Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS

Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS Mohamed Mohamud Mohamed, Abdirisak Artan, Abdirashid Mohamed Hussein, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8232528/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Immunization remains one of the most effective strategies for preventing childhood morbidity and mortality, yet coverage in Somalia continues to be among the lowest globally. Persistent insecurity, population mobility, and systemic health system challenges limit the uptake of routine childhood vaccines. Given the extremely low levels of full immunization coverage reported nationally, this study assessed minimum immunization coverage, defined as receipt of at least one dose of BCG, pentavalent, oral polio (excluding birth dose), and measles vaccines. The objective was to estimate the prevalence of minimum immunization coverage and examine maternal and household determinants among children aged 12 to 23 months. Methods This study analyzed nationally representative data from the 2020 Somalia Health and Demographic Survey. A total of 2,969 children aged 12 to 23 months were included. Weighted descriptive statistics were used to summarize population characteristics, while bivariate and multivariable logistic regression analyses identified factors associated with minimum immunization coverage. All analyses accounted for the complex sampling design, and statistical significance was set at p < 0.05. Results Only 4 percent of children received the minimum recommended vaccinations. Significant disparities were observed across regions, with coverage ranging from 1 to 9 percent. In the adjusted analysis, maternal primary (AOR = 2.45, p = 0.003) and secondary education (AOR = 7.24, p < 0.001), higher household wealth (middle: AOR = 6.05, p < 0.001; fourth: AOR = 3.47, p = 0.006; highest: AOR = 7.04, p < 0.001), and urban residence (AOR = 1.87, p = 0.035) were independently associated with greater odds of minimum immunization. Children living in Nugaal, Mudug, Galgaduud, and Hiraan also had significantly higher odds of being immunized compared with the reference region. Conclusion Minimum immunization coverage among Somali children remains critically low, reflecting persistent inequities in access to routine vaccination services. Maternal education, household wealth, place of residence, and regional location were key determinants of uptake. Strengthening routine immunization systems, expanding outreach to underserved and mobile populations, and addressing socioeconomic barriers are essential to increase vaccine coverage and reduce preventable childhood mortality in Somalia. Childhood immunization Minimum immunization coverage Vaccine uptake Maternal determinants Somalia Health inequalities DHS Routine immunization Figures Figure 1 Figure 2 BACKGROUND Immunization is widely recognized as one of the most effective and cost-efficient public health interventions for reducing childhood morbidity and mortality worldwide ( 1 ). The World Health Organization (WHO) estimates that vaccines prevent between 3.5 and 5 million deaths annually, yet an estimated 20 million infants still miss essential vaccinations each year due to inequities in access, fragile health systems, and socioeconomic barriers ( 2 , 3 ). In low income and humanitarian settings, vaccine preventable diseases remain a major cause of child mortality, underscoring the importance of strengthening routine childhood immunization programs. Despite global progress, sub-Saharan Africa continues to have some of the lowest immunization coverage rates. Structural constraints, including weak health systems, shortages of trained health workers, recurrent conflict, and population displacement, contribute to persistent gaps in vaccine accessibility and uptake ( 4 , 5 ). Somalia represents one of the most severely affected contexts in this regard. Prolonged insecurity, climate related emergencies, and decades of underinvestment have undermined the capacity of the Somali health system to deliver reliable routine immunization services ( 5 , 6 ). According to recent estimates, Somalia has some of the lowest full immunization coverage levels globally, with wide geographic and socioeconomic disparities ( 5 , 7 – 9 ). Given the exceptionally low levels of full immunization coverage reported in national assessments, meaningful analysis of complete vaccine series is often constrained by small sample sizes and insufficient statistical power. For this reason, several studies conducted in fragile and low coverage settings have adopted a minimum or basic immunization definition, which considers whether a child has received at least one dose each of the essential childhood vaccines such as Bacillus Calmette Guerin (BCG), pentavalent, oral polio vaccine (OPV), and measles vaccine ( 10 – 12 ). This pragmatic approach provides an important indicator of program reach in contexts where service continuity is limited and where very few children complete the entire schedule. In Somalia, applying the minimum immunization criterion allows for a more accurate assessment of baseline coverage patterns and facilitates identification of maternal and household factors associated with initial vaccination contact. Evidence from several low-income contexts indicates that maternal education, household wealth, geographic access, and urban residence are strong predictors of childhood immunization uptake ( 13 – 15 ). However, empirical evidence from Somalia remains limited, and few studies have examined maternal determinants using nationally representative data. Understanding these factors is vital for strengthening the immunization system, particularly in a setting where preventable child deaths remain high and routine service delivery continues to face operational challenges. This study therefore examined the prevalence of minimum immunization coverage and assessed maternal and household determinants among children aged 12 to 23 months using data from the 2020 Somalia Health and Demographic Survey. Generating updated and representative evidence is essential for guiding national and subnational strategies aimed at