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Beyond therapeutic feeding: a call for integrated strategies to end child malnutrition in Somalia

Somalia records one of the highest global burdens of child wasting and stunting, with approximately 1.7–1.85 million children under five estimated to be affected by acute malnutrition annually during 2022–2025, including approximately 421,000–513,550 children with severe acute malnutrition. For over two decades, the dominant policy response has been community-based management of acute malnutrition (CMAM), a curative intervention that treats clinical endpoints rather than underlying drivers. Despite meeting international cure-rate standards, CMAM alone cannot address the food insecurity, water, sanitation and hygiene (WASH), microbial and parasitic infectious diseases, health-system, and climatic drivers that perpetuate malnutrition. This paper integrates recent Somali survey, programme-evaluation, and administrative data to show that the national burden of acute malnutrition has remained high despite continued treatment scale-up, with stunting falling only 9.7 percentage points over 24 years, relapse after discharge remaining a documented challenge, and nationally representative Somalia-specific estimates of CMAM treatment coverage remaining unavailable. Diagnostic discordance between screening tools leaves an unknown share of wasted children undetected, and persistent sex- and region-based disparities highlight structural gaps. Ending child malnutrition in Somalia requires rebalancing investment from an emergency, treatment-centred paradigm toward integrated, multisectoral strategies combining therapeutic feeding with WASH investment, maternal and infant feeding support, primary health-care strengthening, climate-resilient livelihoods, and shock-responsive social protection. We propose four policy shifts: sustaining CMAM while addressing diagnostic gaps, mandating nutrition-sensitive financing, institutionalizing relapse prevention, and expanding anticipatory financing. These shifts require governance reforms and multi-year donor commitment to address the determinants of child nutrition in Somalia comprehensively.

Abdifatah Mohamed Tahlil, Mohamed Jama Hashi, Hafsa Mohamed Hassan et al.

Individual- and community-level factors associated with intimate partner controlling behavior among women in Somaliland: a multilevel analysis of the 2020 Somaliland demographic and health survey

Background Intimate partner controlling behavior (IPCB) is a key manifestation of coercive control and an important precursor to other forms of intimate partner violence. Despite its adverse consequences for women’s autonomy, mental health, and well-being, evidence on the prevalence and factors associated with IPCB in Somaliland remains limited. This study aimed to estimate the prevalence and identify the individual- and community-level factors associated with IPCB among ever-married women in Somaliland. Methods A secondary analysis of the 2020 Somaliland Demographic and Health Survey (SLDHS) was conducted using a weighted sample of 9,428.14 (unweighted n = 9,593) ever-married women aged 15–49 years. IPCB was defined as experiencing at least one of five partner controlling behaviors reported for the respondent’s current husband/partner. Multilevel logistic regression models, incorporating the DHS sample weight (V005) and clustering by primary sampling unit (135 clusters), were fitted to account for the hierarchical structure of the survey data and to identify factors associated with IPCB. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was declared at p < 0.05. Results The prevalence of IPCB was 26.7% (95% CI: 25.8–27.6%; unweighted prevalence 25.1%). Women aged 25–29 years (AOR = 1.60, 95% CI: 1.01–2.53), those with primary education (AOR = 1.70, 95% CI: 1.44–2.00), and women from middle- (AOR = 1.46, 95% CI: 1.20–1.77) and rich-wealth households (AOR = 1.56, 95% CI: 1.30–1.88) had higher odds of experiencing IPCB. Conversely, joint healthcare decision-making (AOR = 0.69, 95% CI: 0.60–0.79), current pregnancy (AOR = 0.73, 95% CI: 0.63–0.85), marriage at ages 19–26 years (AOR = 0.71, 95% CI: 0.63–0.80) or >26 years (AOR = 0.63, 95% CI: 0.49–0.81), household size of 4–7 members (AOR = 0.81, 95% CI: 0.71–0.92), partner employment (AOR = 0.77, 95% CI: 0.68–0.87), and residence in Marodijeh, Togdheer, Sool, and Sanaag regions were associated with lower odds of IPCB. Conclusion Approximately one in four ever-married women in Somaliland experienced intimate partner controlling behavior, underscoring IPCB as an important public health and gender equality concern. Both individual- and community-level factors were significantly associated with women’s odds of experiencing IPCB, highlighting the need for multilevel interventions that strengthen women’s decision-making autonomy, delay early marriage, promote girls’ education, and implement context-specific strategies to prevent coercive control and advance gender equality.

