Prevalence and associated determinants of disability among women aged 15-49 years in Somalia: evidence from a 2018/2019 nationwide survey.

Background: Disability among women of reproductive age is a critical public health issue with significant social and economic implications. Understanding individual- and community-level determinants is essential for targeted interventions. Objective: This study examines the prevalence and determinants associated with disability among women aged 15-49 years in Somalia. Method: Data from the Somalia Health and Demographic Survey (SHDS) were analyzed using STATA 17.0, employing a multivariable multilevel logistic regression model to assess individual- and community-level determinants of disability. Multicollinearity was assessed and found not to be a concern. The SHDS used a stratified two-stage cluster sampling design in which enumeration areas were selected with probability proportional to size, followed by systematic selection within each cluster, and inclusion of all eligible individuals, ensuring nationally representative data across population groups. Only statistically significant predictors were reported. Findings: Overall, 3.05% of women reported a disability. At the individual level, the odds of disability increased with older age (25-34 years: AOR = 1.42; 35-49 years: AOR = 2.17) and among women who were divorced (AOR = 2.34), abandoned (AOR = 4.99), widowed (AOR = 2.20), or never married (AOR = 3.36), while higher education (AOR = 0.51), larger household size (6-10 members: AOR = 0.71; ≥11 members: AOR = 0.67), higher wealth (highest quintile: AOR = 0.63), and health insurance coverage (AOR = 0.04) were protective. At the community level, rural residence (AOR = 0.45) and living in the southern areas (AOR = 0.75) were associated with lower odds of disability compared with urban and northern areas. Conclusion: The findings underscore the need for targeted, evidence-informed policies that address the determinants associated with disability among women of reproductive age in Somalia. Priority should be given to expanding access to education for women, improving health insurance coverage for disadvantaged and low-income groups, and reinforcing social protection systems for the marginalized groups. In addition, efforts should focus on improving the availability, accessibility, and quality of disability-related health services, with particular emphasis on urban areas and the northern areas, where the likelihood of disability was relatively higher compared with rural residence and the southern areas.