Multilevel analysis of prevalence and associated factors of minimum dietary diversity among children 6-23 months in Somaliland: evidence from Somaliland demographic and health survey (2020).

backgroundInadequate feeding practices during infancy and early childhood have profound and often irreversible consequences for child nutrition, with devastating impacts particularly prevalent in low- and middle-income countries. These suboptimal practices contribute significantly to elevated mortality rates and heightened global disease burden. Alarmingly, more than 3.4 million children under the age of five lose their lives each year due to inappropriate feeding practices, underscoring the urgent need for targeted interventions to address this critical public health challenge. In Somaliland, little is known about how the dietary diversity of children aged 6-23 months aligns with the recommendations and factors that shape it, whether individual, community-based, or both.

methodsThis study used data from the Somaliland Demographic and Health Survey 2020 (SLDHS 2020). SLDHS2020 represents the nationwide household survey gathering demographic and health information across all six primary regions of Somaliland. The survey participants were women aged between 15 and 49 years.

resultsThe prevalence of infants and young children who met the recommended minimum dietary diversity was only 9.3%. Mothers aged 35 years and older were 2.75 times more likely to have MDD in their children compared to those aged 15-24 years (AOR = 2.75, 95% CI: 1.00-7.12). Similarly, mothers with formal education had 2.45 times higher odds of ensuring MDD for their children than those without formal education (AOR = 2.45, 95% CI: 1.26-4.77). Mothers without media exposure were 85% less likely to provide diverse diets to their children than those with media exposure (AOR = 0.15, 95% CI: 0.045-0.502). Older children (12-23 months) had nearly five times higher odds of meeting MDD than younger children (6-8 months) (AOR = 4.95, 95% CI: 1.59-15.3).

conclusionThe study found that only 9.3% of children aged 6-23 months in Somaliland met the Minimum Dietary Diversity (MDD) criteria. Significant variations were observed in relation to the mother's educational attainment, with those possessing formal education exhibiting 2.45 times higher odds of their children achieving MDD (AOR = 2.45, 95%CI:1.26-4.77). Additionally, maternal age was a factor, as mothers aged 35 and above had 2.75 times higher odds (AOR = 2.75, 95%CI:1.00-7.12). Household wealth also played a critical role, with children from wealthier families having 6.78 times higher odds (AOR = 6.78, 95%CI:1.82-25.1). Geographic disparities were evident, as children residing in Togdheer had 95% lower odds (AOR = 0.05, 95%CI:0.00-0.299) than those in Awdal, and those in rural or nomadic settings experienced diminished access (AOR = 0.28-0.48). Given that 80.8% of mothers lack formal education and 97.7% have no media exposure, it is imperative to prioritise maternal literacy programs, region-specific agricultural support, and expanded media outreach to address these disparities.