Anemia among Under-Five Children in Internally Displaced Camps in Mogadishu, Somalia: A Cross-Sectional Study on Prevalence, Severity, and Associated Risk Factors

Anemia among Under-Five Children in Internally Displaced Camps in Mogadishu, Somalia: A Cross-Sectional Study on Prevalence, Severity, and Associated Risk Factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anemia among Under-Five Children in Internally Displaced Camps in Mogadishu, Somalia: A Cross-Sectional Study on Prevalence, Severity, and Associated Risk Factors Abas Mohamed Sharif, Lul Mohamud Mohamed, Anas Salad Mohamed, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5358174/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Globally, 269 million children under the age of five (39.8%) are anemic, with 60.2% of these children residing in Africa. Despite its serious health and social implications, anemia remains a significant public health challenge. Given the limited evidence on the prevalence and determinants of anemia among children under five in Somalia, this study aimed to assess the prevalence, severity and associated factors of anemia among internally displaced children under five years old in the Daynile IDP camps, Somalia. Method and materials: A community-based cross-sectional study was conducted in the Daynile IDP camps in Mogadishu, Somalia, from October 2022 to September 2023, involving a total of 435 children under five years of age. Socio-demographic data and other predisposing factors were collected through a structured questionnaire. Venous blood samples were drawn and analyzed for complete blood count (CBC) using a Mindray auto-hematology analyzer. Data were entered and analyzed using IBM SPSS Statistics version 29. Binary and multiple logistic regressions were performed to assess factors associated with anemia. Adjusted Odds Ratios (AOR) with their corresponding 95% Confidence Intervals (CI) were calculated. A p-value of less than 0.05 was considered statistically significant. Results: The prevalence of anemia was found to be 62.5% (95% CI: 58.5–67.5%), with the majority of anemic children (33.8%) classified as having moderate anemia. Microcytic hypochromic anemia was present in 89.3% of the cases. The prevalence of anemia was found to be 62.5% (95% CI: 58.5–67.5%), with the majority of anemic children (33.8%) classified as having moderate anemia. Microcytic hypochromic anemia was present in 89.3% of the cases. Significant predictors of anemia among under five children in these IDP camps included age ≤ 24 months (AOR = 2.326, 95% CI = 1.540-3.513), male gender (AOR = 1.734, 95% CI = 1.168-2.574), home delivery (AOR = 4.281, 95% CI = 1.901-9.639), non-exclusive breastfeeding (AOR = 2.018, 95% CI = 1.327-3.068), early introduction of complementary foods (AOR = 2.085, 95% CI = 1.356-3.206), lack of iron supplementation (AOR = 2.447, 95% CI = 1.596-3.751), diarrhea in last two weeks (AOR = 3.201, 95% CI = 2.132-4.806), fever in last two weeks (AOR = 2.781, 95% CI = 1.846-4.192), and lack of deworming medication (AOR = 1.600, 95% CI = 1.073-2.385). Conclusion: The study reveals a very high prevalence of anemia among children under five, reflecting a serious public health issue according to WHO classification. Preventive measures such as exclusive breastfeeding, timely introduction of complementary foods, periodic deworming, promotion of dietary diversity, iron supplementation, and strong government commitment to child welfare are essential for reducing under-five anemia and improving overall child health. Anemia under five children IDP Camps Mogadishu Jazeera University BACKGROUND Anemia is defined as lower than normal hemoglobin (Hb) concentration, hematocrit, or red blood cell count per liter compared to healthy individuals of the same age, sex, race, and environmental conditions [1]. Childhood anemia is prevalent in developed and underdeveloped nations, significantly increasing morbidity and mortality rates among children under the age of five [2]. It adversely affects physical, social, and mental development, leading to immune system issues, delayed motor and cognitive skills, academic struggles, and reduced productivity, all of which can limit children's earning potential and hinder economic growth [3]. Anemia, a multi-factorial health issue, is influenced by various risk factors. In children, common causes include inadequate intake and poor absorption of iron-rich foods, such as meat, alongside acute blood loss, and inherited or acquired disorders [4,5]. Additionally, micronutrient deficiencies, consumption of iron absorption inhibitors like tea and coffee, and increased intake of absorption enhancers such as vitamin C contribute to anemia [6]. Other nutritional factors like calcium, along with infectious diseases like malaria and hookworm infestations, further compound the risk [7]. Socio-demographic factors, including child age, sex, place of residence, maternal age, and education level, also play pivotal roles in predisposing children under five to anemia [6]. A total of 269 million children worldwide aged 6–59 months had anemia in 2019, representing 39.8% of this demographic [8]. The African Region exhibits the highest prevalence, with 60.2% of children under five affected [9]. Additionally, South Asian regions reported higher prevalence rates, with 55.12% in 2016 and 52% in 2019 [10]. Data on anemia in Somali children was first assessed over a decade ago in a national survey conducted in 2009, revealing an overall prevalence of 59.3% among 784 children sampled from 30 clusters and tested using the HemoCue. A follow-up survey in 2019 reported a prevalence of 43.4% among 1675 children, also assessed using the HemoCue [11]. Specific data from Hargeisa City, Somaliland, showed an overall prevalence of 49.4% among under-five children attending public health facilities [3]. In neighboring areas, such as the Shebelle Zone, Somali Region, Eastern Ethiopia, the prevalence was notably high at 72% among under-five children [12]. Risk factors for anemia in Somali children identified from these studies include iron and vitamin A deficiencies, malaria, poor sanitary conditions, lack of deworming, recent illness (e.g., diarrhea, fever), child's age and sex, mother's educational level, and timing of complementary feeding [3,11,12]. Children in refugee camps and emergency areas face an extremely vulnerability to anemia and other micronutrient deficiencies due to various factors, including inadequate food supplies, limited access to healthcare, unhealthy environments, poor feeding practices, overcrowding, insufficient clean water, increased exposure to diseases, and a lack of specialized services [13]. Dependence on food aid can worsen these issues, particularly for those in long-term camp settings. In Somalia, approximately 2.6 million people are internally displaced, with a significant concentration, about half a million, in Mogadishu [14,15]. Apart from nationwide survey data, there is limited data, especially regional data in southern Somalia, which can provide details on the prevalence of anemia and associated risk factors among children less than five years of age, therefore, this study aimed to assess the prevalence, severity, and associated factors of anemia among under-five children in IDPs in Mogadishu, Somalia. METHODS AND MATERIALS Study design and setting A community-based cross-sectional study was conducted in Daynile district, which is one of 17 districts in Benadir region, Somalia, where most displaced settlement are located to determine the prevalence, severity and risk factors of anemia among under-five children from October 2022 to September 2023. Sample size determination The sample size calculation was determined using the single proportion formula (n = [(Z α/2 ) 2 × (1-p)]/d2) with a 95% confidence level, 5% margin of error, and a 43.4% prevalence of anemia in Somali children based on findings from the 2019 Somalia Micronutrient Survey [11]. After adjusting for 15% non-response, a total of 445 samples were computed. Sampling techniques The sampling procedure for these study involved multistage cluster sampling. In the first stage, the district of Daynile was selected purposively. Out of 450 camps in Daynile, 50 were randomly selected. In the final stage, households in the selected IDP camps were selected through systematic random sampling with kth = 14. Where households had more than one under-five-year-old child, only one child was randomly selected using the lottery method to exclude duplication of results. Measurement of variables Outcome variable The outcome variable of this study is Anemia, in this study a child is considered as an anemic if the hemoglobin level is less than 11g/dl. On the bases of its severity, anemia was categorized as severe anemia ( 24 months) , age of mother/caregiver (16-27 , 28-37 and > 38 Years) , educational status (Illiterate, Quran, Primary, Secondary and above), Marital status (Married, Divorced, and Widow), Parity (Primiparous, Multiparous and Grand Multipara), Birth space (< 2 and ≥ 24 years), Place of birth (Home, Hospital and MCH), family size ( $3 dollars). Health Related factors i ncluded were History of Malarial infection (Yes and No), History of diarrhea (Yes and No), History of Fever and Deworming or anti helminthic treatment (Albendazole) (Yes and No). Nutritional Status factors i ncluded were Iron supplementation (Yes and No), Vitamin A supplementation (Yes and No), Exclusive breast-feeding (6 months and 6 and < 6 months), and Dietary diversity score (Below 4 and 4and above). Data collection Data was collected through face-to-face interviews with the mothers or caregiver of the child using a pretested open and closed questionnaire. 