Gollis University

Background - Maternal and neonatal tetanus (MNT) remains a significant public health challenge in Somaliland. While the 2020 Somaliland Health and Demographic Survey (SLDHS) reports a national Tetanus Toxoid-Containing Vaccine (TTCV2+) coverage of 20.2%, this aggregate figure masks profound sub-national disparities. Traditional design-based direct estimates at the district level are often rendered unreliable by high sampling variance and "noise" due to restricted sample sizes. Objective - This study aimed to mitigate sampling variance and generate reliable sub-national estimates of tetanus immunization coverage in Somaliland by applying the Fay-Herriot Small Area Estimation (SAE) approach. Methods - Using data from the 2020 SLDHS, we compared design-based direct estimates with the Empirical Best Linear Unbiased Predictor (EBLUP) derived from a Fay-Herriot area-level model. The model "borrowed strength" from regional trends to stabilize noisy estimates. Precision was evaluated using the Coefficient of Variation (CV), and spatial distribution was visualized through Ordinary Kriging interpolation to delineate regional gradients. Results - The SAE model significantly improved the precision of district-level estimates, particularly in areas with high initial uncertainty. For instance, in districts such as Zeylac and Xudun, direct CVs exceeding 90% were reduced to 72.8% and 81.5%, respectively. The model moderated extreme outliers, such as the 40% raw prevalence in Borama, down to a stabilized 34.9%. The findings reveal a stark longitudinal gradient - TTCV2 + coverage is concentrated in western districts (~ 30–35%), while central, eastern, and southern regions exhibit systemic deprivation, with rates plateauing near 10%. Conclusion - The Fay-Herriot SAE approach successfully filtered out sampling artifacts to provide a high-resolution spatial surface of immunization coverage. The results indicate that the vast majority of Somaliland remains dangerously below the WHO 90% elimination target. These stabilized sub-national data are critical for evidence-based policy targeting, highlighting the urgent need for nomadic-sensitive health interventions in eastern and southern "cold spots."

Women’s household decision-making autonomy is a fundamental dimension of empowerment and an important determinant of maternal health, reproductive agency, and household welfare. In fragile and conflict-affected settings such as Somalia, persistent gender inequalities, insecurity, and sociocultural norms continue to limit women’s participation in household decisions. Despite growing global attention to women’s empowerment, nationally representative evidence on regional and socioeconomic inequalities in women’s autonomy in Somalia remains scarce. This study analyzed data from the 2020 Somali Demographic and Health Survey (SDHS), including a weighted sample of 8,436 ever-married women aged 15–49 years. Household decision-making autonomy was defined as women’s participation, either alone or jointly with their husbands, in decisions regarding personal healthcare, major household purchases, and visits to family or relatives. Descriptive statistics and multivariable logistic regression analyses were conducted while accounting for the complex survey design and sampling weights. Overall, 60.6

High-risk fertility behaviour (HRFB), characterised by early or advanced maternal age at childbirth, short birth intervals, and high parity, remains a major public health concern because of its strong association with adverse maternal and neonatal outcomes. Somalia, a fragile and conflict-affected setting with persistently high fertility and maternal mortality rates, lacks comprehensive multilevel evidence on the determinants of HRFB. This study examined the socioeconomic and contextual factors associated with HRFB among women of reproductive age in Somalia. A cross-sectional analysis was conducted using data from the 2020 Somalia Demographic and Health Survey (SDHS). The weighted sample included 12,796 women aged 15–49 years with a history of childbirth. HRFB was defined as the presence of at least one risk condition: maternal age < 18 or > 34 years at birth, birth interval < 24 months, or birth order ≥ 3. Multilevel binary logistic regression models were fitted to identify individual-, household-, and community-level determinants, accounting for clustering at the community level. Adjusted odds ratios (AORs) with 95

Abstract Background Financial inclusion and internet access are important drivers of women’s socioeconomic empowerment, yet evidence from fragile and low-resource settings remains limited. In Somaliland, nationally representative evidence on formal financial participation and digital connectivity among women is scarce. This study assessed the prevalence and determinants of formal bank account ownership and internet access among women of reproductive age in Somaliland. Methods A cross-sectional study was conducted using data from the 2020 Somaliland Demographic and Health Survey (SLDHS). The analysis included 15,827 women aged 15–49 years. Descriptive statistics were used to estimate the weighted prevalence of formal bank account ownership and internet access. Bivariate associations were examined using Pearson’s chi-square test, and multivariable logistic regression models were fitted to identify factors independently associated with each outcome. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results The weighted prevalence of formal bank account ownership was 1.43%, while 6.92% of women reported internet use. Formal bank account ownership was positively associated with being aged 35–39 years (AOR = 6.28, 95% CI: 1.24–31.88), secondary education (AOR = 2.42, 95% CI: 1.20–4.84), belonging to a rich household (AOR = 1.75, 95% CI: 1.30–2.37), and residence in Sool region (AOR = 2.20, 95% CI: 1.41–3.43). Internet access was significantly associated with primary (AOR = 2.29, 95% CI: 1.75–3.01) and secondary education (AOR = 8.29, 95% CI: 5.75–11.95), literacy (AOR = 4.65, 95% CI: 3.49–6.20), middle (AOR = 5.86, 95% CI: 3.25–10.58) and rich household wealth (AOR = 23.30, 95% CI: 13.95–38.91), and mobile phone ownership, whereas older age was associated with lower odds of internet use. Conclusions This study found that formal bank account ownership and internet access were low among women of reproductive age in Somaliland. Educational attainment was consistently associated with both outcomes, while age, household wealth, mobile phone ownership, and region of residence were associated with one or both measures of financial and digital participation. These findings suggest that socioeconomic, demographic, and geographic disparities are important correlates of women’s access to formal banking and internet services. The results provide baseline evidence that may inform future research and support the development of context-specific strategies aimed at improving equitable access to financial and digital services among women in Somaliland.

This study assessed farmers’ knowledge, attitudes, and management practices (KAP) regarding Tuta absoluta in Xumbowayne Village, Maroodijeex District, Somaliland, and examined gaps between knowledge and practice. A simple random sampling technique was employed to collect data from 118 participants using a structured interview schedule and focus group discussions (FGDs). Descriptive statistics, chi-square tests, and Cramér’s V were applied for data analysis. Results showed that while most farmers had high knowledge (72.0%), the majority exhibited low attitudes (66.1%) and moderate practices (89.8%), with 72.0% falling under low overall KAP. Chemical control was found the dominant strategy, with limited adoption of integrated pest management (IPM). Although KAP components were significantly associated, higher knowledge did not translate into better practices. Education (V = 0.841, p < 0.001) and farm size (V = 0.508, p < 0.001) significantly influenced knowledge and management practices. Therefore, the findings of this study reveal a clear knowledge practice gap driven by institutional and resource constraints, highlighting the need for improved extension services and practical IPM interventions.