Multilevel analysis of prevalence and determinants of diarrhea among under-five children in Somalia: insights from the Somalia demographic and health survey 2020.

BACKGROUND

Diarrheal diseases remain a critical public health challenge, particularly for children under five in low- and middle-income countries such as Somalia. This study aimed to assess the prevalence and determinants of diarrhea in this vulnerable population, utilizing data from the 2020 Somalia Demographic and Health Survey.

METHODS

This investigation employed secondary data from the 2020 Somalia Demographic and Health Survey. The analysis involved the extraction and cleaning of variables using STATA version 17. The primary outcome variable was childhood diarrhea, analyzed alongside 19 explanatory variables encompassing sociodemographic and environmental factors. Descriptive statistics, chi-square tests, and multilevel logistic regression models were employed to elucidate associations.

RESULTS

The study identified a diarrhea prevalence of 5.24%. Notably, sociodemographic factors significantly influenced this prevalence. Families within the second wealth category exhibited reduced odds of diarrhea (AOR = 0.699; 95% CI: 0.522-0.936), with those in the middle wealth category experiencing even lower odds (AOR = 0.524; CI: 0.391-0.702). Vitamin A supplementation was found to be critical; children lacking recent supplementation had increased odds of diarrhea (AOR = 1.790; CI: 1.440-2.225). Furthermore, feeding practices indicated that children not using bottle nipples faced higher odds of diarrhea (AOR = 1.377; CI: 1.172-1.617). Maternal age also played a significant role, with mothers aged 45-49 presenting higher odds of their children experiencing diarrhea (AOR = 7.650; CI: 1.762-33.184). Institutional births were associated with lower odds of diarrhea (AOR = 0.693; CI: 0.568-0.847), while children of educated fathers exhibited increased odds (AOR = 1.414; CI: 1.090-1.833). Additionally, lack of deworming medication significantly heightened the odds of diarrhea (AOR = 4.450; CI: 3.619-5.482).

CONCLUSION

The prevalence of diarrhea among children under five relatively high in Somalia. Key determinants include vitamin A supplementation, feeding with bottle, household wealth, age of mothers, place of delivery, paternal education, and deworming medication. Public health interventions should focus on enhancing household economic status, and ensuring regular deworming. Increasing the coverage and frequency of vitamin A supplementation could enhance children's immune systems and reduce diarrhea incidence. Moreover, targeted economic support, health care programs for older mothers are essential to mitigate the adverse effects of socioeconomic factors on child health, ultimately leading to a substantial reduction in diarrheal diseases among young children.