Peer-reviewed article
Under-5 child mortality rate and associated factors in Somalia: an analysis of the 2020 Somali Health and Demographic Survey
Hamze G. Dahir, Ahmed Tahir Ahmed, Mohamed Arab Abdilahi ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study analyzed a large national health survey from Somalia to estimate how many children die before age 5 and to find out what factors are linked to their deaths. It found that 65 out of every 1000 children born die before turning 5. Children living in rural or nomadic areas, and those who were part of a multiple birth (like twins), had much higher chances of dying. Children born with longer gaps since a previous or before a next sibling had better survival chances. The authors say Somalia is far from meeting international child survival goals and call for better rural healthcare and family planning support.
Key points
- National under-5 mortality rate in Somalia was 65 per 1000 live births (95% CI 62.3-66.7).
- Rural or nomadic residence nearly doubled the odds of child death compared to urban areas (AOR=2.03).
- Multiple births (e.g. twins) were linked to over four times higher odds of death (AOR=4.35).
- Longer birth intervals, both before and after a child's birth, were linked to lower mortality risk.
- Lack of maternal health facility visits showed a borderline, not statistically significant link to higher mortality risk.
Limitations
The study is a cross-sectional secondary analysis, so it can show associations but cannot prove that these factors directly cause child deaths.
Abstract
OBJECTIVES: To estimate the national under-5 mortality rate (U5MR) in Somalia and identify maternal and child-level determinants of child survival using data from the 2020 Somali Health and Demographic Survey (SHDS). DESIGN: Secondary analysis of a nationally representative, community-based, cross-sectional survey. SETTING: Somalia, including urban, rural and nomadic populations across all regions. PARTICIPANTS: A total of 52 198 children under 5 years of age (3161 deaths and 49 037 survivors) born to women of reproductive age (15-49 years) who participated in the 2020 SHDS. MAIN OUTCOME MEASURES: Under-5 mortality, defined as the probability of a child dying before reaching the age of 5 years (0-59 months). RESULTS: The U5MR in Somalia was 65 per 1000 live births (95% CI 62.3 to 66.7). Multivariable logistic regression indicated that children residing in rural or nomadic settings had significantly higher odds of mortality (adjusted OR (AOR)=2.03; 95% CI 1.15 to 3.61) compared with urban residents. Multiple births were associated with a fourfold increase in the odds of death (AOR=4.35; 95% CI 1.94 to 9.73). Longer birth intervals were protective; a preceding interval of 19-23 months (AOR=0.49; 95% CI 0.26 to 0.94) and a succeeding interval of ≥20 months (AOR=0.44; 95% CI 0.29 to 0.66) were associated with lower odds of mortality compared with shorter intervals. Lack of maternal health facility visits showed a marginal, non-significant association with higher odds of mortality (AOR=1.57; 95% CI 0.97 to 2.53; p=0.066). CONCLUSIONS: Somalia's U5MR remains critically high and far from the 2030 Sustainable Development Goal target of 25 per 1000 live births. Identified risk factors are largely preventable. Public health policies should prioritise expanding healthcare infrastructure in rural areas and promoting family planning services to support optimal birth spacing, enhancing child survival.