Abstract
Vitamin A deficiency (VAD) affects children under 5 years of age and leads to deaths predominantly in low- and middle-income countries (LMICs). VAD remains a significant public health concern in Somalia. Therefore, it is necessary to explore the determinants of VAD among children under five in Somalia using country representative data. Therefore, this study investigates the determinants of adequate vitamin A (VA) consumption among Somali children aged 6-23 months, using data from the first-ever Somalia Demographic Health Survey (SDHS) 2020. Secondary data were extracted from SDHS-2020, and after removing the missing observations, a sample of 7344 children aged 6-23 months was considered in this study. The Chi-squared test is used to identify the association between the target variable and covariates. A multilevel analysis was conducted on a sample of 7344 children, examining individual-level (maternal education, wealth, breastfeeding status, VAS history) and community-level (region, urban/rural) factors associated with good VA consumption, defined as consuming at least one VA-rich food item in the previous 24 h. Mixed-effects logistic regression models were used to account for data clustering. A significant proportion of children (n = 4488, 61.1%) did not consume VA-rich foods. Key predictors of consuming VA-rich foods included maternal provision of vitamin A supplements in the past 6 months (AOR = 3.1, 95% CI: 2.6-3.7) and current breastfeeding status. Children residing in the Sool region demonstrated higher odds of receiving VA, while higher maternal education and middle-income status were associated with lower odds of receiving VA, indicating that these factors inversely impacted the consumption of vitamin A. Community-level variance highlighted the importance of contextual factors. The findings highlight the importance of sustained VAS programs and breastfeeding promotion in combating VAD in Somalia. Mothers' education and media exposure should be increased to lessen the burden of VAD. Addressing socioeconomic disparities and tailoring interventions to regional contexts are crucial for improving child nutrition outcomes.