# Relationship between maternal social support and undernutrition among children under 5 years in Siem Reap Province, Cambodia: the chain mediating roles of household food insecurity and maternal depression

## TL;DR

This study in Cambodia found that better maternal social support reduces child undernutrition, partly by lowering household food insecurity and maternal depression.

## Contribution

The study identifies a chain mediation pathway involving household food insecurity and maternal depression linking maternal social support to child undernutrition.

## Key findings

- Stunting and wasting rates among children under five were 34.9% and 15.6%, respectively.
- Maternal social support was negatively correlated with child undernutrition (β = -0.32).
- The mediating effect of food insecurity and depression accounted for 29.67% of the total effect.

## Abstract

Undernutrition among children under five years (CUFY) is a leading global public health issue worldwide, including in Cambodia. This study aimed to determine the prevalence of undernutrition and the mediating effect of maternal depression and household food insecurity on the association between maternal social support and undernutrition among CUFY in Siem Reap Province, Cambodia.

A semi-structured questionnaire was utilized to survey 450 mothers in Siem Reap Province, Cambodia. Maternal social support, maternal depression, and household food insecurity were assessed separately using the Maternity Social Support Scale (MSSS), Patient Health Questionnaire-2 (PHQ-2), and Household Food Insecurity Access Scale (HFIAS). Undernutrition indicators were evaluated using height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), calculated according to WHO Anthro standards. A chi-square test was employed to illustrate the distribution of the variables. Structural equation modeling was used to analyze the chain-mediating effect of maternal depression and household food insecurity on the relationship between maternal social support and undernutrition among CUFY.

The prevalence of stunting and wasting among CUFY was 34.9% and 15.6%, respectively. Structural equation modeling (SEM) results showed that maternal social support had a negative effect on children’s undernutrition (β = -0.32), indicating that social support is negatively correlated with child undernutrition. Women with higher levels of social support are less likely to have a child suffering from undernutrition compared to women with lower levels of social support. Household food insecurity and maternal depression mediated the association between social support and undernutrition, and the mediating effect accounted for 29.67% of the total effect.

Undernutrition among CUFY was relatively high in Siem Reap Province, Cambodia. Maternal depression and household food insecurity partially mediated the association between maternal social support and undernutrition. Providing postpartum workshops promotes awareness about depression, enhances social support, and reduces household food insecurity.

The online version contains supplementary material available at 10.1186/s12889-025-25913-0.