Prevalence of Childhood Illnesses and Determinants of Acute Respiratory Infection Among Children Aged 0-59 Months in Somaliland: A Cross-Sectional Study.

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.