1. Specimen collection Two milliliters of venous blood were drawn by a qualified nurse under sterile conditions and placed into EDTA anticoagulant tubes, mixed for 5 minutes, and labeled with the participant's ID. These samples were then analyzed by technicians at Jazeera University Hospital Lab, and the results were recorded. Anemia was defined according to WHO criteria [16], with severity classified as mild, moderate, or severe. Additional sub-classification was based on red blood cell indices such as MCV and MCH, where a higher, normal, or lower MCV indicates macrocytic, normocytic, or microcytic average RBC, respectively. Similarly, a normal or decreased MCH often suggests that the RBC is either normochromic or hypochromic. Normal MCV with normal MCH but low Hb indicates normocytic normochromic anemia; normal MCV with decreased MCH tends to show normocytic hypochromic anemia; decreased MCV with normal MCH indicates microcytic normochromic anemia; and decreased MCV with decreased MCH indicates microcytic hypochromic anemia. Children with mild to moderate anemia received iron supplements and health education, while those with severe anemia were referred to Benadir Hospital for further investigations and treatments. The normal reference ranges for the RBC indices of MCV and MCH are shown in Table 1. Statistical analysis Descriptive and inferential methods were employed for data analysis. Categorical variables were presented as frequencies and proportions, while quantitative variables were described using median (range). Prevalence rates were estimated with a 95% confidence interval, and chi-square tests were used to identify associations between qualitative variables. Multivariable logistic regression analysis was carried out by including variables with p < 0.2 from bivariable logistic regression. Finally, the strength of association was measured by adjusted odds ratios with a 95% confidence interval (CI) for exposure variables and the outcome variable (Anemia). P-value< 0.05 was regarded statistically significant in all conditions of the analysis. All statistical analyses were performed using the IBM statistical Package for Social Science (IBM SPSS). RESULTS Data from 435 study participants were included in the analysis out of 445 calculated samples, with 97.8% response rate. Socio demographic characteristics Table 2 shows that the majority of children (253, 58.2%) were aged 25-59 months, with slightly more females (235, 52.9%) than males (205, 47.1%). Over half (51.7%) of mothers/caregivers were aged 28-37 years. Regarding marital status, most were married (338, 77.7%), followed by divorced (79, 18.2%) and widowed (16, 4.1%). Educationally, over two-thirds (318, 73%) of mothers/caregivers had no formal education. Parity analysis revealed a majority of grand multiparous mothers (257, 59.1%), followed by multiparous (167, 38.4%) and a small primiparous group (10, 2.5%). Birth spacing showed nearly half (228, 52.4%) with short intervals (<2 years). Home deliveries were most frequent (343, 78.9%), with health facilities used by a smaller portion (62, 14.3%). Most families (320, 73.6%) had a daily income of 2-3 dollars. Lastly, family size analysis indicated a majority of households with 5 or more members (381, 87.6%). Prevalence and severity pattern of Anemia among study participants The overall prevalence of anemia in under five year children Internally Displaced camps of Mogadishu, Somalia was found to be was 62.5%, as shown in Table 3. Among these anemic children, the severity distribution showed (147, 33.8%) with moderate anemia, (108, 24.8%) with mild anemia, and a smaller portion (17, 3.9%) with severe anemia. Morphologic classification of anemic children among study participants An analysis of morphological characteristics of anemic children Table 4 revealed Microcytic hypochromic anemia as the most prevalent type, affecting (243, 89.3%) of children, followed by Normocytic normochromic anemia (15, 5.5%), Normocystic hypochromic anemia (8, 3%) and Microcytic normochromic anemia was identified in a smaller portion (6, 2.2%). Multivariable logistic regression analysis A multivariate logistic regression analysis in Tables 5 revealed a complex interplay between child characteristics, dietary factors, and health issues influencing childhood anemia risk. Children ≤ 24 months (AOR=2.326, 95% CI=1.540-3.513, P-value <0.001) and males (AOR=1.734, 95% CI=1.168-2.574, P-value=0.006) were more likely to be anemic. Deliveries at healthcare institutions were associated with a lower risk of anemia compared to home births (AOR=4.281, 95% CI=1.901-9.639, P-value <0.001). Interestingly, children born to older mothers had a lower risk of anemia (AOR=0.544, 95% CI=0.353-0.837, P-value=0.006). Deficient dietary practices also significantly increased the risk of anemia, Children not receiving exclusive breastfeeding (AOR=2.018, 95% CI=1.327-3.068, P-value=0.001) and those with early introduction of complementary foods (before 6 months) (AOR=2.085, 95% CI=1.356-3.206, P-value <0.001) were more likely to be anemic. Lack of iron supplementation also had a strong association (AOR=2.447, 95% CI=1.596-3.751, P-value <0.001). Additionally, low dietary diversity scores, indicating a limited variety of foods consumed (AOR=5.794, 95% CI=3.071-10.932, P-value <0.001), were associated with a higher likelihood of anemia. Finally, health factors also played a role, Children with a history of recent diarrhea (AOR=3.201, 95% CI=2.132-4.806, P-value <0.001) or fever (AOR=2.781, 95% CI=1.846-4.192, P-value <0.001) in the past few weeks were more likely to be anemic. Moreover, not receiving deworming medication also contributed to a greater risk of anemia (AOR=1.600, 95% CI=1.073-2.385, P-value=0.021). DISCUSSIONS The continued collection of data on anemia prevalence is crucial for public health, given its association with morbidity and mortality, especially among vulnerable populations like displaced children [17]. The overall prevalence of anemia in this study was 62.5% (95% CI: 58.5–67.5%), which is considered a serious public health issue by WHO [18]. This is higher than the 43.4% reported in a 2019 nationwide survey in Somalia [11] and the 49.4% found in Hargeisa City, Somaliland [3]. Other studies reported lower rates, such as 52.6% in southern Ethiopia [19] and 49.4% in Sudan [20]. The discrepancies in anemia prevalence could be due to differences in study areas, limited access to healthcare, overcrowding, and dependence on food aid, particularly in long-term camp settings. The findings in this study are similar to the 60.2% anemia prevalence among children in Africa reported by WHO [8], 58.8% in Namutumba district, Uganda [21], 59.7% in Jablia refugee camp, Palestinian territory [22], and 59% from a systematic review in Africa [23]. However, the current finding is lower than studies conducted in African IDPs and refugee camps such as Cameroon (84.0%) [24], Burma (72.6%) [25], the Shebelle zone, eastern Ethiopia (72%) [12], and Arusha District, Tanzania (84.6%) [4]. The lower anemia prevalence in our study may be due to the high infection burden and geographical differences in the previous studies. In our study, the majority of anemic children under five had moderate anemia (33.8%), followed by mild anemia (24.8%) and severe anemia (3.9%). This distribution is similar to studies in Kebribeyah refugee camp, Somali region of eastern Ethiopia (48.1%) [26], Edo state, Nigeria (36%) [27], and Cameroon (52.4%) [24], which also showed a higher prevalence of moderate anemia. However, the prevalence of severe anemia in our findings (3.9%) is lower than in studies conducted in Myanmar (10.9%) [25] and Burma refugee camps (10.4%) [28]. This difference may be due to different Hb cutoff values for severe anemia (7 mg/dl in our study vs. 8 mg/dl in others) and higher infection burdens, such as malaria, in the other studies. Our study revealed that the predominant morphological form of anemia was microcytic-hypochromic (89.3%), followed by normocytic normochromic anemia (5.5%). These findings are consistent with studies conducted in Uganda [29], Kenya [30], and Ghana [31], which also showed a high prevalence of microcytic-hypochromic anemia among children under five. Socio-demographic factors play a significant role in determining anemia among children. In this study, the child's age, sex, the mother's age, and place of delivery were significantly associated with anemia in children. Children under the age of two years were 2.3 times more likely to have anemia compared to children aged two to five years (AOR: 2.3; 95% CI: 1.540-3.513). This aligns with research from Sudan [20], Ethiopia [19], and Ghana [32], indicating that the first two years of life are critical for anemia vulnerability due to factors like iron store depletion by six months [21] and increased susceptibility to infections [19]. Rapid physical growth and the introduction of nutritionally poor complementary foods may also contribute to this heightened risk [4]. Older children tend to have a more diverse diet, reducing their anemia risk [32]. There was a significant disparity in anemia prevalence between male and female children, with