improving routine immunization and reducing preventable child mortality in Somalia. METHODS Study Design and Data Source This study utilized data from the 2020 Somalia Health and Demographic Survey, a nationally representative cross-sectional survey implemented by the Government of Somalia with technical support from international partners. The survey employed a stratified, two-stage cluster sampling design to generate population-level estimates of key demographic and health indicators. In the first stage, enumeration areas were selected using probability proportional to size. In the second stage, households were systematically sampled within each selected cluster. All women aged 15 to 49 years who were either usual residents or who spent the night before the survey in selected households were eligible for interview. This analysis used the Kid Recode (KR) dataset, which contains detailed vaccination histories and sociodemographic characteristics of children born within the five years preceding the survey. Study Population The study included children aged 12 to 23 months at the time of the survey. This age group is recommended for monitoring routine immunization coverage, as children should have had the opportunity to receive all basic vaccines by 12 months. Records with missing information on vaccination status or key explanatory variables were excluded. After applying these criteria, a total of 2,969 children were included in the final analysis. Outcome Variable The primary outcome was minimum immunization coverage. A child was classified as having minimum immunization coverage if they had received at least one dose each of the following vaccines: Bacillus Calmette-Guérin (BCG), pentavalent or DPT vaccine, oral polio vaccine (OPV) excluding the birth dose, and measles vaccine. Vaccination status was determined from vaccination card records where available, or from maternal recall if cards were absent. This minimum immunization definition is commonly applied in low-coverage and fragile settings, where full immunization is rare, allowing for a more pragmatic assessment of service reach ( 1 , 16 ). Explanatory Variables Explanatory variables were selected based on conceptual relevance and existing evidence on determinants of childhood immunization in low-resource settings. The following maternal, household, and contextual characteristics were included: Maternal age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years) Maternal education (none, primary, secondary, higher) Marital status (married, divorced, widowed) Sex of household head (male, female) Household wealth index (lowest, second, middle, fourth, highest) Distance to a health facility (big problem, not a big problem) Place of residence (rural, urban, nomadic) Region of residence (18 administrative regions) Statistical Analysis Weighted descriptive analyses were conducted to summarize sociodemographic characteristics of the study population, presented as frequencies and percentages. The prevalence of minimum immunization coverage was estimated overall and disaggregated by explanatory variables. Bivariate associations between each predictor and the outcome were examined using crude odds ratios and 95 percent confidence intervals. Variables of theoretical importance and those showing associations in the bivariate analysis were included in a multivariable logistic regression model to identify independent determinants of minimum immunization coverage. Adjusted odds ratios with corresponding 95 percent confidence intervals were reported. All analyses applied sampling weights and accounted for clustering and stratification using the SVY commands in Stata to adjust for the complex survey design. Statistical significance was defined as p < 0.05. Ethical Considerations The SDHS 2020 dataset is publicly accessible and fully anonymized. Permission to use the data was obtained from the DHS Program. As this study involved secondary analysis of de-identified data, no additional ethical approval was required. RESULTS Maternal Sociodemographic Characteristics A total of 2,969 children aged 12–23 months were included in the analysis. The majority of their mothers were aged 25–29 years (30.2%), followed by those aged 20–24 years (23.9%). More than four-fifths of mothers (81.3%) had no formal education, while only 3.4% and 1.2% had secondary and higher education respectively (Table 1 ). Most women were married (92.7%), and 22% belonged to the fourth wealth quintile, while 21% were in the lowest quintile. Households were predominantly male-headed (70.5%). Distance to a health facility was perceived as a big problem by 62.1% of respondents. Urban residents constituted 59.3% of the sample, whereas nomadic households accounted for 12.6%. Regionally, Banadir contributed the largest share of the sample (24.7%). Table 1 maternal sociodemographic characteristics Variable Category Weighted Frequency Percent (%) Age Group (5-year) 15–19 215 7.20% 20–23 711 23.90% 25–29 897 30.20% 30–34 558 18.80% 35–39 427 14.40% 40–44 141 4.70% 45–49 20 0.70% Education Level No Education 2,413 81.30% Primary 422 14.20% Secondary 100 3.40% Higher 35 1.20% Marital Status Married 2,753 92.70% Divorced 167 5.60% Widowed 48 1.60% Wealth Quintile Lowest 623 21.00% Second 641 21.60% Middle 562 18.90% Fourth 659 22.20% Highest 485 16.30% Sex of Household Head Male 2,032 70.50% Female 849 29.50% Distance to Health Facility Big Problem 1,843 62.10% Not a Big Problem 1,123 37.90% Residence Type Rural 836 28.20% Urban 1,761 59.30% Nomadic 373 12.60% Region Awdal 60 2.00% Woqooyi Galbeed 180 6.10% Togdheer 165 5.60% Sool 92 3.10% Sanaag 120 4.00% Bari 191 6.40% Nugaal 86 2.90% Mudug 208 7.00% Galgaduud 176 5.90% Hiraan 120 4.00% Middle Shabelle 286 9.60% Banadir 733 24.70% Bay 162 5.50% Bakool 90 3.00% Gedo 131 4.40% Lower Juba 170 5.70% Prevalence and Regional Disparities in Basic Immunization Coverage Overall, only 4% of children aged 12–23 months had received the minimum recommended vaccinations, while 96% were not fully immunized (Fig. 1 ). Substantial disparities were observed across regions (Fig. 2 ). Coverage ranged from 1% in Woqooyi Galbeed and 2% in Awdal and Gedo, to higher levels