Prevalence and Associated Factors of Chronic Diseases Among Adults in Somaliland: A Multilevel Analysis From the 2020 SLHDS.

Background: Chronic diseases represent a growing public health challenge globally, particularly in developing regions like Sub-Saharan Africa. Somaliland faces a dual burden of communicable and non-communicable diseases amidst post-conflict recovery, yet data on non-communicable disease (NCD) prevalence and determinants remain scarce. This study aimed to ascertain the prevalence and identify socio-demographic factors associated with self-reported chronic diseases among adults in Somaliland. Methods: This cross-sectional study utilized data from the Somaliland Health and Demographic Survey (SLHDS) 2020. The final sample of 11,153 adults had a highly skewed age distribution (94.6% aged 35-44), a primary limitation of this analysis. The outcome was a self-reported physician diagnosis of any chronic disease. A multilevel mixed-effect logistic regression model was employed to identify significant determinants while adjusting for confounders. Results: The analysis identified several factors associated with reporting a chronic disease. Higher odds were observed among female-headed households (adjusted odds ratio [AOR]: 1.26; 95% CI: 1.06-1.48) and divorced individuals (AOR: 1.92; 95% CI: 1.55-2.37). Conversely, lower odds were associated with higher education (AOR: 0.53; 95% CI: 0.34-0.82) and nomadic residence (AOR: 0.34; 95% CI: 0.22-0.51). Unexpectedly, lack of electricity and no savings were also associated with lower odds, likely reflecting diagnostic access bias and reverse causation. Conclusion: Findings suggest that self-reported chronic diseases are associated with specific socio-demographic vulnerabilities in Somaliland. The results should be interpreted with extreme caution and viewed as hypothesis-generating at best. Future research using objective measures and representative sampling is urgently needed to validate these associations and accurately quantify the NCD burden.