males being 1.7 times more likely to be anemic (AOR: 1.7; 95% CI: 1.168-2.574). This finding aligns with studies from South Africa [33], eastern Ethiopia [12], and Kenya [34]. Children born to older mothers had a lower risk of anemia, likely due to greater maternal experience and improved caregiving practices. This finding supports a study conducted in Northeast Ethiopia [35], which indicates that maternal age influences the quality of care and feeding techniques, reducing malnutrition risk. Children born at home were 1.8 times more likely to be anemic compared to those born at health institutions (AOR: 1.8; 95% CI: 1.074-2.912), echoing findings from Ethiopia [35]. Institutional delivery improves maternal health and infant care practices, reducing anemia risk. Other socio-demographic factors like mother’s educational level, occupation, family income, parity, and marital status were not significant predictors of anemia in this study. Health and nutritional related factors also play an important role in determining anemia in children under five by increasing iron requirements or depleting its stores. This community-based cross-sectional study found a significant association between anemia and a lack of exclusive breastfeeding during the first six months of life. Breastfed babies for less than six months were 2 times more likely to be anemic compared to those exclusively breastfed (AOR=2.018, 95% CI=1.327-3.068). Similarly, children receiving complementary foods before six months of age were 2 times more likely to be anemic compared to those who received complementary feeding at six months (AOR=2.085, 95% CI=1.356-3.206). Most digestive enzymes are inadequate until six months [37], and introducing food during this time can interfere with iron absorption from breast milk [38]. Early exposure to microbial pathogens through complementary foods increases the risk of infection and malabsorption, contributing to anemia [39]. Children who did not receive iron supplements were 2.4 times more likely to be anemic compared to those who did (AOR=2.447, 95% CI=1.596-3.751). Although there are no studies directly linking anemia and lack of iron supplements, evidence suggests that daily iron supplementation in babies aged 6 to 23 months lowers their anemia risk [40, 41 & 42]. Similarly, children scoring below 4 in dietary diversity were 5.8 times more likely to be anemic compared to those scoring 4 and above (AOR=5.794, 95% CI=3.071-10.932), consistent with a study in South Ethiopia [35]. Dietary diversity is a good proxy for micronutrient adequacy; a lack of it increases the likelihood of childhood anemia [35]. Children with a history of diarrhea in the last two weeks were three times more likely to be anemic compared to those without (AOR=3.201, 95% CI=2.132-4.806), aligning with studies in Hargeisa City, Somaliland [3], and Kombolcha town, Northeast Ethiopia [36]. Children with a history of fever in the last two weeks were 2.8 times more likely to be anemic compared to those without fever (AOR=2.781, 95% CI=1.846-4.192), similar to findings in the Somali region, eastern Ethiopia [12] and the 2016 Ethiopia Demographic and Health Survey [44]. Children without deworming medication were 1.5 times more likely to be anemic compared to those who received it (AOR=1.600, 95% CI=1.073-2.385). This aligns with study report documented from Hargeisa city, Somaliland [3], Ethiopia [35]. LIMITATION Despite the comprehensive analysis presented in this study, several limitations should be considered. First, the cross-sectional design of the study restricts the ability to establish causality between identified risk factors and the prevalence of anemia among internally displaced persons (IDP) children under five. Second, the reliance on self-reported data for variables such as dietary practices and illness history introduces potential recall bias. Third, the findings are geographically specific to the Daynile IDP camps, limiting their generalizability to broader populations or other settings. Fourth, the lack of longitudinal data hinders understanding of how anemia prevalence and associated risk factors evolve over time within IDP communities. Finally, the study did not include malaria and HIV tests or stool examinations for parasitic infections, which could explain some of the findings. CONCLUSION The study highlights a severe public health issue with a high prevalence of anemia among children under five based on WHO cut off values, significantly higher than previous findings in Somalia and comparable regions. Most cases were moderate anemia, followed by mild and severe forms, predominantly microcytic-hypochromic. Several socio-demographic factors influence anemia prevalence, including age, sex, maternal age, and place of delivery. Younger children, male children, and those born at home were more susceptible, while older maternal age lowers risk due to better caregiving practices. Health and nutritional factors also play a crucial role in anemia risk. Non-exclusive breastfeeding, early complementary feeding, lack of iron supplements, low dietary diversity, recent illness, and absence of deworming medication significantly increase anemia prevalence. These findings underscore the need for comprehensive public health interventions, such as promoting exclusive breastfeeding, ensuring iron supplement access, improving dietary diversity, and enhancing healthcare services to reduce infection risks and improve maternal and child health practices. Abbreviations AOR Adjusted Odds Ratio CBC Complete Blood Count CI Confidence Interval Hb Hemoglobin IDP Internally Displaced People IQR Inter-quartile range Declarations Ethics declaration and consent to participate Ethical approval for this study was obtained from the Ethical Review Committee of Jazeera University, with ethical clearance reference number JU/MD/Res008/2022. The study was conducted in accordance with the Declaration of Helsinki. An official letter of support was provided to the camp administration to facilitate cooperation and authorize the study on anemia among under-five children in internally displaced camps in Mogadishu, Somalia. Informed consent was obtained from the mothers or caregivers of the participating children. The researchers clearly explained the study procedures, ensuring that participants' dignity, identity, and confidentiality were protected. Participation was voluntary, and participants were informed of their right to withdraw from the study at any time without any consequences. Clinical trial number: not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding The study received no funding from any agency. Author contribution Abas Mohamed Sharif, the corresponding author, was responsible for the study design, data analysis, interpretation of results, and manuscript preparation. Dr. Lul Mohamud Mohamed supervised data collection, verified laboratory results, reviewed and edited the manuscript. Dr. Anas Salad Mohamed, Dr. Abdikarim Abdullahi Mohamed, Dr. Zahra Mohamed Nur, Dr. Nasra Abdullahi Yusuf and Dr. Ifrah Abdirahman Ahmed conducted data collection, performed laboratory investigations, handled data entry, and carried out the preliminary analysis. Mohamed Hayir Tahlil Mohamud reviewed and edited the manuscript. All authors contributed to the writing, reading, and approval of the final manuscript. Acknowledgements We appreciate all the investigators’ efforts in data collection. We acknowledge all Jazeera University Hospital laboratory technicians for their helpful guidance and consultants. Special thanks to the executives of the IDP settlements who gave permission and released their members to assist where necessary. Lastly thanks to all study participants. References Turner, J., Parsi, M., Madhu, ;, & Affiliations, B. (2022). 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Anemia and associated factors among children aged 6 – 23 months in Damot Sore . 1–9. Elmardi, K. A., Adam, I., Malik, E. M., Ibrahim, A. A., Elhassan, A. H., Kafy, H. T., Nawai, L. M., & Abdin, M. S. (2020). Anaemia prevalence and determinants in under 5 years children : findings of a cross- sectional population-based study in Sudan . 1–14. Kuziga, F., Adoke, Y., & Wanyenze, R. K. (2017). Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: A cross- sectional study. BMC Pediatrics , 17 (1), 1–9. https://doi.org/10.1186/s12887-017-0782-3 Sirdah MM, Yaghi A, Yaghi AR: Iron deficiency anemia among kindergarten children living in the marginalized areas of Gaza Strip, Palestine. Revista brasileira de hematologia e hemoterapia 2014, 36:132–138. doi: 10.5581/1516-8484.20140030 Tadesse, S. E., Zerga, A. A., Mekonnen, T. C., Tadesse, A. W., Hussien, F. M., Feleke, Y. W., Anagaw, M. Y., & Ayele, F. Y. (2022). Burden and Determinants of Anemia among Under-Five Children in Africa : Systematic Review and Meta-Analysis . 