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1. ASSESSMENT OF MALNUTRITION
AMONG CHILDREN UNDER FIVE
YEARS IN CAKARA VILLAGE,
HARGEISA, SOMALILAND
SUBMITTED BY: RAMADAN HASSAN MOHAMED, HANSE OSMAN AHMED,
ABDIFATAH RASHID HASSAN
SUPERVISOR: MR. HUSSEIN ABDI ALI ISMAIL
EDNA ADAN UNIVERSITY - DEPARTMENT OF NURSING

2. PROBLEM STATEMENT & SIGNIFICANCE
• MALNUTRITION AMONG UNDER-FIVE CHILDREN REMAINS A MAJOR CAUSE OF
MORBIDITY AND MORTALITY IN SOMALILAND.
• THERE IS A LACK OF COMMUNITY-SPECIFIC DATA TO GUIDE INTERVENTIONS.
• THIS STUDY PROVIDES CRITICAL DATA FOR POLICYMAKERS, HEALTH PROVIDERS,
AND NGOS.
• FINDINGS CONTRIBUTE TO ACHIEVING SDG 2 (ZERO HUNGER) AND SDG 3
(GOOD HEALTH & WELL-BEING).
• SERVES AS BASELINE FOR FUTURE RESEARCH AND COMMUNITY INTERVENTIONS.

3. OBJECTIVES OF THE STUDY
• GENERAL OBJECTIVE: ASSESS THE PREVALENCE AND DETERMINANTS OF
MALNUTRITION AMONG UNDER-FIVE CHILDREN IN CAKARA.
• SPECIFIC OBJECTIVES:
• 1. TO DETERMINE THE PREVALENCE OF MALNUTRITION (MUAC, WEIGHT, HEIGHT).
• 2. TO IDENTIFY SOCIO-ECONOMIC FACTORS ASSOCIATED WITH MALNUTRITION.
• 3. TO IDENTIFY ENVIRONMENTAL FACTORS CONTRIBUTING TO MALNUTRITION.

4. METHODOLOGY (1)
• STUDY DESIGN: COMMUNITY-BASED CROSS-SECTIONAL STUDY.
• STUDY AREA: CAKARA VILLAGE, PERI-URBAN HARGEISA.
• STUDY PERIOD: APRIL - JULY 2024.
• STUDY POPULATION: 272 CHILDREN (6-59 MONTHS) WITH THEIR
PRIMARY CAREGIVERS.
• SAMPLING: STRATIFIED BY ZONES, SYSTEMATIC RANDOM SAMPLING OF
HOUSEHOLDS.

5. METHODOLOGY (2)
• DATA COLLECTION TOOL: STRUCTURED QUESTIONNAIRE TRANSLATED
INTO SOMALI.
• MEASUREMENTS: WEIGHT, HEIGHT/LENGTH, MID-UPPER ARM
CIRCUMFERENCE (MUAC).
• DATA ANALYSIS: SPSS V25 (DESCRIPTIVE STATISTICS, CHI-SQUARE TESTS).
• ETHICS: INFORMED CONSENT OBTAINED, APPROVALS FROM EDNA ADAN
UNIVERSITY AND LOCAL AUTHORITIES.

6. KEY FINDING 1: ALARMING
PREVALENCE OF MALNUTRITION
Category Frequency Percentage (%)
Normal 29 10.7
Moderately Malnourished 177 65.1
Severely Malnourished 66 24.3
Total 272 100%

7. INTERPRETATION - PREVALENCE
• A TOTAL OF 89.4% OF CHILDREN WERE MALNOURISHED.
• THIS FAR EXCEEDS WHO’S EMERGENCY THRESHOLD OF 15%.
• THE FINDINGS HIGHLIGHT A SEVERE PUBLIC HEALTH CRISIS IN
CAKARA VILLAGE.

8. KEY FINDING 2: COMPLEMENTARY
FEEDING PRACTICES
Category Frequency Percentage (%)
Before 6 months 26 9.6
At 6 months 103 37.9
After 6 months 143 52.5
Total 272 100%

9. INTERPRETATION - FEEDING
PRACTICES
• EXCLUSIVE BREASTFEEDING WAS RELATIVELY HIGH (78.7%).
• HOWEVER, 62.1% OF CAREGIVERS INTRODUCED COMPLEMENTARY
FOODS AT THE WRONG TIME.
• THIS NUTRITIONAL GAP INCREASES THE RISK OF UNDERNUTRITION
DURING EARLY CHILDHOOD.

