**4. Association between IPV and child morbidity**

#### **4.1 IPV and diarrheal morbidity**

Maternal experience of any physical or sexual IPV (AOR: 1.50; 95% CI: 1.04–2.27) was associated childhood diarrheal morbidity; as were physical IPV only (AOR: 1.35; 95% CI: 1.01–2.30) and both physical and sexual IPV (AOR: 2.38; 95% CI: 1.32-4.31) **(Table 3).**

#### **4.2 IPV and symptoms of ARI**

Maternal experience of any physical or sexual IPV (AOR: 1.46; 95% CI: 1.02–2.12) was associated with ARI morbidity; as were physical IPV only (AOR: 1.72; 95% CI: 1.13-2.64) and both physical and sexual IPV (AOR: 1.83; 95% CI: 1.03-3.37) **(Table 3)**.

#### **4.3 IPV and childhood fever**

Maternal experience of any physical or sexual IPV (AOR: 1.30; 95% CI: 1.00–1.72) and both physical and sexual IPV (AOR: 1.90; 95% CI: 1.19-3.03) were associated with fever among children **(Table 3)**.

physical and mental health outcomes reduce a mother's ability to cope with the everyday needs of a small child and diminish the quality of different care-giving behaviors; this in turn leads to the negative health consequences for her children (Marie, Carol, & Armar-Klemesu, 1999; Stewart, 2007). Our results, therefore, indicate that the prevention of both physical and sexual violence from husbands is important for the improvement of childhood

Currently identified associations of any physical or sexual IPV with all common childhood illness provide a critical context for the elevated rates of infant and early childhood deaths demonstrated in prior work (Jejeebhoy, 1998; Ahmed, Koenig, Stephenson, 2006; Leland & Subramanian, 2009) among women who experience IPV (i.e., the currently documented increased rates of diarrhea, ARI and fever likely relate to

Some limitations should be considered when interpreting our findings. First, the current analyses are cross-sectional and, thus, do not allow for assessment of the chronology of the associated events or inferences regarding causality. Longitudinal research regarding the relations of IPV to childhood morbidity outcomes is needed to provide clarity regarding these concerns. Second, though psychological violence is an important fact of IPV (Leland & Subramanian, 2009), this information was not available in the current study. Finally, the possibility of underreporting must also be considered; because IPV is by nature a private phenomenon and one that is often stigmatized, women may be reluctant to reveal their abuse status. However, the personal interview method used in this study is widely used for this type of IPV research (Fried at al., 2006). In addition, to ascertain physical and sexual IPV, this study used multiple, behaviorally-specific questions, which are considered the best, methodologically, for eliciting correct responses (Leland & Subramanian, 2009; Straus, 1979).Moreover, according to the BDHS interviewers were provided training for implementing the domestic violence module based on a training manual specially developed to enable the field staff to collect violence data in a secure, confidential, and ethical manner, in order to create a safe atmosphere in which respondents would feel comfortable discussing this issue (NIPORT, 2009). In addition, the domestic violence module was administered at the end of the interview, so that both interviewers and respondents become well acquainted with each other

In conclusion any physical or sexual IPV was associated with the increased risk of all common childhood illness namely, diarrhea, ARI and fever among children below five years of age in Bangladesh. In interventions aimed at improving child morbidity status, efforts are needed to protect women from the physical and sexual violence of their husbands. These findings may be relevant in other resource-limited settings as well where the prevalence of child morbidity is high and may be of interest to clinicians when assessing children with different problems related to morbidity status. Future longitudinal studies, however, are needed for assessment of

The authors have indicated they have no financial relationships relevant to this article to

morbidity status in Bangladesh.

increased risk of child death).

**6. Conclusion** 

**7. Financial disclosure** 

disclose.

by the time they reach the section on domestic violence.

the chronology of the associated child morbidity or inferences regard.

#### **4.4 IPV and any childhood illness**

Maternal experience of any physical or sexual IPV (AOR: 1.38; 95% CI: 1.05–1.80) and both physical and sexual IPV (AOR: 2.21; 95% CI: 1.37-3.60) were associated with any illness among children **(Table 3)**.


Models were adjusted for maternal age, maternal education, maternal decision making autonomy, mother's occupation, mother's BMI, parity, residence, household members, child sex, child age, initiation of breastfeeding, duration of breastfeeding,, types of cooking fuel, stunting, underweight, wasting, and wealth index.

Table 3. Adjusted ORs and 95% CIs for Associations between Different Aspects of Maternal IPV and Morbidity Status for Children Under-five Years (n=1851)
