Peer-reviewed article
Prevalence of Childhood Illnesses and Determinants of Acute Respiratory Infection Among Children Aged 0-59 Months in Somaliland: A Cross-Sectional Study.
Hassan MS, Abdilahi MA, Abdirahman A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined the prevalence and risk factors for acute respiratory infection (ARI), diarrhea, and fever among children under five in Somaliland using data from 30,253 children in the 2020 Demographic and Health Survey. ARI affected 1.1% of children, with significant risk factors including higher birth order, male sex, and younger maternal age, while urban residence and access to improved water sources were protective. The findings suggest interventions should target high-risk groups and address factors like household crowding alongside efforts to empower young mothers.
Key points
- 2-week prevalence of ARI was 1.1%, diarrhea 5.3%, and fever 6.8% among children aged 0-59 months
- Children with birth order of 6th or higher had over 8 times the odds of ARI compared to first-borns
- Male children had 39% higher odds of ARI than female children
- Children of mothers aged 35+ had 92% lower odds of ARI compared to children of mothers under 20 years
- Urban residence and access to improved water sources were associated with reduced ARI risk
Limitations
This is a cross-sectional study, so it cannot establish causality or determine whether observed associations are causal or confounded. The study relies on survey data with 2-week recall for illness symptoms, which may underestimate or misclassify conditions.
Abstract
Background and aims Acute respiratory infection (ARI), diarrhea, and fever are major causes of childhood morbidity in low- and middle-income countries. Understanding the local determinants of these illnesses is essential for targeted public health strategies. This study aims to determine the prevalence of these conditions and identify the risk factors specifically for ARI among children under five in Somaliland. Methods This study is a cross-sectional analysis of data from the 2020 Somaliland Demographic and Health Survey (SLDHS). The sample comprised 30,253 children aged 0-59 months. Bivariate cross-tabulations and multivariate logistic regression analyses, adjusted for the complex survey design, were used to identify factors associated with ARI, defined as cough accompanied by short, rapid breathing. Data analysis was performed using Stata version 17. Results The 2-week prevalence was 5.3% (n = 2420) for diarrhea, 6.8% (n = 3105) for fever, and 1.1% (n = 502) for ARI. Multivariate analysis (n = 30,253) for ARI revealed several significant determinants. Strong risk factors included higher birth order, with children of 6th or higher order having over eight times the odds of ARI compared to first-borns (AOR: 8.44, 95% CI: 4.92-14.47). Higher household wealth was paradoxically associated with increased risk. Male children also had higher odds of ARI (AOR: 1.39, 95% CI: 1.07-1.80). Conversely, older maternal age was strongly protective; children of mothers aged 35+ had 92% lower odds of ARI than those of mothers < 20 years (AOR: 0.08, 95% CI: 0.04-0.16). Urban residence (AOR: 0.63, 95% CI: 0.42-0.96) and access to an improved water source (AOR: 0.58, 95% CI: 0.37-0.91) were also significant protective factors. Conclusion While the prevalence of ARI is low, its determinants in Somaliland are complex. Interventions should focus on high-risk groups, including families with high parity and male children. The strong protective effect of older maternal age suggests a need to empower adolescent girls and young women. The paradoxical association with wealth underscores the importance of environmental factors such as household crowding and urbanization.