10. KEY FINDING 3: SOCIO-ECONOMIC
DETERMINANTS
• MATERNAL EDUCATION: 49.3% OF MOTHERS HAD NO FORMAL
EDUCATION (P=0.001).
• HOUSEHOLD INCOME: 90.8% OF HOUSEHOLDS EARNED LESS THAN
$200/MONTH.
• FAMILY SIZE: 38.6% OF HOUSEHOLDS HAD 3+ CHILDREN UNDER FIVE.
• CONCLUSION: POVERTY, LOW MATERNAL EDUCATION, AND LARGE
FAMILY SIZES INCREASE MALNUTRITION RISK.

11. KEY FINDING 4: ENVIRONMENTAL
DETERMINANTS
• WATER SOURCE: 86.4% RELIED ON UNSAFE SOURCES (WATER TRUCKS,
RIVERBEDS).
• WATER TREATMENT: 84.6% NEVER TREATED DRINKING WATER
(P=0.001).
• SANITATION: 83.8% USED PIT TOILETS.
• CONCLUSION: POOR WASH CONDITIONS PERPETUATE INFECTIONS
AND WORSEN MALNUTRITION.

12. DISCUSSION
• THE CRISIS IS DRIVEN BY POVERTY, LOW MATERNAL EDUCATION, AND
POOR WASH PRACTICES.
• HIGH MALNUTRITION PERSISTS DESPITE 61.8% LIVING WITHIN 1 KM OF
HEALTH FACILITIES.
• BARRIERS INCLUDE COST, AWARENESS, AND QUALITY OF SERVICES.
• FINDINGS ALIGN WITH STUDIES FROM OTHER SUB-SAHARAN AFRICAN
SETTINGS.

13. LIMITATIONS & CONCLUSION
• LIMITATIONS: CROSS-SECTIONAL DESIGN, SELF-REPORTED DATA BIAS,
LIMITED GENERALIZABILITY.
• CONCLUSION: SEVERE AND WIDESPREAD ACUTE MALNUTRITION IN
CAKARA VILLAGE.
• THE CAUSES ARE MULTIFACTORIAL: SOCIO-ECONOMIC, BEHAVIORAL,
AND ENVIRONMENTAL FACTORS.

14. RECOMMENDATIONS
• EMERGENCY ACTION: SCALE UP CMAM PROGRAMS FOR ACUTE MALNUTRITION.
• HEALTH EDUCATION: PROMOTE OPTIMAL BREASTFEEDING, COMPLEMENTARY
FEEDING, HYGIENE.
• LIVELIHOOD SUPPORT: INTRODUCE CASH TRANSFERS AND VILLAGE SAVINGS
PROGRAMS.
• WASH: INVEST IN CLEAN WATER, SANITATION, AND WATER TREATMENT
PRACTICES.
• HEALTH SYSTEM: TRAIN HEALTH WORKERS, STRENGTHEN LOCAL SERVICE QUALITY.

15. DISSEMINATION OF THE RESULTS
The results of this study will be disseminated through:
- Edna Adan University academic presentations
- Local health authorities for policy guidance
- Community awareness sessions in Cakara Village
- Possible submission to national or regional health conferences

16. ACKNOWLEDGEMENTS
• SUPERVISOR: MR. HUSSEIN ABDI ALI ISMAIL.
• COMMUNITY OF CAKARA VILLAGE AND LOCAL AUTHORITIES.
• FAMILIES AND FRIENDS FOR THEIR SUPPORT.
• FACULTY AND STAFF OF EDNA ADAN UNIVERSITY.

17. SELECTED REFERENCES
• WHO (2009). WHO CHILD GROWTH STANDARDS AND SEVERE ACUTE
MALNUTRITION.
• UNICEF (2020). THE STATE OF THE WORLD'S CHILDREN: NUTRITION.
• BLACK RE ET AL. (2013). MATERNAL AND CHILD UNDERNUTRITION. THE
LANCET.
• PRÜSS-USTÜN A ET AL. (2019). BURDEN OF DISEASE FROM INADEQUATE
WASH.

18. BACKGROUND TO COMMUNITY HEALTH
y, especially in low-resource settings. Consequences include impaired growth, weakened immunity, incr

19. BACKGROUND TO COMMUNITY HEALTH
y, especially in low-resource settings. Consequences include impaired growth, weakened immunity, incr

20. BACKGROUND TO THE TOPIC UNDER
STUDY
economic shocks that worsen food insecurity. An estimated 1.7 million under-five children in Somalia a

21. BACKGROUND TO THE STUDY AREA
dy focuses on generating localized data for Cakara Village, a peri-urban settlement in Hargeisa, Som