2022 . Sumbele IUN, Asoba GN, Teh RN, Metuge S, Anchang-Kimbi JK, Nkuo-Akenji T: Burden of moderate to severe anaemia and severe stunting in children < 3 years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study. BMC Pediatrics 2020, 20(1):396. Zhao A, Zhang Y, Peng Y, Li J, Yang T, Liu Z, et al.: Prevalence of anemia and its risk factors among children 6–36 months old in Burma. The American journal of tropical medicine and hygiene 2012, 87(2):306–311. doi: 10.4269/ajtmh.2012.11-0660 Jemal Y, Haidar J, Makau WK: The magnitude and determinants of anaemia among refugee preschool children from the Kebribeyah refugee camp, Somali region, Ethiopia. South African Journal of Clinical Nutrition 2017, 30(1):1–6. Ajakaye OG, Ibukunoluwa MR: Prevalence and risk of malaria, anemia and malnutrition among children in IDPs camp in Edo State, Nigeria. Parasite Epidemiology and Control 2020, 8:e00127. doi: 10.1016/j.parepi.2019.e00127 Kemmer TM, Bovill ME, Kongsomboon W, Hansch SJ, Geisler KL, Cheney C, et al.: Iron deficiency is unacceptably high in refugee children from Burma. The Journal of nutrition 2003, 133(12):4143–4149. doi: 10.1093/jn/133.12.4143 District, G., Oyet, C., & Webbo, F. (2018). Prevalence , morphological characterization , and associated factors of anemia among children below 5 years of age attending St . Mary ’ s Hospital . 195–201. Awuor, S. O., Eric, O. O., Musyoki, S., Daud, I. I., Nyangaresi, R. O., Mugah, P., & Mukunzi, B. (2021). Morphological patterns of anemia among under five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu county, Kenya. Journal of Clinical Images and Medical Case Reports , 2 (2). https://doi.org/10.52768/2766-7820/1048 Adu-amankwaah, J., Allotey, E. A., Kwasie, D. A., Afeke, I., Owiafe, P. K., Adiukwu, P. C., & Ndudiri, O. V. (2018). Prevalence and Morphological Types of Anaemia among Children Under-Five Years in the Volta Regional Hospital of Ghana . 5 , 1–10. https://doi.org/10.4236/oalib.1104351 Ewusie, J. E., Ahiadeke, C., Beyene, J., & Hamid, J. S. (2014). Prevalence of anemia among under-5 children in the Ghanaian population: Estimates from the Ghana demographic and health survey. BMC Public Health , 14 (1), 1–9. https://doi.org/10.1186/1471-2458-14-626 Mamabolo, R. L., Alberts, M., Africa, S., Sciences, M., Campus, T., Africa, S., Mamabolo, R., Africa, S., & Commons, C. (2014). Prevalence of anaemia and its associated factors in African children at one and three years residing in the Capricorn District of Limpopo Province , South Africa . 1–9. https://doi.org/110.4102/curationis.v37i1.1160 Kisiangani, I., Fl Mbakaya, C., Makokha, A., Mbakaya, C., & Makokha, A. (2015). Prevalence of Anaemia and Associated Factors Among Preschool Children (6-59 Months) in Western Province, Kenya. Public Health and Preventive Medicine , 1 (1), 28–32. http://www.publicscienceframework.org/journal/phpmhttp://creativecommons.org/licenses/by-nc/4.0/ Fentaw, W., Belachew, T., & Andargie, A. (2023). Anemia and associated factors among 6 to 59 months age children attending health facilities in Kombolcha town, Northeast Ethiopia: a facility-based cross-sectional study. BMC Pediatrics , 23 (1), 1–9. https://doi.org/10.1186/s12887-023-04031-z Melku, M., Alene, K. A., Terefe, B., Enawgaw, B., Biadgo, B., Abebe, M., Muchie, K. F., Kebede, A., Melak, T., & Melku, T. (2018). Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: A community-based cross-sectional study. Italian Journal of Pediatrics , 44 (1), 1–12. https://doi.org/10.1186/s13052-018-0547-0 Saldiva S. R. D. M., Venancio S. I., Gouveia A. G. C., Castro A. L. D. S., Escuder M. M. L., Giugliani E. R. J. Regional influence on early consumption of foods other than breast milk in infants less than 6 months of age in Brazilian State capitals and the Federal District. Cadernos de Saude Publica . 2011;27(11):2253–2262. doi: 10.1590/S0102-311X2011001100018. Oski F. A., Landaw S. A. Inhibition of iron absorption from human milk by baby food. The American Journal of Diseases of Children . 1980;134(5):459–460. Meinzen-Derr J. K., Guerrero M. L., Altaye M., Ortega-Gallegos H., Ruiz-Palacios G. M., Morrow A. L. Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. Journal of Nutrition . 2006;136(2):452–458. Berglund, S. K., Westrup, B., & Domellöf, M. (2015). Iron supplementation until 6 months protects marginally low-birth-weight infants from iron deficiency during their first year of life. Journal of Pediatric Gastroenterology and Nutrition , 60 (3), 390–395. https://doi.org/10.1097/MPG.0000000000000633 Pasricha, S. R., Hayes, E., Kalumba, K., & Biggs, B. A. (2013). Effect of daily iron supplementation on health in children aged 4-23 months: A systematic review and meta-analysis of randomised controlled trials. The Lancet Global Health , 1 (2), e77–e86. https://doi.org/10.1016/S2214-109X(13)70046-9 WHO. (2023). Daily iron supplementation in children 6-23 months of age . https://www.who.int/tools/elena/interventions/iron-children-6to23 Sorsa, A., Habtamu, A., & Kaso, M. (2021). Prevalence and Predictors of Anemia Among Children Aged 6–23 Months in Dodota District, Southeast Ethiopia: A Community-Based Cross-Sectional Study. Pediatric Health, Medicine and Therapeutics , Volume 12 , 177–187. https://doi.org/10.2147/phmt.s293261 Gebrehaweria, M., Gebremeskel, & Tirore, L. L. (2020). Factors Associated with Anemia Among Children 6 – 23 Months of Age in Ethiopia : A Multilevel Analysis of Data from the 2016 Ethiopia Demographic and Health Survey . 347–357. Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files TablesAnemiaamongUnderFiveChildreninInternallyDisplacedCampsinMogadishuSomalia.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5358174","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374497441,"identity":"59025e94-4dec-41a0-b517-2d21552523d6","order_by":0,"name":"Abas Mohamed 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09:03:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21710,"visible":true,"origin":"","legend":"","description":"","filename":"TablesAnemiaamongUnderFiveChildreninInternallyDisplacedCampsinMogadishuSomalia.docx","url":"https://assets-eu.researchsquare.com/files/rs-5358174/v1/fb7ab308970af9af58ce8786.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anemia among Under-Five Children in Internally Displaced Camps in Mogadishu, Somalia: A Cross-Sectional Study on Prevalence, Severity, and Associated Risk Factors","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAnemia is defined as lower than normal hemoglobin (Hb) concentration, hematocrit, or red blood cell count per liter compared to healthy individuals of the same age, sex, race, and environmental conditions\u0026nbsp;[1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildhood anemia is prevalent in developed and underdeveloped nations, significantly increasing morbidity and mortality rates among children under the age of five\u0026nbsp;[2]. It adversely affects physical, social, and mental development, leading to immune system issues, delayed motor and cognitive skills, academic struggles, and reduced productivity, all of which can limit children\u0026apos;s earning potential and hinder economic growth\u0026nbsp;[3].\u003c/p\u003e\n\u003cp\u003eAnemia, a multi-factorial health issue, is influenced by various risk factors. In children, common causes include inadequate intake and poor absorption of iron-rich foods, such as meat, alongside acute blood loss, and inherited or acquired disorders\u0026nbsp;[4,5]. Additionally, micronutrient deficiencies, consumption of iron absorption inhibitors like tea and coffee, and increased intake of absorption enhancers such as vitamin C contribute to anemia\u0026nbsp;[6]. Other nutritional factors like calcium, along with infectious diseases like malaria and hookworm infestations, further compound the risk\u0026nbsp;[7]. Socio-demographic factors, including child age, sex, place of residence, maternal age, and education level, also play pivotal roles in predisposing children under five to anemia\u0026nbsp;[6].\u003c/p\u003e\n\u003cp\u003eA total of 269 million children worldwide aged 6\u0026ndash;59 months had anemia in 2019, representing 39.8% of this demographic [8]. The African Region exhibits the highest prevalence, with 60.2% of children under five affected\u0026nbsp;[9]. Additionally, South Asian regions reported higher prevalence rates, with 55.12% in 2016 and 52% in 2019\u0026nbsp;[10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData on anemia in Somali children was first assessed over a decade ago in a national survey conducted in 2009, revealing an overall prevalence of 59.3% among 784 children sampled from 30 clusters and tested using the HemoCue. A follow-up survey in 2019 reported a prevalence of 43.4% among 1675 children, also assessed using the HemoCue\u0026nbsp;[11]. Specific data from Hargeisa City, Somaliland, showed an overall prevalence of 49.4% among under-five children attending public health facilities\u0026nbsp;[3]. In neighboring areas, such as the Shebelle Zone, Somali Region, Eastern Ethiopia, the prevalence was notably high at 72% among under-five children\u0026nbsp;[12].\u003c/p\u003e\n\u003cp\u003eRisk factors for anemia in Somali children identified from these studies include iron and vitamin A deficiencies, malaria, poor sanitary conditions, lack of deworming, recent illness (e.g., diarrhea, fever), child\u0026apos;s age and sex, mother\u0026apos;s educational level, and timing of complementary feeding\u0026nbsp;[3,11,12].\u003c/p\u003e\n\u003cp\u003eChildren in refugee camps and emergency areas face an extremely vulnerability to anemia and other micronutrient deficiencies due to various factors, including inadequate food supplies, limited access to healthcare, unhealthy environments, poor feeding practices, overcrowding, insufficient clean water, increased exposure to diseases, and a lack of specialized services\u0026nbsp;[13]. Dependence on food aid can worsen these issues, particularly for those in long-term camp settings. In Somalia, approximately 2.6 million people are internally displaced, with a significant concentration, about half a million, in Mogadishu\u0026nbsp;[14,15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApart from nationwide survey data, there is limited data, especially regional data in southern Somalia, which can provide details on the prevalence of anemia and associated risk factors among children less than five years of age, therefore, this study aimed to assess the prevalence, severity, and associated factors of anemia among under-five children in IDPs in Mogadishu, Somalia.