Abdulkadir Mohamed Nuh, Abdirashiid Muhumed Guled, Mohamed Abdilahi Mohamed et al.

Practical Tools for Practitioners: Unravelling Power Dynamics as a Prelude to Preventing Violence Against Women and Children

<p>This paper explores how to employ effective, community-engaged strategies to understand and address the underlying power asymmetries that fuel violence against women and children. Utilising Participatory Action Research and underpinned by Integral Activist Epistemology, the action research adopts a novel approach combining Theory U and Powercube frameworks to facilitate a comprehensive understanding and transformation of these power relations in Shinyanga district, Tanzania.</p> <p>The paper describes the journey of engaging the community in identifying and challenging the unwritten rules that perpetuate violence. Key to this process is the recognition of violence as a manifestation of deeply ingrained patriarchal power structures, which are sustained through coercion and social exclusion, yet paradoxically fragile due to the pain these norms inflict on the whole community, including men. This understanding leads to the development of practical, community-led interventions, or 'prototypes', aimed at reshaping these dynamics.</p> <p>Key messages from the action research highlight the critical role of local context in shaping interventions, the importance of reframing existing cultural practices so that they are more inclusive, and the necessity for long-term commitment from development actors for sustainable change. The implications extend beyond Shinyanga, offering insights for practitioners globally. This paper contributes to the academic discourse on violence prevention but also serves as a practical guide, providing tools and strategies for practitioners working towards creating safer, more inclusive communities.</p>

Kate McAlpine

Violence against children and youth in refugee settings in Uganda: Factsheet

This factsheet presents key findings from the first-ever Humanitarian Violence Against Children and Youth Survey conducted in refugee settlements across Uganda.

Violence against children and youth in refugee settings in Ethiopia: Factsheet

This factsheet presents key findings from the second-ever Humanitarian Violence Against Children and Youth Survey conducted in refugee camps across Ethiopia.

Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage

Background Oral diseases are among the most common noncommunicable conditions globally, yet oral health remains poorly integrated into primary health care (PHC) and universal health coverage, especially in fragile, low-limited settings. As Somalia rebuilds its health system through the Health Sector Strategic Plan III 2022–2026, the Essential Package of Health Services 2020, the Investment Case for the Somali Health Sector 2022–2027, and community health reforms, this study examined the place of oral health within national health policies. It identified barriers to integration and explored feasible pathways for strengthening PHC-based oral health. Methods The study used a qualitative policy and health-systems analysis combining documentary review with 13 key-informant interviews. Participants represented national policymakers, health-system technical advisers, regulators, academics, professional associations, and providers at public hospital, and private dental settings. Data were analyzed thematically and mapped against the WHO health-system building blocks, PHC principles, and the WHO Global Strategy and Action Plan on Oral Health 2023–2030. Results Somalia's policy environment offers opportunities for oral health integration, but stakeholders highlighted a persistent gap between policy recognition and implementation within routine PHC. Seven interrelated themes were identified: (1) policy recognition without operationalization; (2) fragmented governance, weak regulation, and limited coordination; (3) reliance on out-of-pocket financing and private-sector; (4) workforce, education, and task-sharing constraints; (5) predominantly curative, urban, hospital-based service with weak linkage to maternal and child health (MCH) and PHC; (6) limited oral health data and evidence generation; and (7) opportunities for phased integration through PHC, MCH, school health, community health workers, and NCD platforms Policymakers emphasized the need for stronger policy implementation, financing, regulation, standards, and data systems, while service providers highlighted unaffordable care, delayed care-seeking, workforce and infrastructure shortages, and missed opportunities for prevention. Conclusion Oral health integration in Somalia is a broader health system challenge rather than solely a dental-service issue. The most feasible approach is a phased, system-based model that prioritizes strengthened governance, a defined minimum oral health within PHC, workforce task-sharing, screening, counselling, referral pathways, private-sector regulation, essential commodities, and oral health indicators in District Health Information System 2 (DHIS2), followed by the gradual expansion of curative and rehabilitative services.

