Prevalence and determinants of fever, diarrhea, and acute respiratory infection among children aged 5–59 months in Somaliland, 2020: insights from a nationwide survey

BackgroundAcute respiratory infections (ARIs), diarrhea, and fever remain major public health burdens among children in low- and middle-income countries, including Somaliland. These illnesses contribute substantially to childhood morbidity and healthcare utilization. This study aimed to determine the prevalence and determinants of these common childhood illnesses in Somaliland.MethodsSecondary analysis of data from the 2020 Somali Demographic and Health Survey (SDHS), a nationwide cross-sectional survey, was conducted. The analysis focused on children aged 5–59 months. Data on diarrhea, fever, and acute respiratory infection (ARI) in the two weeks preceding the survey were analyzed using binary logistic regression to identify associated factors.ResultsA total of 4,702 children aged 5–59 months were included in the analysis. The prevalence of fever, diarrhea, and ARI was 6.07%, 4.75%, and 3.66%, respectively. Child age was the most consistent determinant: children aged ≥25 months had significantly lower odds of diarrhea (AOR = 0.53; 95% CI: 0.31–0.90), fever (AOR = 0.53; 95% CI: 0.31–0.90), and ARI (AOR = 0.37; 95% CI: 0.20–0.67) compared to those aged ≤12 months. Notable regional variations were identified; children residing in Togdheer demonstrated substantially lower odds of diarrhea (AOR = 0.30; 95% CI: 0.14–0.67; p = 0.003), fever (AOR = 0.30; 95% CI: 0.14–0.68; p = 0.004), and ARI (AOR = 0.29; 95% CI: 0.12–0.71; p = 0.006) in comparison to those in Maroodi-Jeeh. A nomadic lifestyle was associated with decreased odds of diarrhea (AOR = 0.48; 95% CI: 0.31–0.75; p = 0.001), fever (AOR = 0.49; 95% CI: 0.32–0.77; p = 0.002), and ARI (AOR = 0.58; 95% CI: 0.34–0.98; p = 0.042) relative to rural living. Access to healthcare emerged as a significant protective factor against diarrhea (AOR = 0.43; 95% CI: 0.28–0.67; p < 0.001) and fever (AOR = 0.44; 95% CI: 0.28–0.68; p < 0.001), though not for ARI (AOR = 0.81; 95% CI: 0.52–1.27; p = 0.363). Vaccination status did not show a significant association with diarrhea (AOR = 1.12; 95% CI: 0.58–2.16; p = 0.726), fever (AOR = 1.12; 95% CI: 0.58–2.17; p = 0.727), or ARI (AOR = 1.37; 95% CI: 0.65–2.89; p = 0.401).ConclusionsChildhood illnesses remain a public health concern in Somaliland, particularly among younger children. Key determinants include child age, maternal age, geographic location, residence type, and access to healthcare. Targeted interventions focusing on early childhood, improving healthcare access, and addressing regional disparities are essential to reduce morbidity.