**1. Introduction**

78 Health Management – Different Approaches and Solutions

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(2008), Development of Visceral Fat Estimation Method based on Bioelectrical Impedance Analysis Method, *Journal of SOFT*, Vol. 20, No. 1, pp. 90-99, ISSN 1347Although Bangladesh is on track to achieve Millennium Development Goal 4 (MDG4: reduce child mortality, approximately less than 50 per 1000 live births by 2015) (International Center for Diarrheal Disease Research, Bangladesh [ICDDR, B], 2007), child mortality rate still remains very high in this country. In Bangladesh, the mortality rate of under-five children was 65 per 1000 live births in 2007 and diarrhea (20%), acute respiratory infections (ARI) (18%) accounted for 38 % of the under-five deaths (United Nations International Children's Emergency Fund [UNICEF], 2010). Fever, is another symptom of acute infections and malaria among children in Bangladesh and contributes to high levels of malnutrition and mortality (National Institute of Population Research and Training [NIPORT], 2009; Rayhan, Khan, & Shahidullah, 2007).

Although clinical (Haque et al., 2003), nutritional (Daniel et al., 2008; Tomkins, Dunn, & Hayes, 1989), household environmental (Gasana et al., 2002; Cairncross et al., 2010) and socio-demographic (Barros et al., 2010; Rayhan, Khan, & Shahidullah, 2007) risk factors of ARI, diarrhea, and fever are well documented, research has only begun to investigate the influence of other aspects of the social environment. Intimate partner violence (IPV) is defined as the range of sexually, psychologically, and physically coercive acts used against women by current or former male intimate partners (World Health Organization [WHO], 1997). Intimate partner violence is considered to be one of the psychosocial factors that might influence child morbidity status (Campbell 2002). It can affect child morbidity status through psychological stress of the child, resulting from observing IPV; stress in turn can exert an effect on immune reactivity and link to increase vulnerability to illness (Friedman & David, 2002). Besides, IPV can affect child health outcome through direct violence, injury, and mistreatment of children from fathers who abuse their female partners (Herrenkohl et al., 2008; Christian et al., 1997), or through physical or psychological maternal health outcomes such as stress and depression, suicidal thoughts and infectious diseases including HIV/AIDS (Ellsberg et al., 2008; Sutherland, Bybee, & Sullivan, 1998; Coker et al., 2002; Silverman et al., 2007; Silverman et al., 2008) or through diminishing mother's autonomy, social isolation, and lack of control over financial resources (Ellsberg et al., 2008; Smith & Martin, 1995; Forte et al., 1996), that can prevent proper care of the child.

whether the child had been ill with fever, experienced an episode of diarrhea, and ill with a cough accompanied by short, rapid breathing in the 2 weeks prior to the survey. A symptom of ARI was defined as report of cough accompanied by short, rapid breathing. Binary variables were created to define diarrhea, ARI and fever, which indicated the presence of each of these outcomes among the children in the past 2 weeks. A binary variable was also created to assess the overall level of illness in the child, which was dichotomized into "0" no

182 declined to participate

6,507 not surveyed with the IPV module

22 missing answers to IPV questions

272 not currently married

2194 women (aged 15-49 years) had no child or having children aged ≥60 months

8 children lived elsewhere

18 multiple births

124 missing regarding nutritional outcome

Women's experience of IPV was the main exposure of interest in this study. The BDHS measured IPV using a shortened and modified Conflict Tactics Scale (CTS) (Straus, 1979;

illness and "1" as illness (combined fever, ARI and diarrhea).

11,178 deemed eligible to participate (15-49 years)

10, 996 participated

4489 surveyed with the IPV module

4,467 answered all IPV questions

4,195 currently married women (aged 15-49 years whose children are eligible for the study)

2001 women with children 0-59 months

> 1993 children lived with mothers

> 1975 singleton aged 0-59 months

1851 singleton aged 0-59 months with complete information (final sample)

Fig. 1. Selection of sample

**2.3 Exposures** 

Within and outside of South Asia, increasing evidence has shown a linkage between high rates of IPV among women (IPV; 18%-66%) (Bates et al., 2004; Bhuiya, Sharmin & Hanifi, 2003; Jain et al., 2004) and poor child health outcomes, such as miscarriage (Silverman et al., 2007; Bair-Merritt, Blackstone, & Feudtner, 2006), child under-nutrition (Ackerson & Subramanian, 2008; Hasselmann & Reichenheim, 2006), and infant and child mortality Jejeebhoy, 1998; Ahmed, Koenig, & Stephenson**,** 2006; Leland KA &Subramanian, 2009). However, the literature on consequences of IPV on young children's morbidity pattern is limited, and weaknesses in methodology. Within South Asia a recent investigation in India indicates an association between IPV and childhood asthma (Subramanian, Ackerson, & Subramanyam, 2007). Another study found that young children of Bangladeshi women abused by their husbands were more likely to be at risk of ARI and diarrhea diseases (Silverman et al., 2009). Outside the region of South Asia, a recent study in Uganda supports that the history of women subjected to IPV predicts the risk of diarrhea and overall illness of the infant (Karamagi et al., 2007). However, most of these studies have some methodological weaknesses such as based on community specific small samples or based on husband's report of IPV or measured only the physical type of IPV by using single global question. This lack has limited our understanding of the extent to which childhood morbidity may be affected by the physical and sexual IPV, using the multiple, behaviorally specific questions based on women's report of IPV. Thus, this study, aimed to examine the association of physical and sexual forms of IPV with childhood fever, ARI, and diarrheal morbidity in a nationally representative sample in Bangladesh.
