Factors associated with malnutrition among children aged 6-59 months in Burao, Somaliland.

Abstract

Malnutrition remains a pervasive challenge in Burao, Somaliland, particularly among children aged 6-59 months. This study investigates the multifactorial determinants of malnutrition, focusing on socio-economic status, child care practices, and child characteristics, to inform targeted interventions and policy reforms. A descriptive cross-sectional design was employed, recruiting 144 mother-child pairs from two public hospitals in Burao. Data were collected using structured questionnaires administered to caregivers, capturing socio-economic factors (e.g., income, maternal education), child care practices (e.g., breastfeeding, hygiene), and child characteristics (e.g., age, birth order). Anthropometric measurements (weight, height, mid-upper arm circumference) were used to classify malnutrition (wasting, stunting, underweight). Statistical analyses included Goodman-Kruskal's gamma (γ) to assess ordinal associations and multivariable logistic regression to identify predictors. Significance was set at p < 0.05, with 95% confidence intervals (CIs). The study revealed a high burden of malnutrition: 42% stunting, 30.4% underweight, and 49.3% wasting. Socio-economic deprivation showed a strong correlation with malnutrition (γ = 0.781, p < 0.001), with low-income households (<$100/month) facing nearly triple the risk (aOR = 2.80, 95% CI: 1.70-4.60). Suboptimal child care practices, such as non-exclusive breastfeeding (aOR = 3.60, 95% CI: 2.10-6.20) and poor hygiene (aOR = 1.90, 95% CI: 1.10-3.30), significantly elevated malnutrition odds. Child characteristics, particularly age (12-23 months: aOR = 1.70, 95% CI: 1.10-2.60) and higher birth order (OR = 2.10, 95% CI: 1.30-3.40), demonstrated the strongest association (γ = 0.882, p < 0.001). It is recommended that the Ministry of Health Development prioritize nutritional programs for children under five, enhance child welfare policies, and promote educational initiatives for mothers on exclusive breastfeeding and complementary feeding practices.