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Background <p>Acute respiratory infection (ARI) and diarrhea are major public health concerns among children under-five years of age. Somalia has one of the highest under-five mortality rates in sub-Saharan Africa, with diarrhea and ARI accounting for most deaths. No national studies have explicitly assessed the determinants of diarrhea and ARI among children in urban and rural settings. This study aimed to assess the prevalence and determinants of diarrhea and ARI among children under-five in urban and rural Somalia.</p> Methods <p>We analyzed nationally representative data from the 2020 Somali Health and Demographic Survey (SHDS) of 7732 under-five-year-old children with complete responses to the variables studied. Descriptive analyses were used to summarize the respondents’ characteristics. Multiple logistic regression was used to assess the determinants of diarrhea and ARI. We present our findings as adjusted odds ratios with a 95% confidence interval (95% CI), and a p-value &lt; 0.05 was considered significant. We employed sample weights, stratification, and clustering to account for the sampling design of the SHDS. We adhered to the STROBE checklist for manuscript reporting.</p> Results <p>The prevalence of ARI was 10.7% and 12.2% in urban and rural areas, respectively, whereas that of diarrhea was 8.8% and 11.0%, respectively. Residence in the North-West, child age of 0–23 months, prelacteal feeding, maternal age of 15–24 and 25–34 years, no media exposure, and belonging to a poor wealth index were significantly associated with higher odds of diarrhea and ARI among under-fives. Being the first child in birth order, average size at birth, institutional delivery, antenatal care visits, and improved sources of drinking water and sanitation facilities were significantly associated with lower odds of diarrhea and ARI among children aged under-five years in an urban-rural setting in this study.</p> Conclusion <p>Diarrhea and ARI morbidity in children are significant health challenges in urban and rural areas of Somalia. Public health interventions aimed at high-risk regions, young mothers, impoverished households, home deliveries, and unsanitary use of drinking water and sanitation facilities are crucial for reducing the burden of diarrhea and ARI in children under-five years of age in Somalia.</p> Graphical Abstract <p></p>

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Determinants of diarrhea and acute respiratory infection among under-five children in urban-rural Somalia: a nationally representative cross-sectional study

  • 期刊论文

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  • 发表日期：

    2026年5月7日

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  • Sahardid Hussein Ibrahim,
  • Zhongliang Zhou

摘要

Background

Acute respiratory infection (ARI) and diarrhea are major public health concerns among children under-five years of age. Somalia has one of the highest under-five mortality rates in sub-Saharan Africa, with diarrhea and ARI accounting for most deaths. No national studies have explicitly assessed the determinants of diarrhea and ARI among children in urban and rural settings. This study aimed to assess the prevalence and determinants of diarrhea and ARI among children under-five in urban and rural Somalia.

Methods

We analyzed nationally representative data from the 2020 Somali Health and Demographic Survey (SHDS) of 7732 under-five-year-old children with complete responses to the variables studied. Descriptive analyses were used to summarize the respondents’ characteristics. Multiple logistic regression was used to assess the determinants of diarrhea and ARI. We present our findings as adjusted odds ratios with a 95% confidence interval (95% CI), and a p-value < 0.05 was considered significant. We employed sample weights, stratification, and clustering to account for the sampling design of the SHDS. We adhered to the STROBE checklist for manuscript reporting.

Results

The prevalence of ARI was 10.7% and 12.2% in urban and rural areas, respectively, whereas that of diarrhea was 8.8% and 11.0%, respectively. Residence in the North-West, child age of 0–23 months, prelacteal feeding, maternal age of 15–24 and 25–34 years, no media exposure, and belonging to a poor wealth index were significantly associated with higher odds of diarrhea and ARI among under-fives. Being the first child in birth order, average size at birth, institutional delivery, antenatal care visits, and improved sources of drinking water and sanitation facilities were significantly associated with lower odds of diarrhea and ARI among children aged under-five years in an urban-rural setting in this study.

Conclusion

Diarrhea and ARI morbidity in children are significant health challenges in urban and rural areas of Somalia. Public health interventions aimed at high-risk regions, young mothers, impoverished households, home deliveries, and unsanitary use of drinking water and sanitation facilities are crucial for reducing the burden of diarrhea and ARI in children under-five years of age in Somalia.

Graphical Abstract