Acute malnutrition is the adverse outcome of young children in this research. These conditions contribute to a higher rate of mortality and morbidity in the children. The United Nations assembly had launched sustainable development goals with much emphasis to decrease infant's and young child's morbidity and mortality in 2015 due to such deadly outcomes. Hence, the importance of conducting a study to assess different factors that hide behind the scene is not a controversial issue.

Decrement of infant and young children's morbidity and mortality is one of the global agendas contained in SDG. This alarms researchers to investigate the factors that can contribute to such a condition whose overall result is highly significant for the policymakers and stakeholders to plan new approaches.

Different maternal physical health-related factors have been relatively investigated widely at the national level in a better manner as compared to maternal mental health; although it is highly important for the physical and psychological well-being of the mother as well as the infants.

It is important to carry out a study on different aspects of women's health to provide certain guidance to Midwives, Gynecologists, and other health care providers who care for pregnant women at the prenatal and postnatal unit to assure comprehensive physical and emotional support.

To provide psychological and social intervention to pregnant women and mothers, studies that assess the mental health well-being of the mother are important.

To clarify this issue, the objective of the present study is to examine whether maternal mental health is associated with a child's nutritional status in the sixth month of life.

This study was conducted in public health facilities (2 hospitals and 3 health centers) of Mekelle Special zone, Tigray regional state, northern Ethiopia, in 2018/19. Mekelle is the capital city of Tigray Regional State located at about 783 km away north of Addis Ababa, Capital city of the Federal Democratic Republic of Ethiopia at geographical coordination of 39°28` East longitude and 13°32` North latitude. This study was conducted from March 10, 2019, to June 10, 2019.

An institution-based case-control study was employed in Mekelle public health facilities. Subjects were selected using a consecutive sampling technique. The source population was all mothers with young children visiting Mekelle public health institutions during the study period.

Case: Young child’s having acute malnutrition

Control: Young children having a normal nutritional status

Some words may be confusing, to avoid this, for this research we have used the following definitions

(1) WHO - ASSIST V3.0- A probable case of substance use problem (abuse or dependence) in this study is defined as a score of 0-3, 4-26 and 27+ was low, moderate, and high consecutively for Tobacco, cannabis, and Amphetamine. But a score of 0-10, 11-26 and 27+ was low, moderate and high consecutively for Alcohol.

(2) Common mental disorders: A score of seven or more in SRQ-20 in the past 4 weeks was considered as having common mental disorders.

(3) Acute malnutrition (SAM): a Mid Upper Arm Circumference (MUAC) < 125 mm or presence of nutritional bilateral pitting edema.

(4) ARI - ARI was defined as the presence of cough/cold with fever and/or fast breathing.

(5) Diarrhea - Diarrhea was defined as three or more loose stools passed in a 24-h period.

(6) Food insecurity - The households were categorized into four groups: food secure, mildly food insecure, moderately food insecure, and severely food insecure. These categories were further categorized into two groups of households: food secure and food insecure (which included the mildly, moderately, and severely food-insecure groups).

Case: During the study, young children were considered for the study as if they are aged 12 to 23 months and their mothers were the primary caregiver of the child during the visit. Cases had acute malnutrition as defined in the World Health Organization (WHO) child growth standard measurements.

Control: Inclusion criteria for controls are having a visit to Mekelle public health facilities for other health problems but having normal nutritional status during the study period.

Case: The exclusion criterion for cases was if the child is aged below 12 and above 23 months, their mothers were not the primary caregiver of the child during the visit and if the mother experienced any loss (death, divorce, etc.) in the past two months.

Control: Young children with MUAC score of greater than 16.5.

In the socio-demographic section, we have collected information about family income, maternal age, education, and occupation including spouses' maternal control over finances. Children were considered to be malnourished if they had a MUAC of less than 125 mm according to WHO growth standard measurements [1].

Maternal CMD was measured using the WHO recommended screening tool called the Self Reporting Questionnaire-20 (SRQ-20) that includes twenty questions with a recall period of 30 d before the administration of the questionnaire. The SRQ-20 measures several symptoms of depression, including headache, poor appetite, sleep disturbance, depressed mood, unhappiness, helplessness, and psychomotor retardation. Each question is given a score of 0 or 1 depending on the 'no' or 'yes' response, respectively. The scores are added to generate an overall SRQ-20 scale, where higher scores indicate higher levels of maternal CMD and vice versa. This tool is reliable, valid, and adaptable for screening mental disorders in the developing world [15] including Ethiopia. We used a cut-off of 7 to classify women with CMD, as suggested by several validation studies. In this study, the Cronbach's Alpha is 0.89.

