The risk factors of infant mortality in Somalia: evidence from the 2018/2019 Somali health & demographic survey

Abstract
Background Globally, infant mortality is one of the major public health threats, especially in low-income countries.
The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death
rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant
mortality in Somalia using national representative data.
Method In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in
Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square
test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate
potential confounders that act as risk factors for infant death.
Results The study found that infant mortality was highest among male babies, multiple births, and those babies
who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with
small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who
delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that
mothers who did use ANC services (HR=0.740; 95% CI=0.618–0.832), sex of the baby (HR=0.661; 95% CI=0.484–
0.965), duration of pregnancy (HR=0.770; 95% CI=0.469–0.944), multiple births (HR=1.369; 1.142–1.910) and place of
residence (HR=1.650; 95% CI=1.451–2.150) were found to be statistically significantly related to infant death.
Conclusion The study investigated the risk factors associated with infant mortality by analyzing data from the first
Somali Health and Demographic Survey (SHDS), which included a representative sample of the country’s population.
Place of residence, gestational duration, infant’s gender, antenatal care visits, and multiple births were identified as
determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in
crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services,
particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women
about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of
these vital health services and their positive impact on infant survival rates.
Keywords Infant mortality, ANC, Cox proportional hazard model, Somalia