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community-based cross-sectional study was conducted in Daynile district, which is one of 17 districts in Benadir region, Somalia, where most displaced settlement are located to determine the prevalence, severity and risk factors of anemia among under-five children from October 2022 to September 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size calculation was determined using the single proportion formula (n = [(Z\u003csub\u003eα/2\u003c/sub\u003e)\u003csup\u003e2\u003c/sup\u003e × (1-p)]/d2) with a 95% confidence level, 5% margin of error, and a 43.4% prevalence of anemia in Somali children based on findings from the 2019 Somalia Micronutrient Survey [11]. After adjusting for 15% non-response, a total of 445 samples were computed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling techniques\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sampling procedure for these study involved multistage cluster sampling. In the first stage, the district of Daynile was selected purposively. Out of 450 camps in Daynile, 50 were randomly selected. In the final stage, households in the selected IDP camps were selected through systematic random sampling with kth = 14. Where households had more than one under-five-year-old child, only one child was randomly selected using the lottery method to exclude duplication of results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome variable of this study is Anemia, in this study a child is\u0026nbsp;considered as an anemic if the hemoglobin level is less than 11g/dl.\u0026nbsp;On the bases of its severity, anemia was categorized as severe anemia (\u0026lt; 7.0 g/dl), Moderate anemia (7.0 9.9 g/dl) and Mild anemia (10.0-10.9 g/dl) (16).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic variables\u003c/strong\u003e Included were Sex (male, female), Age of child (≤ 24 and \u0026gt; 24 months) , age of mother/caregiver (16-27 , 28-37 and \u0026gt; 38 Years) , educational status (Illiterate, Quran, Primary, Secondary and above), Marital status (Married, Divorced, and Widow), Parity (Primiparous, Multiparous and Grand Multipara), Birth space (\u0026lt; 2 and \u0026nbsp;≥ 24 years), Place of birth (Home, Hospital and MCH), family size (\u0026lt; 5 and \u0026nbsp;≥ 5), and daily family income (≤ $1 dollar, $2-3 dollars and \u0026gt; $3 dollars).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Related factors i\u003c/strong\u003encluded were History of Malarial infection (Yes and No), History of diarrhea (Yes and No), History of Fever and Deworming or anti helminthic treatment (Albendazole) (Yes and No).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutritional Status factors i\u003c/strong\u003encluded were Iron supplementation (Yes and No), Vitamin A supplementation (Yes and No), Exclusive breast-feeding (6 months and \u0026lt; 6 months), Introduction time of Complementary feeding (at 6, \u0026gt; 6 and \u0026lt; 6 months), and Dietary diversity score (Below 4 and 4and above).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected through face-to-face interviews with the mothers or caregiver of the child using a pretested open and closed questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp; \u0026nbsp;Specimen collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo milliliters of venous blood were drawn by a qualified nurse under sterile conditions and placed into EDTA anticoagulant tubes, mixed for 5 minutes, and labeled with the participant's ID. These samples were then analyzed by technicians at Jazeera University Hospital Lab, and the results were recorded. Anemia was defined according to WHO criteria\u0026nbsp;[16], with severity classified as mild, moderate, or severe. Additional sub-classification was based on red blood cell indices such as MCV and MCH, where a higher, normal, or lower MCV indicates macrocytic, normocytic, or microcytic average RBC, respectively. Similarly, a normal or decreased MCH often suggests that the RBC is either normochromic or hypochromic.\u003c/p\u003e\n\u003cp\u003eNormal MCV with normal MCH but low Hb indicates normocytic normochromic anemia; normal MCV with decreased MCH tends to show normocytic hypochromic anemia; decreased MCV with normal MCH indicates microcytic normochromic anemia; and decreased MCV with decreased MCH indicates microcytic hypochromic anemia.\u003c/p\u003e\n\u003cp\u003eChildren with mild to moderate anemia received iron supplements and health education, while those with severe anemia were referred to Benadir Hospital for further investigations and treatments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe normal reference ranges for the RBC indices of MCV and MCH are shown in\u0026nbsp;Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive and inferential methods were employed for data analysis. Categorical variables were presented as frequencies and proportions, while quantitative variables were described using median (range). Prevalence rates were estimated with a 95% confidence interval, and chi-square tests were used to identify associations between qualitative variables. Multivariable logistic regression analysis was carried out by including variables with p \u0026lt; 0.2 from bivariable logistic regression. Finally, the strength of association was measured by adjusted odds ratios with a 95% confidence interval (CI) for exposure variables and the outcome variable (Anemia). P-value\u0026lt; 0.05 was regarded statistically significant in all conditions of the analysis. All statistical analyses were performed using the IBM statistical Package for Social Science (IBM SPSS).\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eData from \u003cstrong\u003e435\u003c/strong\u003e study participants were included in the analysis out of 445 calculated samples, with 97.8% response rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows that\u0026nbsp;the majority of children (253, 58.2%) were aged 25-59 months, with slightly more females (235, 52.9%) than males (205, 47.1%). Over half (51.7%) of mothers/caregivers were aged 28-37 years. Regarding marital status, most were married (338, 77.7%), followed by divorced (79, 18.2%) and widowed (16, 4.1%). Educationally, over two-thirds (318, 73%) of mothers/caregivers had no formal education. Parity analysis revealed a majority of grand multiparous mothers (257, 59.1%), followed by multiparous (167, 38.4%) and a small primiparous group (10, 2.5%). Birth spacing showed nearly half (228, 52.4%) with short intervals (\u0026lt;2 years). Home deliveries were most frequent (343, 78.9%), with health facilities used by a smaller portion (62, 14.3%). Most families (320, 73.6%) had a daily income of 2-3 dollars. Lastly, family size analysis indicated a majority of households with 5 or more members (381, 87.6%).\u003c/p\u003e\n\u003ch3\u003ePrevalence and severity pattern of Anemia among study participants\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe overall prevalence of anemia in under five year children Internally Displaced camps of Mogadishu, Somalia was found to be was 62.5%, as shown in Table 3. Among these anemic children, the severity distribution showed (147, 33.8%) with moderate anemia, (108, 24.8%) with mild anemia, and a smaller portion (17, 3.9%) with severe anemia.\u003c/p\u003e\n\u003ch3\u003eMorphologic classification of anemic children among study participants\u003c/h3\u003e\n\u003cp\u003eAn analysis of morphological characteristics of anemic children Table 4 revealed Microcytic hypochromic anemia as the most prevalent type, affecting (243, 89.3%) of children, followed by Normocytic normochromic anemia (15, 5.5%), Normocystic hypochromic anemia (8, 3%) and Microcytic normochromic anemia was identified in a smaller portion (6, 2.2%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;logistic regression analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multivariate logistic regression analysis in Tables 5 revealed a complex interplay between child characteristics, dietary factors, and health issues influencing childhood anemia risk. Children ≤ 24 months (AOR=2.326, 95% CI=1.540-3.513, P-value \u0026lt;0.001) and males (AOR=1.734, 95% CI=1.168-2.574, P-value=0.006) were more likely to be anemic. Deliveries at healthcare institutions were associated with a lower risk of anemia compared to home births (AOR=4.281, 95% CI=1.901-9.639, P-value \u0026lt;0.001). Interestingly, children born to older mothers had a lower risk of anemia (AOR=0.544, 95% CI=0.353-0.837, P-value=0.006).\u003c/p\u003e\n\u003cp\u003eDeficient dietary practices also significantly increased the risk of anemia, Children not receiving exclusive breastfeeding (AOR=2.018, 95% CI=1.327-3.068, P-value=0.001) and those with early introduction of complementary foods (before 6 months) (AOR=2.085, 95% CI=1.356-3.206, P-value \u0026lt;0.001) were more likely to be anemic. Lack of iron supplementation also had a strong association (AOR=2.447, 95% CI=1.596-3.751, P-value \u0026lt;0.001). Additionally, low dietary diversity scores, indicating a limited variety of foods consumed (AOR=5.794, 95% CI=3.071-10.932, P-value \u0026lt;0.001), were associated with a higher likelihood of anemia.