Predictors of the risk of malnutrition among children under the age of 5 years in Somalia

OBJECTIVE: To investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6–59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions. DESIGN: Cross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6–59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data. SETTING: The study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia. SUBJECTS: Children between the ages of 6 and 59 months in Somalia. RESULTS: The estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6–59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively. CONCLUSIONS: Infection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.