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This study reviews: (1) how levels of donor financing of the health sector in Somalia varied over the decade 2000-09, (2) which health interventions were prioritized by donors, and (3) how evenly health sector aid was distributed to the different zones of Somalia. The overall aim of the study was to create evidence for donors, implementers, and health specialists involved in allocation of financial resources to the Somalia health sector. The results of the study are based on quantitative data collected from 38 Development Assistance Committee (DAC) donors and implementing agencies active in Somalia. Quantitative data were collected between March and May 2007 and in March 2010, with response rates of 96 and 95 percent, respectively. The report is organized in five chapters. Chapter one provides the background to the study, along with its aims and objectives, and contextualizes the study area, Somalia. Chapter two provides the conceptual framework for the research by looking at aid financing trends in developing countries, in the health sector, in fragile states, and in Somalia. Chapter three describes the methodology, the data collection process, types of data collected, and methodological limitations. Chapter four presents the quantitative findings in terms of total health sector aid financing, and expenditure by disease and by zone. Chapter five offers conclusions linked to the four primary study objectives and provides recommendations for future funding.

A powerful, evocative and deeply personal journey into the refugee crisis past and present. In 2015, journalist Aamna Mohdin travelled to Calais to report from the frontlines of the refugee crisis. It was on her return to London, when she discussed her experiences with her parents, that she came face-to-face with a reality she had been outrunning for nearly two decades: that she had been a refugee herself. Aamna herself had arrived in the UK aged seven, after her parents fled war-torn Somalia. Determined to piece their scattered family history together in the present, she set off on a mission: first into the past, to uncover her parents' experience of displacement in their own words; and then on the road, first to Somalia, and then to the refugee camp in Kenya that was her home in early childhood.

This study reviews aid flows to the health sector in Somalia over the period 2000-2006. In close collaboration with the Health Sector Committee of the Coordination of International Support to Somalis the authors collected quantitative and qualitative data from twenty-six international agencies operating in Somalia, including bilateral and multilateral donors.The paper reaches three main conclusions. First, aid financing to the health sector in Somalia has been constantly growing, reaching US 7-10 per capita in 2006. Although this is a considerable amount compared to other fragile states, it may still be insufficient to address the population’s needs and to meet the high operational costs to work in Somalia. Secondly, contributions to the health sector could and should be more strategic. The focus on some vertical programs (e.g. HIV/AIDS and malaria) seems to have diverted attention away from other important programs (e.g. immunization and reproductive health) and from basic health system needs (infrastructure, human resources, etc.). The third conclusion is that more analytical work on health financing is needed to drive policy decisions in Somalia. Similarly to other fragile states, quality information on health sector financing is scanty, thus affecting the policy making process negatively.

Diarrhea remains a leading cause of morbidity and mortality among children under five years of age, particularly in low- and middle-income countries. This study investigated the prevalence and determinants of diarrhea in Somaliland using nationally representative data from the 2020 Somaliland Health and Demographic Survey (SLDHS) 2020. We employed a cross-sectional study design and analyzed data from 1,112 women (aged 15-49) and their children under the age of five from six geographic regions in Somaliland. Variables were selected based on data availability in SLDHS 2020, including socioeconomic, demographic, and environmental factors. We employed descriptive statistics and binary logistic regression to identify significant associations of the variables with childhood diarrhea. Additionally, supervised machine-learning models (Logistic Regression, Probit Regression, Random Forest, Decision Tree, and SVM) were used to identify key determinants of diarrhea. The overall prevalence of diarrhea was 7.2%, with significant regional variation (Togdheer: 12.5%; Awdal: 4.24%). Nomadic households had a significantly higher incidence (8.62%) than rural (2.41%) and urban (5.16%) households. Logistic regression analysis highlighted region, household wealth index, and sanitation access as significant predictors. Interestingly, maternal educational level was not significantly associated with the prevalence of diarrhea. The Decision Tree model achieved the highest accuracy (92.3%) and sensitivity (33.3%), while Logistic Regression had specificity >97%. This study underscores the importance of region-specific public health strategies focused on improving access to water and sanitation, especially in nomadic and low-income populations. Despite the high overall accuracy, the machine-learning models indicated that the predictive accuracy for positive diarrhea cases could be further refined. Efforts to alleviate diarrhea among young children in Somaliland should prioritize the enhancement of infrastructure and sanitation resources in underserved communities.

Background Globally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data. Method In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death. Results The study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618–0.832), sex of the baby (HR = 0.661; 95% CI = 0.484–0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469–0.944), multiple births (HR = 1.369; 1.142–1.910) and place of residence (HR = 1.650; 95% CI = 1.451–2.150) were found to be statistically significantly related to infant death. Conclusion The study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country’s population. Place of residence, gestational duration, infant’s gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates.