such as 9% in Mudug and Hiraan, and 7% in Nugaal and Bay. No region reached even 10% coverage, indicating uniformly low immunization uptake nationwide. Bivariate Analysis of Maternal Factors Associated with Minimum Immunization Coverage In the crude analysis (Table 2 ), maternal age showed significant associations with minimum immunization coverage. Compared with mothers aged 15–19 years, those aged 25–29 years (COR = 0.43; p = 0.032), 30–34 years (COR = 0.35; p = 0.011), and 35–39 years (COR = 0.26; p = 0.011) were significantly less likely to have fully immunized children. Maternal education demonstrated a strong positive gradient. Children of mothers with primary education (9.7% coverage; COR = 3.95; p < 0.001) and secondary education (24.3% coverage; COR = 11.80; p < 0.001) were substantially more likely to be immunized than those of mothers with no education. Wealth status was also strongly associated with immunization. Compared with the poorest households (1.1% coverage), immunization was higher among middle (6.4%; COR = 6.45; p < 0.001), fourth (4.4%; COR = 4.32; p = 0.001), and highest quintiles (10.3%; COR = 10.73; p < 0.001). Children of divorced mothers were more likely to be immunized (10.1%; COR = 2.58; p = 0.010) compared with those of married mothers. Neither sex of household head nor distance to a health facility reached statistical significance, although children from households reporting easier access showed somewhat higher immunization (5.6%; COR = 1.49; p = 0.068). Urban (4.9%; COR = 1.49; p = 0.144) and nomadic (5.1%; COR = 1.56; p = 0.129) residence did not show statistically significant differences in the crude analysis. Several regions like Mudug (COR = 5.39; p = 0.026), Hiraan (COR = 5.54; p = 0.029), and Nugaal (COR = 4.28; p = 0.057), demonstrated higher odds of immunization relative to the reference region. Table 2 bivariate analysis of factors associated with minimum immunization coverage Variable Minimum Immunization Coverage COR [95% CI] P-value No Freq. (%) Yes Freq. (%) Age Group 15–19 (Reference) 198 (92.2%) 17 (7.8%) 1 - 20–24 656 (92.2%) 55 (7.8%) 1.00 [0.49–2.05] 0.998 25–29 865 (96.4%) 32 (3.6%) 0.43 [0.20–0.93] 0.032 30–34 542 (97.1%) 16 (2.9%) 0.35 [0.15–0.79] 0.011 35–39 417 (97.8%) 9 (2.2%) 0.26 [0.09–0.73] 0.011 40–44 138 (97.7%) 3 (2.3%) 0.28 [0.05–1.71] 0.168 45–49 19 (98.1%) 0 (0.0%) 0.23 [0.03–1.90] 0.172 Education Level No Education (Reference) 2,349 (97.4%) 64 (2.6%) 1 - Primary 381 (90.3%) 41 (9.7%) 3.95 [2.38–6.56] < 0.001 Secondary 76 (75.7%) 24 (24.3%) 11.80 [6.25–22.30] < 0.001 Higher 31 (89.3%) 4 (10.7%) 4.41 [1.38–14.11] 0.012 Marital Status Married (Reference) 2,640 (95.9%) 114 (4.1%) 1 - Divorced 150 (89.9%) 17 (10.1%) 2.58 [1.26–5.28] 0.01 Widowed 46 (95.0%) 2 (5.0%) 1.22 [0.16–9.02] 0.847 Wealth Index Lowest (Reference) 616 (98.9%) 7 (1.1%) 1 - Second 629 (98.2%) 12 (1.8%) 1.71 [0.67–4.35] 0.259 Middle 526 (93.6%) 36 (6.4%) 6.45 [2.73–15.22] < 0.001 Fourth 630 (95.6%) 29 (4.4%) 4.32 [1.83–10.22] 0.001 Highest 435 (89.7%) 50 (10.3%) 10.73 [4.69–24.51] < 0.001 Sex of Household Head Male (Reference) 1,946 (95.8%) 86 (4.2%) 1 - Female 806 (94.9%) 43 (5.1%) 1.23 [0.77–1.94] 0.384 Distance to Health Facility Big Problem (Reference) 1,773 (96.2%) 70 (3.8%) 1 - Not a Big Problem 1,060 (94.4%) 63 (5.6%) 1.49 [0.97–2.28] 0.068 Residence Type Rural (Reference) 808 (96.7%) 28 (3.3%) 1 - Urban 1,674 (95.1%) 86 (4.9%) 1.49 [0.87–2.53] 0.144 Nomadic 354 (94.9%) 19 (5.1%) 1.56 [0.88–2.75] 0.129 Region North West (Reference) 59 (98.1%) 1 (1.9%) 1 - Woqooyi Galbeed 177 (98.6%) 3 (1.4%) 0.76 [0.14–4.30] 0.759 Togdheer 158 (95.8%) 7 (4.2%) 2.31 [0.46–11.70] 0.311 Sool 89 (95.9%) 4 (4.1%) 2.25 [0.48–10.41] 0.301 Sanaag 114 (95.7%) 5 (4.3%) 2.39 [0.52–10.87] 0.261 Bari 185 (96.5%) 7 (3.5%) 1.94 [0.38–9.94] 0.427 Nugaal 79 (92.5%) 6 (7.5%) 4.28 [0.96–19.14] 0.057 Mudug 188 (90.7%) 19 (9.3%) 5.39 [1.22–23.78] 0.026 Galgaduud 166 (94.4%) 10 (5.6%) 3.11 [0.65-15.00] 0.157 Hiraan 108 (90.5%) 11 (9.5%) 5.54 [1.19–25.70] 0.029 Middle Shabelle 278 (97.0%) 9 (3.0%) 1.61 [0.29–8.86] 0.581 Banadir 706 (96.4%) 27 (3.6%) 1.99 [0.44–9.11] 0.375 Bay 151 (93.2%) 11 (6.8%) 3.84 [0.68–21.61] 0.126 Bakool 85 (95.2%) 4 (4.8%) 2.66 [0.56–12.58] 0.216 Gedo 128 (98.0%) 3 (2.0%) 1.08 [0.16–7.22] 0.94 Lower Juba 163 (95.9%) 7 (4.1%) 2.27 [0.44–11.65] 0.326 Multivariable Analysis of Maternal Determinants of Minimum Immunization Coverage After adjusting for all covariates (Table 3 ), several predictors remained significantly associated with minimum immunization coverage. Maternal education persisted as a strong determinant. Compared with no education, the odds of a child receiving minimum immunization were significantly higher among mothers with primary education (AOR = 2.45; p = 0.003) and secondary education (AOR = 7.24; p < 0.001). Higher education showed a positive but non-significant association (AOR = 2.70; p = 0.097). Marital status remained significant, with children of divorced women more likely to be immunized (AOR = 2.17; p = 0.020) compared with those of married women. Wealth status continued to demonstrate strong associations. Children in middle (AOR = 6.05; p < 0.001), fourth (AOR = 3.47; p = 0.006), and highest wealth quintiles (AOR = 7.04; p < 0.001) had significantly higher odds of receiving the minimum immunization package than those in the poorest households. Urban residence became statistically significant in the adjusted model, with children in urban households exhibiting higher odds of immunization (AOR = 1.87; p = 0.035). Nomadic residence, however, was not significant. Significant regional differences persisted. Compared with the reference region, higher odds of immunization were observed in Nugaal (AOR = 11.03; p = 0.005), Mudug (AOR = 13.17; p = 0.002), Galgaduud (AOR = 7.54; p = 0.028), and Hiraan (AOR = 10.49; p = 0.006). Distance to a health facility was not significantly associated with minimum immunization coverage in the multivariable model (AOR = 1.14; p = 0.572). Table 3 multivariable analysis of determinants of minimum immunization coverage Variable Minimum Immunization Coverage COR [95% CI] P-value No Freq. (%) Yes Freq. (%) Age Group 15–19 (Reference) 198 (92.2%) 17 (7.8%) 1 - 20–24 656 (92.2%) 55 (7.8%) 1.04 [0.46–2.37] 0.926 25–29 865 (96.4%) 32 (3.6%) 0.46 [0.19–1.12] 0.089 30–34 542 (97.1%) 16 (2.9%) 0.37 [0.15–0.92] 0.033 35–39 417 (97.8%) 9 (2.2%) 0.35 [0.11–1.14] 0.082 40–44 138 (97.7%) 3 (2.3%) 0.50 [0.08–3.35] 0.478 45–49 19 (98.1%) 0 (0.0%) 0.25 [0.02–3.37] 0.293 Education Level No Education (Reference) 2,349 (97.4%) 64 (2.6%) 1 - Primary 381 (90.3%) 41 (9.7%) 2.45 [1.36–4.42] 0.003 Secondary 76 (75.7%) 24 (24.3%) 7.24 [3.19–16.40] < 0.001 Higher 31 (89.3%) 4 (10.7%) 2.70 [0.83–8.72] 0.097 Marital Status Married (Reference) 2,640 (95.9%) 114 (4.1%) 1 - Divorced 150 (89.9%) 17 (10.1%) 2.17 [1.13–4.18] 0.02 Widowed 46 (95.0%) 2 (5.0%) 0.78 [0.06–10.31] 0.848 Wealth Index Lowest (Reference) 616 (98.9%) 7 (1.1%) 1 - Second 629 (98.2%) 12 (1.8%) 1.76 [0.69–4.48] 0.237 Middle 526 (93.6%) 36 (6.4%) 6.05 [2.54–14.38] < 0.001 Fourth 630 (95.6%) 29 (4.4%) 3.47 [1.42–8.49] 0.006 Highest 435 (89.7%) 50 (10.3%) 7.04 [2.80-17.71] < 0.001 Distance to Health Facility Big Problem (Reference) 1,773 (96.2%) 70 (3.8%) 1 - Not a Big Problem 1,060 (94.4%) 63 (5.6%) 1.14 [0.72–1.80] 0.572 Residence Type Rural (Reference) 808 (96.7%) 28 (3.3%) 1 - Urban 1,674 (95.1%) 86 (4.9%) 1.87 [1.04–3.35] 0.035 Nomadic 354 (94.9%) 19 (5.1%) 1.52 [0.78–2.98] 0.222 Region North West (Reference) 59 (98.1%) 1 (1.9%) 1 - Woqooyi Galbeed 177 (98.6%) 3 (1.4%) 1.07 [0.17–6.80] 0.939 Togdheer 158 (95.8%) 7 (4.2%) 3.39 [0.58–19.85] 0.176 Sool 89 (95.9%) 4 (4.1%) 3.23 [0.59–17.80] 0.178 Sanaag 114 (95.7%) 5 (4.3%) 2.80 [0.52–15.18] 0.233 Bari 185 (96.5%) 7 (3.5%) 4.15 [0.71–24.12] 0.113 Nugaal 79 (92.5%) 6 (7.5%) 11.03 [2.07–58.81] 0.005 Mudug 188 (90.7%) 19 (9.3%) 13.17 [2.55–67.91] 0.002 Galgaduud 166 (94.4%) 10 (5.6%) 7.54 [1.25–45.50] 0.028 Hiraan 108 (90.5%) 11 (9.5%) 10.49 [1.94–56.80] 0.006 Middle Shabelle 278 (97.0%) 9 (3.0%) 3.27 [0.50-21.42] 0.216 Banadir 706 (96.4%) 27 (3.6%) 2.41 [0.47–12.21] 0.289 Bay 151 (93.2%) 11 (6.8%) 4.33 [0.66–28.26] 0.126 Bakool 85 (95.2%) 4 (4.8%) 4.80 [0.86–26.66] 0.073 Gedo 128 (98.0%) 3 (2.0%) 3.36 [0.41–27.33] 0.258 Lower Juba 163 (95.9%) 7 (4.1%) 3.31 [0.56–19.55] 0.186 DISCUSSION This study examined the prevalence and determinants of minimum immunization coverage among children aged 12 to 23 months in Somalia using nationally representative SDHS 2020 data. The findings demonstrate extremely low uptake of basic childhood vaccines, with only 4 percent of children receiving the minimum recommended doses. This level is substantially lower than regional averages in sub-Saharan Africa and far below the global target of 90 percent coverage articulated in the Global Vaccine Action Plan ( 1 , 17 , 18 ). The persistent low coverage reflects long-standing challenges within Somalia's health system, including insecurity, limited access to services, human resource shortages, and socioeconomic inequalities that disproportionately affect vulnerable populations ( 6 , 19 , 20 ). The study identified several maternal and household factors that significantly predict minimum immunization coverage. Maternal education emerged as one of the most influential determinants. Children of mothers with primary or secondary education had significantly higher odds of being immunized compared with children of mothers with no formal schooling. This pattern is consistent with evidence from multiple low-income settings where education increases health literacy, improves understanding of vaccine benefits, and enhances mothers' ability to navigate the health system ( 21 – 23 ). The particularly strong effect of secondary education underscores the importance of interventions aimed at improving girls' access to formal education as a long-term strategy to enhance population health outcomes. Household wealth was also strongly associated with immunization status. Children from middle, fourth, and highest wealth quintiles had significantly higher odds of completing basic immunization than those from the poorest households. Wealth-related disparities are well documented in immunization research and often reflect differences in transportation costs, opportunity costs of seeking care, and affordability of indirect health expenses ( 24 , 25 ). In Somalia, where health service infrastructure remains unevenly distributed and many communities rely on private or informal providers, economic constraints may further impede access. These findings highlight the need for targeted strategies that reduce financial barriers, such as community outreach, mobile clinics, and integration of immunization with other essential maternal and child health services. Urban residence significantly increased the likelihood of immunization in the adjusted model, consistent with studies from Ethiopia, Kenya, and Nigeria showing that urban populations benefit from closer proximity to facilities and more consistent service availability ( 14 , 26 – 28 ). However, Somalia's unique nomadic populations remain particularly underserved, which contributes to the observed rural–urban inequalities. Strengthening immunization delivery in hard-to-reach and mobile communities should therefore be a policy priority. The analysis also revealed substantial regional disparities. Children in Mudug, Nugaal, Galgaduud, and Hiraan were significantly more likely to be immunized than those in the reference region, although absolute levels remained very low in all areas. Regional differences in immunization uptake in Somalia may be influenced by variations in security conditions, humanitarian presence, vaccine supply chains, and functionality of district-level health systems. Previous studies have similarly shown marked geographic heterogeneity in coverage across Somalia’s federal member states ( 8 , 9 ). These findings underscore the importance of tailored subnational programming that considers local barriers and opportunities. Contrary to expectations, perceived distance to a health facility was not significantly associated with immunization coverage after adjustment. This may reflect measurement limitations, as perceived distance may not accurately capture travel time, security constraints, or transportation availability. Prior