# Determinants and spatial distribution of early newborn care in Somalia: evidence from the 2020 Somalia health and demographic survey

## TL;DR

This study finds that early newborn care in Somalia is very low, with significant regional and socioeconomic disparities, and suggests targeted interventions to improve neonatal health outcomes.

## Contribution

The study identifies individual, household, and community-level determinants of early newborn care and maps spatial patterns in Somalia using national survey data.

## Key findings

- Only 5.23% of newborns received adequate early newborn care in Somalia.
- Delivery in a health facility and higher household wealth were strongly associated with receiving ENC.
- Spatial analysis revealed hot spots in northwestern regions and cold spots in southern regions for ENC coverage.

## Abstract

Early newborn care (ENC) is important for reducing neonatal mortality; however, the rate of receiving adequate newborn care is low in Somalia. Therefore, this study aimed to identify the individual, household, and community-level determinants and map the spatial patterns of ENC in Somalia to take the required actions and policies.

This study considered a weighted sample of 15,024 mother-newborn pairs extracted from a countrywide cross-sectional survey, the 2020 Somali Health and Demographic Survey (SHDS). Multilevel logistic regression was employed to identify factors associated with receiving adequate ENC within two days of birth. Global Moran’s I and Getis-Ord Gi* statistics were used for spatial analysis.

The prevalence of adequate ENC was critically low (5.23%). Findings revealed that delivery in a health facility (vs. home: Adjusted Odds Ratio (AOR) = 0.22, 95% CI: 0.18-0.26), higher household wealth (richest vs. poorest: AOR = 2.02, 95% CI: 1.59-2.57), and higher birth order were influential predictors of receiving ENC. However, having multiple or a higher number of living children was associated with significantly lower odds of receiving ENC. Spatial analysis identified a statistically significant hot spot of higher ENC coverage in the northwestern regions and cold spots of extremely low coverage in the south.

In Somalia, early neonatal care is shockingly insufficient, and significant social and regional disparities. To achieve Sustainable Development Goal 3, interventions must be implemented based on identified cold spots, prioritizing the strengthening of access to skilled care at birth, and addressing the economic vulnerabilities of families.