Routine childhood vaccination is among the most cost-effective, successful public health interventions available. Amid substantial investments to expand vaccine delivery throughout Africa and strengthen administrative reporting systems, most countries still require robust measures of local routine vaccine coverage and changes in geographical inequalities over time. This analysis drew from 183 surveys done between 2000 and 2016, including data from 881 268 children in 49 African countries. We used a Bayesian geostatistical model calibrated to results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, to produce annual estimates with high-spatial resolution (5 ×    5 km) of diphtheria-pertussis-tetanus (DPT) vaccine coverage and dropout for children aged 12–23 months in 52 African countries from 2000 to 2016. Estimated third-dose (DPT3) coverage increased in 72·3% (95% uncertainty interval [UI] 64·6–80·3) of second-level administrative units in Africa from 2000 to 2016, but substantial geographical inequalities in DPT coverage remained across and within African countries. In 2016, DPT3 coverage at the second administrative (ie, district) level varied by more than 25% in 29 of 52 countries, with only two (Morocco and Rwanda) of 52 countries meeting the Global Vaccine Action Plan target of 80% DPT3 coverage or higher in all second-level administrative units with high confidence (posterior probability ≥95%). Large areas of low DPT3 coverage (≤50%) were identified in the Sahel, Somalia, eastern Ethiopia, and in Angola. Low first-dose (DPT1) coverage (≤50%) and high relative dropout (≥30%) together drove low DPT3 coverage across the Sahel, Somalia, eastern Ethiopia, Guinea, and Angola. Despite substantial progress in Africa, marked national and subnational inequalities in DPT coverage persist throughout the continent. These results can help identify areas of low coverage and vaccine delivery system vulnerabilities and can ultimately support more precise targeting of resources to improve vaccine coverage and health outcomes for African children. Bill & Melinda Gates Foundation.

Background Stunting and wasting in children less than 5 years of age are two key indicators of child malnutrition. Reducing their prevalence is a priority of the global public health community and for Somalia, a country suffering complex humanitarian emergencies such as drought, flooding, conflict and large-scale displacements. Methods Data from the nationally representative cross-sectional Somalia Micronutrient Survey (SMS 2019) on 1947 children were analyzed to assess the prevalence and potential risk factors of stunting and wasting. Bivariate and multivariable analyses were conducted separately for children 0–5 months and 6–59 months, and population attributable fractions were calculated using adjusted risk ratios produced by Poisson regression models. Results Among the 1947 children, the prevalence of stunting and wasting were 17.2% (95% CI: 15.0, 19.6) and 11.0% (95% CI: 9.3, 12.9), respectively. Among children 6–59 months of age, those residing in severely food insecure households had a higher risk of stunting (adjusted risk ratio [aRR] 1.47; CI: 1.12, 1.93) compared to those in food secure households. This risk of stunting was also higher in children with inflammation (aRR 1.75; CI: 1.35, 2.25) and iron deficiency (ID) (aRR 2.09; CI: 1.58, 2.80). For wasting, a dose-response relationship was found with household wealth, with the risk of wasting increasing significantly as the household wealth quintile decreased. On the other hand, the risk of wasting was lower in iron-deficient children (aRR 0.69; CI: 0.49, 0.98) than in iron-replete children. Among children 0–5 months of age no variables remained statistically significantly associated with stunting in the multivariable analysis. Wasting, however, was more common in children with recent diarrhea (aRR 3.51; CI: 1.68, 7.36). Conclusions Nutritional status of children in Somalia may be improved by prevention of diarrhea and other infections and improvements in household food security.

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.

Background Drug misuse among adolescents is a growing public health concern in Somalia, with prescription drug abuse emerging as a significant issue. This behavior is influenced by a complex interplay of psychological, social, and environmental factors, including peer pressure, academic stress, and community dynamics. Understanding these factors is essential for designing effective interventions to mitigate the rising trend of substance abuse among Somali youth. Methods This qualitative study employed in-depth interviews (IDIs) and key informant interviews (KIIs) to explore the motivations and risk factors associated with drug misuse among Somali adolescents. A purposive sampling technique was used to recruit 20 participants, including 15 adolescents and 5 key informants (parents, teachers, and community leaders). Data were analyzed using NVivo software, with thematic analysis conducted to identify emerging themes. Results The study identified multiple risk factors contributing to adolescent drug misuse. Psychological stressors, such as anxiety and academic pressure, were key motivations for drug use. Social influences, particularly peer pressure and digital platforms, played a significant role in drug initiation. Family dynamics, including parental neglect and socioeconomic challenges, further exacerbated the problem. Conclusion Addressing adolescent drug misuse in Somalia requires multi-level interventions, including family support, school-based awareness programs, and policy enforcement. Community engagement is crucial in preventing substance abuse among Somali youth.