studies have demonstrated that structural and security-related factors can be stronger barriers to care in fragile settings than geographic distance alone ( 16 , 29 ). CONCLUSION This study demonstrated that minimum immunization coverage among children aged 12 to 23 months in Somalia remains critically low, with only four percent of children receiving the recommended basic vaccinations. Maternal education, household wealth, urban residence, and regional location were significant determinants of immunization uptake, while factors such as perceived distance to a health facility showed no independent association after adjustment. The findings highlight persistent inequalities in vaccine access and underscore the need for strategies that strengthen routine immunization services, expand outreach to underserved rural and nomadic populations, and address socioeconomic barriers. Investments in female education and targeted subnational programming are essential to improving coverage and achieving national and global immunization goals. Strengthening the health system and ensuring reliable vaccine delivery across regions should be prioritized to reduce preventable childhood morbidity and mortality. Strengths and Limitations A major strength of this study is the use of nationally representative SDHS 2020 data, which enhances the generalizability of the findings across all regions of Somalia. The application of appropriate sampling weights and adjustment for the complex survey design improves the accuracy of the estimates. The study also examined a comprehensive set of maternal and household factors, providing valuable insights into socioeconomic and geographic inequalities in immunization coverage. However, several limitations should be acknowledged. First, the analysis relied on cross-sectional data, which limits causal inference. Second, immunization status was determined partly by maternal recall when vaccination cards were unavailable, which may introduce recall bias and lead to misclassification. Third, the study did not include health system factors such as vaccine supply reliability, service readiness, or security constraints, which are known to influence immunization uptake in fragile settings. Despite these limitations, the findings offer important evidence to guide policy interventions aimed at improving childhood immunization coverage in Somalia. Declarations Ethics approval and consent to participate This study was based on secondary analysis of the 2020 Somalia Health and Demographic Survey (SDHS) dataset. The SDHS protocol was approved by the relevant national ethics committees, and informed consent was obtained from all participants during the original data collection. The dataset used in this study is fully anonymized and publicly accessible. Permission to use the data was obtained through the DHS Program. All analyses were conducted in accordance with the Declaration of Helsinki and relevant ethical guidelines for secondary data use. Consent for publication Not applicable. Clinical trial number: Not applicable Availability of data and materials The Somalia Health and Demographic Survey (SHDS) 2020 dataset analyzed in this study is publicly available from the Somali National Bureau of Statistics (SNBS) microdata portal at https://microdata.nbs.gov.so/index.php/catalog/50 upon request and approval. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions MMM contributed to the conception and design of the study, data acquisition, and interpretation of results. JS contributed to methodology design, conducted data analysis, and performed the initial manuscript drafting. Both MMM and JS participated in data acquisition and manuscript preparation. AA, AMH, and MMM contributed to methodology development, provided critical intellectual input, and assisted with review and editing. All authors read and approved the final manuscript. Acknowledgements The authors thank the DHS Program and the Government of Somalia for granting access to the 2020 SDHS dataset. The authors also acknowledge the women and households who participated in the survey. Disclaimer The views expressed in this manuscript are solely those of the authors and do not necessarily reflect the views of the DHS Program, the Government of Somalia, or any affiliated organizations. References Immunization coverage [Internet]. [cited 2025 Feb 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated – WHO, UNICEF [Internet]. [cited 2025 Nov 22]. Available from: https://www.who.int/news/item/15-07-2025-global-childhood-vaccination-coverage-holds-steady-yet-over-14-million-infants-remain-unvaccinated-who-unicef Increases in vaccine-preventable disease outbreaks threaten years of progress, warn WHO, UNICEF, Gavi [Internet]. [cited 2025 Nov 22]. 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Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-22122-7 Mohamud AM, Abdi MA, Abdullahi AM, Abdi AM, Osman MM, Mohamed MA, et al. Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia. IJID Regions. 2025 Mar 1;14:100507. Ahmed A, Ahmed M, Hersi M, Sani J, Halane S, Mohamed ·, et al. Assessing Prevalence and Regional Disparities in Zero-Dose Immunization Among Children Aged 12-23 Months in Somalia. Journal of Epidemiology and Global Health. 2025 Apr 14;15. Frontiers | Trends and projections of age-appropriate vaccination coverage in 41 low- and middle- income countries in Asia and Sub-Saharan Africa, 2000–2030 [Internet]. [cited 2025 Nov 22]. Available from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1371258/full Mahachi K, Kessels J, Boateng K, Jean Baptiste AE, Mitula P, Ekeman E, et al. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine. 2022 Sept 2;40(37):5433–44. Dimitrova A, Carrasco-Escobar G, Richardson R, Benmarhnia T. Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage. PLoS Med. 2023 Jan 17;20(1):e1004166. Factors influencing childhood immunisation uptake in Africa: a systematic review | BMC Public Health | Full Text [Internet]. [cited 2025 Nov 22]. