selected household survey, with one man aged 18–49 years interviewed per house. 8379 interviews were completed with ever partnered men in Bangladesh, Cambodia, China, Indonesia, Papua New Guinea (Bougainville) and Sri Lanka. We present a Structural Equation Model (SEM) to understand paths through which childhood trauma and witnessing IPV impacted perpetration of physical or sexual IPV in adulthood. Results: Among the men, 25.5% had witnessed IPV, 47.0% had perpetrated physical or sexual IPV. Both wit nessing IPV and childhood trauma elevated the likelihood of such perpetration. The SEM showed four paths from witnessing IPV and childhood trauma to the latent variable for physical/sexual IPV perpetration. One was direct and three indirect. Paths were mediated by food insecurity, depression, and a latent variable measuring gender inequitable and anti-social masculinities. The masculinity variable indicators were drug use, harmful alcohol use, bullying, gang membership, fighting with other men, having sex with a sex worker and having raped a non partner. The direct and indirect effects showed both childhood trauma and witnessing maternal IPV to be important, but childhood trauma the more so. Conclusions: Both childhood trauma and witnessing IPV were important in driving IPV perpetration, with in dependent effects, however, broader childhood trauma exposure was most strongly associated. The effects were mediated by food insecurity, depression and gender inequitable and anti-social masculinities, all recognised risk factors for IPV perpetration. Thus, gender transformative IPV prevention interventions that include mental health and economic elements can mitigate the influence of these key exposures.
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    The relationship between antenatal food insecurity, maternal depression and birthweight and stunting: results from the National Income Dynamics Study (NIDS)
    (University of the Witwatersrand, Johannesburg, 2023-07) Harper, Abigail Joan; Mall, Sumaya; Rothberg, Alan; Chirwa, Esnat
    Background: Maternal food insecurity is an important social determinant of health and has been associated with adverse birth and pregnancy outcomes as well as depressive symptoms. Pregnant women and new mothers are vulnerable to both food insecurity and depression. This thesis investigated the relationships between maternal food insecurity, depressive symptoms and low birthweight and stunting using nationally representative longitudinal data from the National Income Dynamics Study (NIDS). In addition, the thesis also examined the association between various food security indicators and adult and child anthropometry. Methods: The NIDS data included three experiential indicators of food security (adult and child hunger in the household in the past twelve months and household food sufficiency in the past 12 months) as well as household dietary diversity in the past thirty days and household food expenditure in the past thirty days. Three of the included studies utilised NIDS data. a) Chapter 4 was a scoping review that examined dietary diversity and maternal depression. b) Chapter 5 gives a broad overview by using cross-sectional data from wave 1 to examine food security indicators in relation to adult and child anthropometry. c) Chapter 6 used maternal data from Wave 1 of NIDS and child data from wave 3 of NIDS to longitudinally examine maternal depression and food insecurity during the periconceptional and antenatal period in relation to a continuous measure of birthweight and children’s height-for-age scores. In this vein, Chapter 6 employs different statistical measures to achieve longitudinal perspectives. d) Chapter 7 used the same dataset as Chapter 6 to examine various maternal exposures in more depth including food security indicators, alcohol use and other maternal characteristics in relation to binary measures of low birthweight and stunting among children born during the reference period. e) The final article used mobile survey data from the MomConnect database, a government database of pregnant and postnatal women. Results: a) For the scoping review, a total of 813 records were screened and 11 articles from 13 different studies met the inclusion criteria. The findings on maternal depression and maternal dietary diversity were mixed; The findings on maternal depression and children’s dietary diversity were also mixed. In the studies that examined maternal depression and dietary diversity as predictor variables for child outcomes, the findings on depression were mixed but dietary diversity was consistently associated with both cognitive and linear growth outcomes among children. b) Among children, the prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8% and 10.4% respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. None of the indicators were associated with stunting in children aged 5-9. Among stunted children, 70.2% lived with an overweight or obese adult, the double burden of malnutrition. Among adults, increased dietary diversity increased the risk of adult overweight and obesity. c) Maternal food insecurity significantly increased the risk of depression among periconceptional and pregnant women but there was no association between maternal depression, food insecurity and mean birthweight or height-for age scores among children. d) Women who reported a child going hungry in the household in the past 12 months were significantly more likely to give birth to a low birthweight infant during the reference period. Low dietary diversity among periconceptional and pregnant women was associated with stunting among children five years later. Low birthweight significantly increased the risk of stunting among children. e) The prevalence of depression in the sample was 16% and pregnant women and new mothers who reported hunger in the household were significantly more likely to be depressed. The qualitative component of the study revealed that women’s main worries could be broadly divided into three categories; worries about hunger and food insecurity, fears that they or their children would be infected with Covid 19 and concerns about unemployment during the lockdown. Conclusion: The studies included in this PhD study demonstrate that food insecurity is an important social determinant of both physical and mental health and a potentially modifiable risk factor for low birthweight and stunting. In both studies that examined maternal depression, food insecurity significantly increased the risk of depression among periconceptional women as well as pregnant women and new mothers. In addition, food insecurity is associated with adverse child health outcomes (low birthweight, stunting and wasting). However, experiential measures of food insecurity are not associated with stunting among young children or adolescents while dietary diversity is. Dietary diversity consistently emerged as an important indicator for children’s linear growth as well as cognitive development in the scoping review. Holistic interventions that focus on the social determinants of health such as food security may improve maternal depressive symptoms among women in resource poor settings. Dietary diversity tools could be refined to also include a category for processed foods given the nutrition transition occurring in many LMICS. More longitudinal research with repeated measurements is required to elucidate the relationship between maternal depression and child health outcomes.