ArticleBMJ open2026
Under-5 child mortality rate and associated factors in Somalia: an analysis of the 2020 Somali Health and Demographic Survey.
Article in BMJ open, 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
objectivesTo estimate the national under-5 mortality rate (U5MR) in Somalia and identify maternal and child-level determinants of child survival using data from the 2020 Somali Health and Demographic Survey (SHDS).
designSecondary analysis of a nationally representative, community-based, cross-sectional survey.
settingSomalia, including urban, rural and nomadic populations across all regions.
participantsA total of 52 198 children under 5 years of age (3161 deaths and 49 037 survivors) born to women of reproductive age (15-49 years) who participated in the 2020 SHDS.
main outcome measuresUnder-5 mortality, defined as the probability of a child dying before reaching the age of 5 years (0-59 months).
resultsThe U5MR in Somalia was 65 per 1000 live births (95% CI 62.3 to 66.7). Multivariable logistic regression indicated that children residing in rural or nomadic settings had significantly higher odds of mortality (adjusted OR (AOR)=2.03; 95% CI 1.15 to 3.61) compared with urban residents. Multiple births were associated with a fourfold increase in the odds of death (AOR=4.35; 95% CI 1.94 to 9.73). Longer birth intervals were protective; a preceding interval of 19-23 months (AOR=0.49; 95% CI 0.26 to 0.94) and a succeeding interval of ≥20 months (AOR=0.44; 95% CI 0.29 to 0.66) were associated with lower odds of mortality compared with shorter intervals. Lack of maternal health facility visits showed a marginal, non-significant association with higher odds of mortality (AOR=1.57; 95% CI 0.97 to 2.53; p=0.066).
conclusionsSomalia's U5MR remains critically high and far from the 2030 Sustainable Development Goal target of 25 per 1000 live births. Identified risk factors are largely preventable. Public health policies should prioritise expanding healthcare infrastructure in rural areas and promoting family planning services to support optimal birth spacing, enhancing child survival.
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