ArticleJournal of health, population, and nutrition2026
Exploring spatial variations and determinants of dietary diversity among children under five years in Somaliland: Spatial and multilevel analysis using DHS data 2020.
Article in Journal of health, population, and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDietary diversity is a critical determinant of child nutritional status. In Somaliland, approximately 45% of under-five mortality is linked to nutrition-related issues. This study investigated the spatial variations and determinants of dietary diversity among children in Somaliland.Methods: A population-based cross-sectional study was conducted using 2020 Somaliland Health and Demographic Survey (SLHDS) data (n = 4,538). Dietary diversity was assessed using WHO criteria—statistical analysis involved multilevel mixed-effects logistic regression to identify individual and community-level predictors. Spatial analysis, including Moran’s I and Getis-Ord Gi* statistics, was used to detect geographic clustering and hotspots of inadequate dietary diversity.
resultsOverall, 58% of children did not meet the Dietary Diversity (MDD) criteria. Multilevel analysis revealed that better dietary diversity was significantly associated with older maternal age (35–49 years: AOR = 0.45, 95% CI: 0.20–0.70) and female-headed households (AOR = 1.20, 95% CI: 1.00–1.40). Conversely, significant risk factors for inadequate intake included unemployment of the household head (AOR = 1.50, 95% CI: 1.20–1.80), children aged 13–60 months, and mothers who married at age 16 or older. At the community level, children in high-poverty areas had 3.5 times higher odds (95% CI: 2.0–6.4) of inadequate dietary diversity. Spatial analysis identified significant geographic disparities; inadequate dietary diversity was most prevalent in the eastern regions of Sool (79.7%) and Sanaag (74.4%), which were confirmed as significant hotspots.
conclusionOver half of the children in Somaliland suffer from inadequate dietary diversity, with clear geographic clustering in eastern regions. Interventions should prioritize high-poverty communities and hotspot regions while addressing socioeconomic barriers such as household unemployment and maternal education.
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