The asset-vulnerability trap: climate shocks and health-seeking behavior for chronic diseases in Somalia.

Somalia faces a dual crisis of high chronic disease burden and extreme climate vulnerability. This study examines the predictors of health-seeking behavior (HSB) for chronic diseases among Somali households. Using data from the 2020 Somali Demographic and Health Survey (SDHS), survey-weighted probit model was applied to a sample of 69,998 individuals to analyze predictors of regular treatment-seeking behavior. Approximately 6.6% of the population reported a chronic disease, with 48.8% of those individuals seeking regular treatment. Wealth (AME = 0.094, p < 0.001) and urban residence (AME = 0.078, p < 0.001) were the strongest predictors of HSB. Secondary education increased HSB by 6.2 percentage points (p = 0.012). Conversely, climate-induced livestock loss significantly hindered HSB, reducing the probability of treatment-seeking by 3.4 percentage points (p = 0.035). Internet access was not a significant predictor. Climate shocks create an economic barrier that prevents vulnerable households from managing chronic conditions. Policy interventions should focus on integrating NCD care into climate adaptation strategies and reducing the rural-urban health gap.