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11466-5 Sani J, Halane S, Ahmed MM, Ahmed AM, Hersi MD. Regional Disparities and Maternal Sociodemographic Determinants of Full Immunization Coverage Among Children Aged 12–23 Months in Nigeria: Insights from NDHS 2018. Pediatric Health Med Ther. 2025 July 8;16:157–70. Mohammed Y, Reynolds HW, Waziri H, Attahiru A, Olowo-okere A, Kamateeka M, et al. Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine: X. 2024 Oct 1;20:100563. Ozawa S, Yemeke TT, Evans DR, Pallas SE, Wallace AS, Lee BY. Defining hard-to-reach populations for vaccination. Vaccine. 2019 Sept 3;37(37):5525–34. Jean Simon D, Kondo Tokpovi VC, Dianou K, Okonji OC, Kiragu A, Olorunsaiye CZ, et al. Regional, subregional and country-level full vaccination coverage in children aged 12–23 months for 34 countries in sub-Saharan Africa: a global analysis using Demographic and Health Survey data. BMJ Glob Health. 2025 Mar 15;10(3):e018333. Vaccination and Immunization Statistics - UNICEF DATA [Internet]. [cited 2025 Nov 22]. Available from: https://data.unicef.org/topic/child-health/immunization/ Nikoloski Z, Mohamoud MM, Mossialos E. Universal health coverage in fragile and conflict-affected States: insights from Somalia. Int J Equity Health. 2025 May 7;24:125. Abdi Y, Abdi M, Bashir S, Ahmed N, Abdullahi Y. The State of Public Health in Somalia: Top 5 Challenges and Strategies for Improvement. Public Health Challenges. 2025 Oct 9;4. Balogun SA, Yusuff HA, Yusuf KQ, Al-Shenqiti AM, Balogun MT, Tettey P. Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status. Pan Afr Med J. 2017 Apr 24;26:217. Abigail E. Maternal Education as a Key Factor in Reducing Vaccine Hesitancy in Low-Income Regions. 2025 Mar 30; O’Neill S, Grieve R, Singh K, Dutt V, Powell-Jackson T. Persistence and heterogeneity of the effects of educating mothers to improve child immunisation uptake: Experimental evidence from Uttar Pradesh in India. Journal of Health Economics. 2024 June 1;96:102899. Sacre A, Bambra C, Wildman JM, Thomson K, Bennett N, Sowden S, et al. Socioeconomic inequalities in vaccine uptake: A global umbrella review. PLoS One. 2023 Dec 13;18(12):e0294688. Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities. Vaccine. 2022 Jan 3;40(1):141–50. Asmare G, Madalicho M, Sorsa A. Disparities in full immunization coverage among urban and rural children aged 12-23 months in southwest Ethiopia: A comparative cross-sectional study. Hum Vaccin Immunother. 18(6):2101316. Gebrehiwot GT, Tilahun M, Gebrehiwot H, Kahsay H, Gebregziabher G, Haddis S, et al. Prevalence and determinants of child immunization coverage in Ethiopia: Evidence from the 2019 mini-demographic and health survey. Human Vaccines & Immunotherapeutics. 2025 Dec 31;21(1):2478707. Ogero M, Orwa J, Odhiambo R, Agoi F, Lusambili A, Obure J, et al. Pentavalent vaccination in Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County. BMC Public Health. 2022 Dec;22(1):826. Evans MV, Andréambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, et al. Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Glob Public Health. 2022 Dec 27;2(12):e0001028. Additional Declarations No competing interests reported. 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Mohamed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYDCCA2BSQo6fvRnElJAhVouFsWTPsQSQFh5itVQkbriRYwBiEdbCd/t04qMbFRKJM2fkfH51o8aCh4H98NEN+LRInsvdbJxzRsK4n+ftNuucY0CH8aSl3cCnxeAM7zbp3DYJ2ZntuduMc9iAWiR4zIjSwrjhQM4z45x/JGhR3HAih/kxkEFYi+QZXohfgIFsxpzbJ8HDRsgvfGd4Nz7OqagDReXjzznfQIzDx/BqQQZsEmCSWOUgwPyBFNWjYBSMglEwcgAAdDJKcn02/6QAAAAASUVORK5CYII=","orcid":"","institution":"Ministry of Health,Puntland state","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"Mohamud","lastName":"Mohamed","suffix":""},{"id":567496958,"identity":"08c1ca3a-f163-44a2-b664-f6445a778ebe","order_by":1,"name":"Abdirisak Artan","email":"","orcid":"","institution":"Ministry of Health,Puntland 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1","display":"","copyAsset":false,"role":"figure","size":22344,"visible":true,"origin":"","legend":"\u003cp\u003eprevalence of minimum immunization coverage\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8232528/v1/b806cec6e4ff7396a7feb8ad.png"},{"id":99288077,"identity":"5a2568ce-73f6-4266-8479-1a328d4dd54e","added_by":"auto","created_at":"2025-12-31 09:39:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35127,"visible":true,"origin":"","legend":"\u003cp\u003eRegional disparities in minimum immunization coverage\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8232528/v1/bbdb333acdf632775a2096e6.png"},{"id":99324315,"identity":"4281b771-49c5-4604-b2dc-9c878bd62f99","added_by":"auto","created_at":"2025-12-31 16:47:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1463916,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8232528/v1/4f94c6b4-3f40-4069-8ae7-67a2358a596e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eImmunization is widely recognized as one of the most effective and cost-efficient public health interventions for reducing childhood morbidity and mortality worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The World Health Organization (WHO) estimates that vaccines prevent between 3.5 and 5\u0026nbsp;million deaths annually, yet an estimated 20\u0026nbsp;million infants still miss essential vaccinations each year due to inequities in access, fragile health systems, and socioeconomic barriers (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In low income and humanitarian settings, vaccine preventable diseases remain a major cause of child mortality, underscoring the importance of strengthening routine childhood immunization programs.