Assessing the Drivers of Wasting among Children Under 5 and Their Mothers in The Bay and Hiran Regions of Somalia

BackgroundTo address Somalias high burden of wasting, it is imperative to understand the countrys context-specific drivers of wasting. This study assessed the drivers of wasting among children under 5 (CU5) and mothers in Somalias Bay and Hiran regions to inform strategies to address wasting. MethodsThe data comes from the midline (September 2023) and endline (December 2023) data collection of a randomized controlled trial. Child and maternal outcomes (weight-for-height z-scores (WHZ) and mid-upper arm circumferences (MUAC), respectively) were explored continuously for children via linear regression and as binary outcomes via Poisson regression for children and mothers. A hierarchical model building approach was used, mapping variables into the basic, intervention, underlying, and immediate levels. Separate midline and endline models were analyzed cross-sectionally, comparing drivers by seasonality, and CU5 models were further stratified by region and age. ResultsThe burden of CU5 wasting was 12.9% at midline and 14.4% at endline. The following variables were drivers of low WHZ across different models: child illness, open defecation, low maternal MUAC, no maternal education, having a male-headed household, and living in a household without joint decision-making. Egg/flesh food consumption and higher maternal MUAC were protective of WHZ. Wasting among mothers was 8% at midline and 12% at endline. Household food insecurity, open defecation, and poor waste disposal practices were drivers of mothers wasting, whereas maternal decision-making was protective. ConclusionThis study highlights variation in the key drivers of wasting by region, season, and child age and contributes to an expanding body of evidence on the multifactorial drivers of wasting, encouraging context-specific approaches that address the immediate, underlying, and basic causes of malnutrition. The findings emphasize the importance of maternal nutrition for child nutrition outcomes and the need for interventions considering household food security, sanitation, and gender dynamics in this humanitarian setting. Registration: The cluster-RCT is registered at ClinicalTrials.gov, ID: NCT06642012.