Household food security was measured using the Household Food Insecurity Access Scale of the Food and Nutrition Technical Assistance Project/US Agency for International Development, which provides information on behavior and perceptions related to household food insecurity – anxiety and uncertainty, insufficient quality of intake, insufficient food intake and its consequences. All the questions were asked for a reference period of 30 days preceding the survey. The households were categorized into four groups: food secure, mildly food insecure, moderately food insecure, and severely food insecure. These categories were collapsed into two groups of households: food secure and food insecure (which included the mildly, moderately, and severely food-insecure groups) [16]. In this study, the Cronbach's Alpha is 0.92.

We have used the WHO - ASSIST V3.0 Alcohol smoking and substance involvement screening test scale to measure substance abuse.

The questionnaire was developed in English and translated into Tigrigna and then back to English to check for its consistency. The data collectors were senior Nurses, midwives, Public Health officers, and General Practitioners with a qualification of BSc degree and above.

The sample size is estimated using the double population proportion formula by considering; 95% confidence interval, 80% power, and a 1:2 ratio of case and control groups. By considering these assumptions, the final sample size is estimated based on the proportion of similar studies done in an urban slum area of Dhaka, Bangladesh [17]. The estimation is done by using Epi-info version-7 software. The largest sample size of the estimate was used for this study. Therefore, the final sample size to be used is 62 Cases and 127 Controls (Table 1).

Therefore, a total of 191 mothers were selected from the public health facilities of the city. Two hospitals and three health centers were included in this study. Then, the sample was proportionally allocated to each health facility based on the number of young children visiting for acute malnutrition in hospitals in similar months of last year and the number of young children visiting the facilities in other cases except malnutrition in similar months of last year. Then, all eligible data entry was done by using EPI- Info version 4.4.2.1 and transfers to SPSS version 21.0 statistical software for cleaning, coding, and analysis. OR, adjusted OR by logistic regression method and Chi-square (χ2) test was used to test the statistical significance and causal relationship at a 5% significance level. Finally, those variables significant at 5% with the outcome variable were selected for multivariate analysis. Graphs and tables were used to represent the data.

Maternal common mental disorder among mothers having a child with acute malnutrition was 36(56.3%) while among mothers having children with normal nutritional status was 35(27.3%).

Mildly, moderately and severely food insecure access of household mothers of acutely malnourished children was 22(34.4%), 12(18.8%), and 5(7.8%) consecutively. On the other hand, mildly and moderately food insecure access of mothers of children with normal nutritional status was 35 (27.3%) and 5 (3.9%), respectively.

The majority of mothers among cases (45 (70.3%)) and controls (94 (73.4%)) had ever used alcohol in their lifetime. Almost one out of two mothers (23 (51.1%)) of a child with acute malnutrition has a moderate risk for alcohol abuse, on the other hand, mothers among controls had 36 (38.3%) moderate risk for alcohol abuse. The risk level of maternal tobacco use among mothers in cases and controls showed 3 (4.7%) and 1 (0.8%) moderate risks, respectively (Table 2).

In the crude analysis (Table 3), mothers educational background, fathers educational background, regular antenatal care, maternal common mental disorder, household food insecurity access, and family monthly income were significantly associated with young children's acute malnutrition and were the variables selected to be included in the multiple linear regression models.

All variables that had p<0.25 in the bivariate analysis were included in multivariate analysis for entering logistic regression. From the total variables included in the logistic regression models, two variables were found to be statistically significant at the level of p<0.05. Accordingly, maternal common mental disorder and maternal regular antenatal care of study participants mothers have demonstrated a statistically significant association with young children's acute malnutrition

As of this result, young children who have a mother with a common mental disorder are 6.1 times [AOR= 6.11, 95%CI (1.18, 31.71)] more likely to develop acute malnutrition than children who have mothers with no common mental disorder. Regarding regular antenatal care, children of mothers who have no regular antenatal care times are more likely to develop acute malnutrition than mothers who have regular antenatal care [AOR=6.80, 95%CI (1.26, 36.72)]. The association between being acutely malnourished young children and the remaining variables was not significant (Table 3).