Health-seeking behavior in conflict-affected settings: a cross-sectional study of internally displaced persons in Somalia.

Introduction: Somalia has a large internally displaced persons (IDP) population due to prolonged conflict and recurrent natural disasters. IDPs face significant health challenges, including limited access to healthcare, poor living conditions, and high rates of preventable diseases. The study aims to investigate health-seeking behaviors among IDPs in Somalia, including factors associated with their decisions to seek healthcare, the types of healthcare services utilized, and barriers encountered in accessing care.

Method: A cross-sectional study was conducted in eight densely populated IDP camps in Mogadishu and Baidoa, Somalia. A total of 1,063 participants aged 18 years and older, residing in the camps for a minimum of three months, were recruited using a multi-stage cluster sampling technique. Data were collected through face-to-face interviews using a structured questionnaire. Data analysis involved descriptive statistics, chi-square tests, and multivariate logistic regression to identify predictors of health-seeking behaviors. Adjusted odds ratios (AOR), 95% confidence intervals (CI), and p-values were reported to measure the strength and significance of associations.

Results: The study revealed that 54.7% of IDPs sought healthcare within the past three months, primarily for acute illnesses. The most prevalent health problems were diarrheal diseases (36.9%), fever/chills (34.3%), and cough/cold (30.9%). Maternal and Child Health (MCH) facilities were the primary source of care (51.9%). Significant barriers to healthcare access included lack of transportation (38.3%), long wait times (26.1%), and medication unavailability (23.4%). Multivariate logistic regression analysis identified that being male (AOR: 2.05, 95% CI: 1.56-2.69, p < 0.001), aged 55 years and above (AOR: 0.14, 95% CI: 0.05-0.37, p = 0.001), single (AOR: 0.20, 95% CI: 0.11-0.37, p < 0.001), residing 6 months to 2 years in the camp (AOR: 1.68, 95% CI: 1.20-2.36, p < 0.001), living more than 2 km from a health facility (AOR: 3.34, 95% CI: 2.41-4.62, p < 0.001), and higher income (AOR: 0.27, 95% CI: 0.15-0.46, p < 0.001) were significantly associated with increased likelihood of seeking healthcare.

Conclusion: A considerable proportion of IDPs sought healthcare, mainly for acute illnesses, but faced substantial barriers to access. These findings underscore the urgent need to improve healthcare infrastructure within IDP camps, enhance the accessibility and affordability of services-particularly for vulnerable groups-and implement health education programs to promote early health-seeking behaviors.