\u003c/p\u003e\n\u003cp\u003eFinally, health factors also played a role, Children with a history of recent diarrhea (AOR=3.201, 95% CI=2.132-4.806, P-value \u0026lt;0.001) or fever (AOR=2.781, 95% CI=1.846-4.192, P-value \u0026lt;0.001) in the past few weeks were more likely to be anemic. Moreover, not receiving deworming medication also contributed to a greater risk of anemia (AOR=1.600, 95% CI=1.073-2.385, P-value=0.021).\u003c/p\u003e"},{"header":"DISCUSSIONS","content":"\u003cp\u003eThe continued collection of data on anemia prevalence is crucial for public health, given its association with morbidity and mortality, especially among vulnerable populations like displaced children [17]. The overall prevalence of anemia in this study was 62.5% (95% CI: 58.5\u0026ndash;67.5%), which is considered a serious public health issue by WHO [18]. This is higher than the 43.4% reported in a 2019 nationwide survey in Somalia [11]\u0026nbsp;and the 49.4% found in Hargeisa City, Somaliland [3]. Other studies reported lower rates, such as 52.6% in southern Ethiopia [19]\u0026nbsp;and 49.4% in Sudan [20].\u003c/p\u003e\n\u003cp\u003eThe discrepancies in anemia prevalence could be due to differences in study areas, limited access to healthcare, overcrowding, and dependence on food aid, particularly in long-term camp settings. The findings in this study are similar to the 60.2% anemia prevalence among children in Africa reported by WHO [8], 58.8% in Namutumba district, Uganda [21], 59.7% in Jablia refugee camp, Palestinian territory [22], and 59% from a systematic review in Africa [23].\u003c/p\u003e\n\u003cp\u003eHowever, the current finding is lower than studies conducted in African IDPs and refugee camps such as Cameroon (84.0%) [24], Burma (72.6%) [25], the Shebelle zone, eastern Ethiopia (72%) [12], and Arusha District, Tanzania (84.6%) [4]. The lower anemia prevalence in our study may be due to the high infection burden and geographical differences in the previous studies.\u003c/p\u003e\n\u003cp\u003eIn our study, the majority of anemic children under five had moderate anemia (33.8%), followed by mild anemia (24.8%) and severe anemia (3.9%). This distribution is similar to studies in Kebribeyah refugee camp, Somali region of eastern Ethiopia (48.1%) [26], Edo state, Nigeria (36%) [27], and Cameroon (52.4%) [24], which also showed a higher prevalence of moderate anemia. However, the prevalence of severe anemia in our findings (3.9%) is lower than in studies conducted in Myanmar (10.9%) [25]\u0026nbsp;and Burma refugee camps (10.4%) [28]. This difference may be due to different Hb cutoff values for severe anemia (7 mg/dl in our study vs. 8 mg/dl in others) and higher infection burdens, such as malaria, in the other studies.\u003c/p\u003e\n\u003cp\u003eOur study revealed that the predominant morphological form of anemia was microcytic-hypochromic (89.3%), followed by normocytic normochromic anemia (5.5%). These findings are consistent with studies conducted in Uganda [29], Kenya [30], and Ghana [31], which also showed a high prevalence of microcytic-hypochromic anemia among children under five.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSocio-demographic factors play a significant role in determining anemia among children. In this study, the child\u0026apos;s age, sex, the mother\u0026apos;s age, and place of delivery were significantly associated with anemia in children.\u003c/p\u003e\n\u003cp\u003eChildren under the age of two years were 2.3 times more likely to have anemia compared to children aged two to five years (AOR: 2.3; 95% CI: 1.540-3.513). This aligns with research from Sudan [20], Ethiopia [19], and Ghana [32], indicating that the first two years of life are critical for anemia vulnerability due to factors like iron store depletion by six months [21]\u0026nbsp;and increased susceptibility to infections [19]. Rapid physical growth and the introduction of nutritionally poor complementary foods may also contribute to this heightened risk [4]. Older children tend to have a more diverse diet, reducing their anemia risk [32].\u003c/p\u003e\n\u003cp\u003eThere was a significant disparity in anemia prevalence between male and female children, with males being 1.7 times more likely to be anemic (AOR: 1.7; 95% CI: 1.168-2.574). This finding aligns with studies from South Africa [33], eastern Ethiopia [12], and Kenya [34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildren born to older mothers had a lower risk of anemia, likely due to greater maternal experience and improved caregiving practices. This finding supports a study conducted in Northeast Ethiopia [35], which indicates that maternal age influences the quality of care and feeding techniques, reducing malnutrition risk.\u003c/p\u003e\n\u003cp\u003eChildren born at home were 1.8 times more likely to be anemic compared to those born at health institutions (AOR: 1.8; 95% CI: 1.074-2.912), echoing findings from Ethiopia [35]. Institutional delivery improves maternal health and infant care practices, reducing anemia risk. Other socio-demographic factors like mother\u0026rsquo;s educational level, occupation, family income, parity, and marital status were not significant predictors of anemia in this study.\u003c/p\u003e\n\u003cp\u003eHealth and nutritional related factors also play an important role in determining anemia in children under five by increasing iron requirements or depleting its stores.\u003c/p\u003e\n\u003cp\u003eThis community-based cross-sectional study found a significant association between anemia and a lack of exclusive breastfeeding during the first six months of life. Breastfed babies for less than six months were 2 times more likely to be anemic compared to those exclusively breastfed (AOR=2.018, 95% CI=1.327-3.068). Similarly, children receiving complementary foods before six months of age were 2 times more likely to be anemic compared to those who received complementary feeding at six months (AOR=2.085, 95% CI=1.356-3.206). Most digestive enzymes are inadequate until six months [37], and introducing food during this time can interfere with iron absorption from breast milk [38]. Early exposure to microbial pathogens through complementary foods increases the risk of infection and malabsorption, contributing to anemia [39].\u003c/p\u003e\n\u003cp\u003eChildren who did not receive iron supplements were 2.4 times more likely to be anemic compared to those who did (AOR=2.447, 95% CI=1.596-3.751). Although there are no studies directly linking anemia and lack of iron supplements, evidence suggests that daily iron supplementation in babies aged 6 to 23 months lowers their anemia risk\u0026nbsp;[40, 41 \u0026amp; 42]. Similarly, children scoring below 4 in dietary diversity were 5.8 times more likely to be anemic compared to those scoring 4 and above (AOR=5.794, 95% CI=3.071-10.932), consistent with a study in South Ethiopia\u0026nbsp;[35]. Dietary diversity is a good proxy for micronutrient adequacy; a lack of it increases the likelihood of childhood anemia\u0026nbsp;[35].\u003c/p\u003e\n\u003cp\u003eChildren with a history of diarrhea in the last two weeks were three times more likely to be anemic compared to those without (AOR=3.201, 95% CI=2.132-4.806), aligning with studies in Hargeisa City, Somaliland\u0026nbsp;[3], and Kombolcha town, Northeast Ethiopia\u0026nbsp;[36].\u003c/p\u003e\n\u003cp\u003eChildren with a history of fever in the last two weeks were 2.8 times more likely to be anemic compared to those without fever (AOR=2.781, 95% CI=1.846-4.192), similar to findings in the Somali region, eastern Ethiopia\u0026nbsp;[12]\u0026nbsp;and the 2016 Ethiopia Demographic and Health Survey\u0026nbsp;[44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildren without deworming medication were 1.5 times more likely to be anemic compared to those who received it (AOR=1.600, 95% CI=1.073-2.385). This aligns with study report documented from Hargeisa city, Somaliland\u0026nbsp;[3], Ethiopia\u0026nbsp;[35].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the comprehensive analysis presented in this study, several limitations should be considered. \u003cstrong\u003eFirst,\u003c/strong\u003e the cross-sectional design of the study restricts the ability to establish causality between identified risk factors and the prevalence of anemia among internally displaced persons (IDP) children under five. \u003cstrong\u003eSecond,\u003c/strong\u003e the reliance on self-reported data for variables such as dietary practices and illness history introduces potential recall bias. \u003cstrong\u003eThird,\u003c/strong\u003e the findings are geographically specific to the Daynile IDP camps, limiting their generalizability to broader populations or other settings. \u003cstrong\u003eFourth,\u003c/strong\u003e the lack of longitudinal data hinders understanding of how anemia prevalence and associated risk factors evolve over time within IDP communities. \u003cstrong\u003eFinally,\u003c/strong\u003e the study did not include malaria and HIV tests or stool examinations for parasitic infections, which could explain some of the findings.