Saido Gedi, Salma Ali Ossoble, Mohamoud M. Dahir et al.

Walking together and leading change: Shaping global solutions to end violence against children

The Baobab Research Programme Consortium (Baobab) is an Africa- based, African-led consortium, spearheaded by the Population Council, Inc., in partnership with the Population Council–Kenya and the African Population and Health Research Centre (APHRC), that is reshaping the narrative around sexual and reproductive health and rights (SRHR) research in refugee settings. Across Africa’s most challenging humanitarian landscapes, Baobab is proving that evidence can ignite action. Starting with the first-ever Humanitarian Violence Against Children and Youth Surveys in Uganda and Ethiopia, Baobab turned data into solutions—co-designing a school-based sexual violence screening model with governments, UNHCR, and civil society. By embedding trained para-social workers (PSWs) in schools, this approach ensures proactive identification, on the spot psychological first aid, rapid referral (where needed), and consistent care for child survivors of sexual violence, all while strengthening existing systems. Uganda’s Ministry of Gender, Labour and Social Development co-designed the model, building upon its existing National PSW Programme, and integrating it into national training and guidance manuals, a bold step toward systemic change. With a proven model now embedded in national systems, Baobab is helping translate frontline success into wider policy influence by elevating Africa-led solutions onto the global stage. Baobab has partnered with the African Child Policy Forum to amplify Africa’s voice globally, shaping commitments from the first-ever Global Ministerial Conference to End Violence Against Children held in Bogota, to ARISE Africa: Accelerating Action to End Violence Against Children. This case study is a blueprint for scalable, replicable interventions that transform crises into opportunities for protection, accountability, and African leadership on the world stage.

Stella Muthuri

Attitudes towards early marriage and related factors among adolescent girls in Ethiopia

Abstract Background Early marriage, although it remains a common practice in sub-Saharan Africa, has detrimental effects on women’s sexual and reproductive health, social networks, and educational attainment. We sought to investigate the association between attitudes towards early marriage and marital status among adolescent girls in Ethiopia. Methods A cross-sectional study was conducted among 3,013 adolescent girls aged 13-17 years of age, living in four districts of the Oromia region of Ethiopia. Sociodemographic characteristics and were participants’ attitudes towards early marriage were measured using a pre-tested structured questionnaire. Results The prevalence of early marriage among adolescent girls was 8.3% and approximately 87.0% of girls had an overall positive attitude towards early marriage. Compared to adolescent girls who were unmarried, those who were married or living with a partner were less likely to believe they should have a say whether they want to marry or not (OR=0.32; 95%CI: 0.18-0.57), believe they should get to decide when to marry (OR=0.52; 0.31-0.88), and believe they should have the final decision over the decision to marry (OR=0.48; 0.32-0.73). Conclusions Interventions to prevent early marriage should strengthen women decision-making processes and promote women’s agency.

Hanna Gulema, Ayah Hamdan, Jessica Gingles et al.

Constrained choices: Exploring the complexities of adolescent girls’ voice and agency in child marriage decisions in Ethiopia

Ethiopia has recently seen a remarkable fall in the proportion of girls who marry in early adolescence, reflecting the country’s lauded efforts to tackle child marriage. However, aggregate national figures mask a more complex reality. This article explores this complexity, drawing on qualitative data with adolescent girls and boys, their caregivers, service providers and community leaders, from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study baseline. Our findings highlight the complex interplay between cultural norms, economic factors, individual voice and agency, and collective support thereof, on the part of leaders and service providers, from grassroots to national levels.

Nicola Jones, Elizabeth Presler-Marshall, Guday Kassahun et al.