Exploring spatial variations and determinants of dietary diversity among children under five years in Somaliland: Spatial and multilevel analysis using DHS data 2020

Abstract

Dietary diversity is a critical determinant of child nutritional status. In Somaliland, approximately 45% of under-five mortality is linked to nutrition-related issues. This study investigated the spatial variations and determinants of dietary diversity among children in Somaliland.Methods: A population-based cross-sectional study was conducted using 2020 Somaliland Health and Demographic Survey (SLHDS) data (n = 4,538). Dietary diversity was assessed using WHO criteria—statistical analysis involved multilevel mixed-effects logistic regression to identify individual and community-level predictors. Spatial analysis, including Moran’s I and Getis-Ord Gi* statistics, was used to detect geographic clustering and hotspots of inadequate dietary diversity. Overall, 58% of children did not meet the Dietary Diversity (MDD) criteria. Multilevel analysis revealed that better dietary diversity was significantly associated with older maternal age (35–49 years: AOR = 0.45, 95% CI: 0.20–0.70) and female-headed households (AOR = 1.20, 95% CI: 1.00–1.40). Conversely, significant risk factors for inadequate intake included unemployment of the household head (AOR = 1.50, 95% CI: 1.20–1.80), children aged 13–60 months, and mothers who married at age 16 or older. At the community level, children in high-poverty areas had 3.5 times higher odds (95% CI: 2.0–6.4) of inadequate dietary diversity. Spatial analysis identified significant geographic disparities; inadequate dietary diversity was most prevalent in the eastern regions of Sool (79.7%) and Sanaag (74.4%), which were confirmed as significant hotspots. Over half of the children in Somaliland suffer from inadequate dietary diversity, with clear geographic clustering in eastern regions. Interventions should prioritize high-poverty communities and hotspot regions while addressing socioeconomic barriers such as household unemployment and maternal education.