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe study highlights a severe public health issue with a high prevalence of anemia among children under five based on WHO cut off values, significantly higher than previous findings in Somalia and comparable regions. Most cases were moderate anemia, followed by mild and severe forms, predominantly microcytic-hypochromic. Several socio-demographic factors influence anemia prevalence, including age, sex, maternal age, and place of delivery. Younger children, male children, and those born at home were more susceptible, while older maternal age lowers risk due to better caregiving practices.\u003c/p\u003e\n\u003cp\u003eHealth and nutritional factors also play a crucial role in anemia risk. Non-exclusive breastfeeding, early complementary feeding, lack of iron supplements, low dietary diversity, recent illness, and absence of deworming medication significantly increase anemia prevalence. These findings underscore the need for comprehensive public health interventions, such as promoting exclusive breastfeeding, ensuring iron supplement access, improving dietary diversity, and enhancing healthcare services to reduce infection risks and improve maternal and child health practices.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplete Blood Count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHb\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIDP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternally Displaced People\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInter-quartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declaration and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Ethical Review Committee of Jazeera University, with ethical clearance reference number JU/MD/Res008/2022. The study was conducted in accordance with the Declaration of Helsinki. An official letter of support was provided to the camp administration to facilitate cooperation and authorize the study on anemia among under-five children in internally displaced camps in Mogadishu, Somalia.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the mothers or caregivers of the participating children. The researchers clearly explained the study procedures, ensuring that participants' dignity, identity, and confidentiality were protected. Participation was voluntary, and participants were informed of their right to withdraw from the study at any time without any consequences. Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding from any agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbas Mohamed Sharif, the corresponding author, was responsible for the study design, data analysis, interpretation of results, and manuscript preparation. Dr. Lul Mohamud Mohamed supervised data collection, verified laboratory results, reviewed and edited the manuscript. Dr. Anas Salad Mohamed, Dr. Abdikarim Abdullahi Mohamed, Dr. Zahra Mohamed Nur, Dr. Nasra Abdullahi Yusuf and Dr. Ifrah Abdirahman Ahmed conducted data collection, performed laboratory investigations, handled data entry, and carried out the preliminary analysis. Mohamed Hayir Tahlil Mohamud reviewed and edited the manuscript. All authors contributed to the writing, reading, and approval of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate all the investigators’ efforts in data collection. We acknowledge all Jazeera University Hospital laboratory technicians for their helpful guidance and consultants. Special thanks to the executives of the IDP settlements who gave permission and released their members to assist where necessary. Lastly thanks to all study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTurner, J., Parsi, M., Madhu, ;, \u0026amp; Affiliations, B. (2022). Anemia Continuing Education Activity. https://www.ncbi.nlm.nih.gov/books/NBK499994/?report=printable\u003c/li\u003e\n\u003cli\u003eChaparro CM, Suchdev PS: Anemia epidemiology, pathophysiology, and etiology in low-and middle-income countries. \u003cem\u003eAnnals of the new York Academy of Sciences\u003c/em\u003e 2019, 1450(1):15. doi: 10.1111/nyas.14092\u003c/li\u003e\n\u003cli\u003eIbrahim Muhumed, M. (2022). Prevalence of Anemia and Associated Factors Among Under Five Children Attending Public Health Facilities in Hargeisa City, Somaliland 2020. \u003cem\u003eScience Journal of Public Health\u003c/em\u003e, 10(2), 92. https://doi.org/10.11648/j.sjph.20221002.14\u003c/li\u003e\n\u003cli\u003eKejo, D., Petrucka, P., Martin, H., Kimanya, M., \u0026amp; Mosha, T. (2018). 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H., Alrahabi, L. M., Thabit, J. M., Al-Bahloul, S. M., Alwashali, F. A., Al-Qhali, R. M., Morshed, M. M., Al\u003cspan dir=\"RTL\"\u003eـ\u003c/span\u003eHossainy, A. S., Al-Maflhi, E. A., \u0026amp; Al-Sufi, N. H. (2023). Prevalence of Intestinal Parasites, Malnutrition, Anemia and Their Risk Factors Among Orphaned Children in Sana\u0026rsquo;a City, Yemen. Universal Journal of Pharmaceutical Research, May. https://doi.org/10.22270/ujpr.v8i2.923\u003c/li\u003e\n\u003cli\u003eSunuwar, D. R., Singh, D. R., Pradhan, P. M. S., Shrestha, V., Rai, P., Shah, S. K., \u0026amp; Adhikari, B. (2023). Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis. BMC Public Health, 23(1), 1\u0026ndash;17. https://doi.org/10.1186/s12889-023-15265-y\u003c/li\u003e\n\u003cli\u003eWirth, J. P., Sesay, F., Mbai, J., Ali, S. I., Donkor, W. E. S., Woodruff, B. A., Pilane, Z., Mohamud, K. M., Muse, A., Yussuf, H. O., Mohamed, W. 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Vitamin and Mineral Nutrition Information System.Geneva: World Health Organization; 2011. p. 1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eKay A, Leidman E, Lopez V, Wilkinson C, Tondeur M, Bilukha O: The burden of anaemia among displaced women and children in refugee settings worldwide, 2013\u0026ndash;2016. \u003cem\u003eBMJ global health\u003c/em\u003e 2019, 4(6):e001837. doi: 10.1136/bmjgh-2019-001837\u003c/li\u003e\n\u003cli\u003eWHO. (2008). \u003cem\u003eAnaemia\u003c/em\u003e. https://www.who.int/data/nutrition/nlis/info/anaemia\u003c/li\u003e\n\u003cli\u003eZone, W., Malako, B. G., Teshome, M. S., \u0026amp; Belachew, T. (2018). \u003cem\u003eAnemia and associated factors among children aged 6 \u0026ndash; 23 months in Damot Sore\u003c/em\u003e. 1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eElmardi, K. A., Adam, I., Malik, E. M., Ibrahim, A. A., Elhassan, A. H., Kafy, H. T., Nawai, L. M., \u0026amp; Abdin, M. S. (2020). \u003cem\u003eAnaemia prevalence and determinants in under 5 years children : findings of a cross- sectional population-based study in Sudan\u003c/em\u003e. 1\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eKuziga, F., Adoke, Y., \u0026amp; Wanyenze, R. K. (2017). Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: A cross- sectional study. \u003cem\u003eBMC Pediatrics\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1186/s12887-017-0782-3\u003c/li\u003e\n\u003cli\u003eSirdah MM, Yaghi A, Yaghi AR: Iron deficiency anemia among kindergarten children living in the marginalized areas of Gaza Strip, Palestine. \u003cem\u003eRevista brasileira de hematologia e hemoterapia\u003c/em\u003e 2014, 36:132\u0026ndash;138. doi: 10.5581/1516-8484.20140030\u003c/li\u003e\n\u003cli\u003eTadesse, S. E., Zerga, A. A., Mekonnen, T. C., Tadesse, A. W., Hussien, F. M., Feleke, Y. W., Anagaw, M. Y., \u0026amp; Ayele, F. Y. (2022). \u003cem\u003eBurden and Determinants of Anemia among Under-Five Children in Africa : Systematic Review and Meta-Analysis\u003c/em\u003e. \u003cem\u003e2022\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eSumbele IUN, Asoba GN, Teh RN, Metuge S, Anchang-Kimbi JK, Nkuo-Akenji T: Burden of moderate to severe anaemia and severe stunting in children \u0026lt; 3 years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study. \u003cem\u003eBMC Pediatrics\u003c/em\u003e 2020, 20(1):396.\u003c/li\u003e\n\u003cli\u003eZhao A, Zhang Y, Peng Y, Li J, Yang T, Liu Z, et al.: Prevalence of anemia and its risk factors among children 6\u0026ndash;36 months old in Burma. \u003cem\u003eThe American journal of tropical medicine and hygiene\u003c/em\u003e 2012, 87(2):306\u0026ndash;311. doi: 10.4269/ajtmh.2012.11-0660\u003c/li\u003e\n\u003cli\u003eJemal Y, Haidar J, Makau WK: The magnitude and determinants of anaemia among refugee preschool children from the Kebribeyah refugee camp, Somali region, Ethiopia. \u003cem\u003eSouth African Journal of Clinical Nutrition\u003c/em\u003e 2017, 30(1):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eAjakaye OG, Ibukunoluwa MR: Prevalence and risk of malaria, anemia and malnutrition among children in IDPs camp in Edo State, Nigeria. \u003cem\u003eParasite Epidemiology and Control\u003c/em\u003e 2020, 8:e00127. doi: 10.1016/j.parepi.2019.e00127\u003c/li\u003e\n\u003cli\u003eKemmer TM, Bovill ME, Kongsomboon W, Hansch SJ, Geisler KL, Cheney C, et al.: Iron deficiency is unacceptably high in refugee children from Burma. \u003cem\u003eThe Journal of nutrition\u003c/em\u003e 2003, 133(12):4143\u0026ndash;4149. doi: 10.1093/jn/133.12.4143\u003c/li\u003e\n\u003cli\u003eDistrict, G., Oyet, C., \u0026amp; Webbo, F. (2018). \u003cem\u003ePrevalence , morphological characterization , and associated factors of anemia among children below 5 years of age attending St . Mary \u0026rsquo; s Hospital\u003c/em\u003e. 195\u0026ndash;201.\u003c/li\u003e\n\u003cli\u003eAwuor, S. O., Eric, O. O., Musyoki, S., Daud, I. I., Nyangaresi, R. O., Mugah, P., \u0026amp; Mukunzi, B. (2021). Morphological patterns of anemia among under five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu county, Kenya. \u003cem\u003eJournal of Clinical Images and Medical Case Reports\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(2). https://doi.org/10.52768/2766-7820/1048\u003c/li\u003e\n\u003cli\u003eAdu-amankwaah, J., Allotey, E. A., Kwasie, D. A., Afeke, I., Owiafe, P. K., Adiukwu, P. C., \u0026amp; Ndudiri, O. V. (2018). \u003cem\u003ePrevalence and Morphological Types of Anaemia among Children Under-Five Years in the Volta Regional Hospital of Ghana\u003c/em\u003e. \u003cem\u003e5\u003c/em\u003e, 1\u0026ndash;10. https://doi.org/10.4236/oalib.1104351\u003c/li\u003e\n\u003cli\u003eEwusie, J. E., Ahiadeke, C., Beyene, J., \u0026amp; Hamid, J. S. (2014). Prevalence of anemia among under-5 children in the Ghanaian population: Estimates from the Ghana demographic and health survey. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1186/1471-2458-14-626\u003c/li\u003e\n\u003cli\u003eMamabolo, R. L., Alberts, M., Africa, S., Sciences, M., Campus, T., Africa, S., Mamabolo, R., Africa, S., \u0026amp; Commons, C. (2014). \u003cem\u003ePrevalence of anaemia and its associated factors in African children at one and three years residing in the Capricorn District of Limpopo Province , South Africa\u003c/em\u003e. 1\u0026ndash;9. https://doi.org/110.4102/curationis.v37i1.1160\u003c/li\u003e\n\u003cli\u003eKisiangani, I., Fl Mbakaya, C., Makokha, A., Mbakaya, C., \u0026amp; Makokha, A. (2015). Prevalence of Anaemia and Associated Factors Among Preschool Children (6-59 Months) in Western Province, Kenya. \u003cem\u003ePublic Health and Preventive Medicine\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(1), 28\u0026ndash;32. http://www.publicscienceframework.org/journal/phpmhttp://creativecommons.org/licenses/by-nc/4.0/\u003c/li\u003e\n\u003cli\u003eFentaw, W., Belachew, T., \u0026amp; Andargie, A. (2023). Anemia and associated factors among 6 to 59 months age children attending health facilities in Kombolcha town, Northeast Ethiopia: a facility-based cross-sectional study. \u003cem\u003eBMC Pediatrics\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1186/s12887-023-04031-z\u003c/li\u003e\n\u003cli\u003eMelku, M., Alene, K. A., Terefe, B., Enawgaw, B., Biadgo, B., Abebe, M., Muchie, K. F., Kebede, A., Melak, T., \u0026amp; Melku, T. (2018). Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: A community-based cross-sectional study. \u003cem\u003eItalian Journal of Pediatrics\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(1), 1\u0026ndash;12. https://doi.org/10.1186/s13052-018-0547-0\u003c/li\u003e\n\u003cli\u003eSaldiva S. R. D. M., Venancio S. I., Gouveia A. G. C., Castro A. L. D. S., Escuder M. M. L., Giugliani E. R. J. Regional influence on early consumption of foods other than breast milk in infants less than 6 months of age in Brazilian State capitals and the Federal District. \u003cem\u003eCadernos de Saude Publica\u003c/em\u003e\u003cem\u003e. \u003c/em\u003e2011;27(11):2253\u0026ndash;2262. doi: 10.1590/S0102-311X2011001100018. \u003c/li\u003e\n\u003cli\u003eOski F. A., Landaw S. A. Inhibition of iron absorption from human milk by baby food. \u003cem\u003eThe American Journal of Diseases of Children\u003c/em\u003e\u003cem\u003e. \u003c/em\u003e1980;134(5):459\u0026ndash;460.\u003c/li\u003e\n\u003cli\u003eMeinzen-Derr J. K., Guerrero M. L., Altaye M., Ortega-Gallegos H., Ruiz-Palacios G. M., Morrow A. L. Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. \u003cem\u003eJournal of Nutrition\u003c/em\u003e\u003cem\u003e. \u003c/em\u003e2006;136(2):452\u0026ndash;458.\u003c/li\u003e\n\u003cli\u003eBerglund, S. K., Westrup, B., \u0026amp; Domell\u0026ouml;f, M. (2015). Iron supplementation until 6 months protects marginally low-birth-weight infants from iron deficiency during their first year of life. \u003cem\u003eJournal of Pediatric Gastroenterology and Nutrition\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e(3), 390\u0026ndash;395. https://doi.org/10.1097/MPG.0000000000000633\u003c/li\u003e\n\u003cli\u003ePasricha, S. R., Hayes, E., Kalumba, K., \u0026amp; Biggs, B. A. (2013). Effect of daily iron supplementation on health in children aged 4-23 months: A systematic review and meta-analysis of randomised controlled trials. \u003cem\u003eThe Lancet Global Health\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(2), e77\u0026ndash;e86. https://doi.org/10.1016/S2214-109X(13)70046-9\u003c/li\u003e\n\u003cli\u003eWHO. (2023). \u003cem\u003eDaily iron supplementation in children 6-23 months of age\u003c/em\u003e. https://www.who.int/tools/elena/interventions/iron-children-6to23\u003c/li\u003e\n\u003cli\u003eSorsa, A., Habtamu, A., \u0026amp; Kaso, M. (2021). Prevalence and Predictors of Anemia Among Children Aged 6\u0026ndash;23 Months in Dodota District, Southeast Ethiopia: A Community-Based Cross-Sectional Study. \u003cem\u003ePediatric Health, Medicine and Therapeutics\u003c/em\u003e, \u003cem\u003eVolume 12\u003c/em\u003e, 177\u0026ndash;187. https://doi.org/10.2147/phmt.s293261\u003c/li\u003e\n\u003cli\u003eGebrehaweria, M., Gebremeskel, \u0026amp; Tirore, L. L. (2020). \u003cem\u003eFactors Associated with Anemia Among Children 6 \u0026ndash; 23 Months of Age in Ethiopia : A Multilevel Analysis of Data from the 2016 Ethiopia Demographic and Health Survey\u003c/em\u003e. 347\u0026ndash;357.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anemia, under five children, IDP, Camps, Mogadishu, Jazeera University","lastPublishedDoi":"10.21203/rs.3.rs-5358174/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5358174/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Globally, 269 million children under the age of five (39.8%) are anemic, with 60.2% of these children residing in Africa. Despite its serious health and social implications, anemia remains a significant public health challenge. Given the limited evidence on the prevalence and determinants of anemia among children under five in Somalia, this study aimed to assess the prevalence, severity and associated factors of anemia among internally displaced children under five years old in the Daynile IDP camps, Somalia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod and materials: \u003c/strong\u003eA community-based cross-sectional study was conducted in the Daynile IDP camps in Mogadishu, Somalia, from October 2022 to September 2023, involving a total of 435 children under five years of age. Socio-demographic data and other predisposing factors were collected through a structured questionnaire. Venous blood samples were drawn and analyzed for complete blood count (CBC) using a Mindray auto-hematology analyzer. Data were entered and analyzed using IBM SPSS Statistics version 29. Binary and multiple logistic regressions were performed to assess factors associated with anemia. Adjusted Odds Ratios (AOR) with their corresponding 95% Confidence Intervals (CI) were calculated. A p-value of less than 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe prevalence of anemia was found to be 62.5% (95% CI: 58.5–67.5%), with the majority of anemic children (33.8%) classified as having moderate anemia. Microcytic hypochromic anemia was present in 89.3% of the cases. The prevalence of anemia was found to be 62.5% (95% CI: 58.5–67.5%), with the majority of anemic children (33.8%) classified as having moderate anemia. Microcytic hypochromic anemia was present in 89.3% of the cases. Significant predictors of anemia among under five children in these IDP camps included age ≤ 24 months (AOR = 2.326, 95% CI = 1.540-3.513), male gender (AOR = 1.734, 95% CI = 1.168-2.574), home delivery (AOR = 4.281, 95% CI = 1.901-9.639), non-exclusive breastfeeding (AOR = 2.018, 95% CI = 1.327-3.068), early introduction of complementary foods (AOR = 2.085, 95% CI = 1.356-3.206), lack of iron supplementation (AOR = 2.447, 95% CI = 1.596-3.751), diarrhea in last two weeks (AOR = 3.201, 95% CI = 2.132-4.806), fever in last two weeks (AOR = 2.781, 95% CI = 1.846-4.192), and lack of deworming medication (AOR = 1.600, 95% CI = 1.073-2.385).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study reveals a very high prevalence of anemia among children under five, reflecting a serious public health issue according to WHO classification. Preventive measures such as exclusive breastfeeding, timely introduction of complementary foods, periodic deworming, promotion of dietary diversity, iron supplementation, and strong government commitment to child welfare are essential for reducing under-five anemia and improving overall child health.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Anemia among Under-Five Children in Internally Displaced Camps in Mogadishu, Somalia: A Cross-Sectional Study on Prevalence, Severity, and Associated Risk Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-18 09:03:52","doi":"10.21203/rs.3.rs-5358174/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab8d8433-e927-40c3-ab7b-2198b18db9af","owner":[],"postedDate":"November 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T09:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-18 09:03:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5358174","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5358174","identity":"rs-5358174","version":["v1"]},"buildId":"CiT4i_kKBbxQbnFL0ufpk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}