\u003c/p\u003e \u003cp\u003eDespite global progress, sub-Saharan Africa continues to have some of the lowest immunization coverage rates. Structural constraints, including weak health systems, shortages of trained health workers, recurrent conflict, and population displacement, contribute to persistent gaps in vaccine accessibility and uptake (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Somalia represents one of the most severely affected contexts in this regard. Prolonged insecurity, climate related emergencies, and decades of underinvestment have undermined the capacity of the Somali health system to deliver reliable routine immunization services (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). According to recent estimates, Somalia has some of the lowest full immunization coverage levels globally, with wide geographic and socioeconomic disparities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the exceptionally low levels of full immunization coverage reported in national assessments, meaningful analysis of complete vaccine series is often constrained by small sample sizes and insufficient statistical power. For this reason, several studies conducted in fragile and low coverage settings have adopted a minimum or basic immunization definition, which considers whether a child has received at least one dose each of the essential childhood vaccines such as Bacillus Calmette Guerin (BCG), pentavalent, oral polio vaccine (OPV), and measles vaccine (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This pragmatic approach provides an important indicator of program reach in contexts where service continuity is limited and where very few children complete the entire schedule. In Somalia, applying the minimum immunization criterion allows for a more accurate assessment of baseline coverage patterns and facilitates identification of maternal and household factors associated with initial vaccination contact.\u003c/p\u003e \u003cp\u003eEvidence from several low-income contexts indicates that maternal education, household wealth, geographic access, and urban residence are strong predictors of childhood immunization uptake (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, empirical evidence from Somalia remains limited, and few studies have examined maternal determinants using nationally representative data. Understanding these factors is vital for strengthening the immunization system, particularly in a setting where preventable child deaths remain high and routine service delivery continues to face operational challenges.\u003c/p\u003e \u003cp\u003eThis study therefore examined the prevalence of minimum immunization coverage and assessed maternal and household determinants among children aged 12 to 23 months using data from the 2020 Somalia Health and Demographic Survey. Generating updated and representative evidence is essential for guiding national and subnational strategies aimed at improving routine immunization and reducing preventable child mortality in Somalia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Data Source\u003c/h2\u003e \u003cp\u003eThis study utilized data from the 2020 Somalia Health and Demographic Survey, a nationally representative cross-sectional survey implemented by the Government of Somalia with technical support from international partners. The survey employed a stratified, two-stage cluster sampling design to generate population-level estimates of key demographic and health indicators. In the first stage, enumeration areas were selected using probability proportional to size. In the second stage, households were systematically sampled within each selected cluster. All women aged 15 to 49 years who were either usual residents or who spent the night before the survey in selected households were eligible for interview. This analysis used the Kid Recode (KR) dataset, which contains detailed vaccination histories and sociodemographic characteristics of children born within the five years preceding the survey.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study included children aged 12 to 23 months at the time of the survey. This age group is recommended for monitoring routine immunization coverage, as children should have had the opportunity to receive all basic vaccines by 12 months. Records with missing information on vaccination status or key explanatory variables were excluded. After applying these criteria, a total of 2,969 children were included in the final analysis.\u003c/p\u003e\n\u003ch3\u003eOutcome Variable\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was minimum immunization coverage. A child was classified as having minimum immunization coverage if they had received at least one dose each of the following vaccines: Bacillus Calmette-Gu\u0026eacute;rin (BCG), pentavalent or DPT vaccine, oral polio vaccine (OPV) excluding the birth dose, and measles vaccine. Vaccination status was determined from vaccination card records where available, or from maternal recall if cards were absent. This minimum immunization definition is commonly applied in low-coverage and fragile settings, where full immunization is rare, allowing for a more pragmatic assessment of service reach (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eExplanatory Variables\u003c/h3\u003e\n\u003cp\u003eExplanatory variables were selected based on conceptual relevance and existing evidence on determinants of childhood immunization in low-resource settings. The following maternal, household, and contextual characteristics were included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eMaternal age\u003c/em\u003e (15\u0026ndash;19, 20\u0026ndash;24, 25\u0026ndash;29, 30\u0026ndash;34, 35\u0026ndash;39, 40\u0026ndash;44, 45\u0026ndash;49 years)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eMaternal education\u003c/em\u003e (none, primary, secondary, higher)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eMarital status\u003c/em\u003e (married, divorced, widowed)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eSex of household head\u003c/em\u003e (male, female)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eHousehold wealth index\u003c/em\u003e (lowest, second, middle, fourth, highest)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eDistance to a health facility\u003c/em\u003e (big problem, not a big problem)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ePlace of residence\u003c/em\u003e (rural, urban, nomadic)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eRegion of residence\u003c/em\u003e (18 administrative regions)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eWeighted descriptive analyses were conducted to summarize sociodemographic characteristics of the study population, presented as frequencies and percentages. The prevalence of minimum immunization coverage was estimated overall and disaggregated by explanatory variables. Bivariate associations between each predictor and the outcome were examined using crude odds ratios and 95 percent confidence intervals. Variables of theoretical importance and those showing associations in the bivariate analysis were included in a multivariable logistic regression model to identify independent determinants of minimum immunization coverage. Adjusted odds ratios with corresponding 95 percent confidence intervals were reported. All analyses applied sampling weights and accounted for clustering and stratification using the SVY commands in Stata to adjust for the complex survey design. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eThe SDHS 2020 dataset is publicly accessible and fully anonymized. Permission to use the data was obtained from the DHS Program. As this study involved secondary analysis of de-identified data, no additional ethical approval was required.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eMaternal Sociodemographic Characteristics\u003c/h2\u003e \u003cp\u003eA total of 2,969 children aged 12\u0026ndash;23 months were included in the analysis. The majority of their mothers were aged 25\u0026ndash;29 years (30.2%), followed by those aged 20\u0026ndash;24 years (23.9%). More than four-fifths of mothers (81.3%) had no formal education, while only 3.4% and 1.2% had secondary and higher education respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most women were married (92.7%), and 22% belonged to the fourth wealth quintile, while 21% were in the lowest quintile. Households were predominantly male-headed (70.5%). Distance to a health facility was perceived as a big problem by 62.1% of respondents. Urban residents constituted 59.3% of the sample, whereas nomadic households accounted for 12.6%. Regionally, Banadir contributed the largest share of the sample (24.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ematernal sociodemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWeighted Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group (5-year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Quintile\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLowest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex of Household Head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to Health Facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBig Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot a Big Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNomadic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwdal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWoqooyi Galbeed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTogdheer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSanaag\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNugaal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMudug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGalgaduud\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHiraan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle Shabelle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBanadir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBakool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGedo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower Juba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence and Regional Disparities in Basic Immunization Coverage\u003c/h2\u003e \u003cp\u003eOverall, only 4% of children aged 12\u0026ndash;23 months had received the minimum recommended vaccinations, while 96% were not fully immunized (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Substantial disparities were observed across regions (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Coverage ranged from 1% in Woqooyi Galbeed and 2% in Awdal and Gedo, to higher levels such as 9% in Mudug and Hiraan, and 7% in Nugaal and Bay. No region reached even 10% coverage, indicating uniformly low immunization uptake nationwide.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBivariate Analysis of Maternal Factors Associated with Minimum Immunization Coverage\u003c/h2\u003e \u003cp\u003eIn the crude analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), maternal age showed significant associations with minimum immunization coverage. Compared with mothers aged 15\u0026ndash;19 years, those aged 25\u0026ndash;29 years (COR\u0026thinsp;=\u0026thinsp;0.43; p\u0026thinsp;=\u0026thinsp;0.032), 30\u0026ndash;34 years (COR\u0026thinsp;=\u0026thinsp;0.35; p\u0026thinsp;=\u0026thinsp;0.011), and 35\u0026ndash;39 years (COR\u0026thinsp;=\u0026thinsp;0.26; p\u0026thinsp;=\u0026thinsp;0.011) were significantly less likely to have fully immunized children. Maternal education demonstrated a strong positive gradient. Children of mothers with primary education (9.7% coverage; COR\u0026thinsp;=\u0026thinsp;3.95; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and secondary education (24.3% coverage; COR\u0026thinsp;=\u0026thinsp;11.80; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were substantially more likely to be immunized than those of mothers with no education. Wealth status was also strongly associated with immunization. Compared with the poorest households (1.1% coverage), immunization was higher among middle (6.4%; COR\u0026thinsp;=\u0026thinsp;6.45; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fourth (4.4%; COR\u0026thinsp;=\u0026thinsp;4.32; p\u0026thinsp;=\u0026thinsp;0.001), and highest quintiles (10.3%; COR\u0026thinsp;=\u0026thinsp;10.73; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Children of divorced mothers were more likely to be immunized (10.1%; COR\u0026thinsp;=\u0026thinsp;2.58; p\u0026thinsp;=\u0026thinsp;0.010) compared with those of married mothers. Neither sex of household head nor distance to a health facility reached statistical significance, although children from households reporting easier access showed somewhat higher immunization (5.6%; COR\u0026thinsp;=\u0026thinsp;1.49; p\u0026thinsp;=\u0026thinsp;0.068). Urban (4.9%; COR\u0026thinsp;=\u0026thinsp;1.49; p\u0026thinsp;=\u0026thinsp;0.144) and nomadic (5.1%; COR\u0026thinsp;=\u0026thinsp;1.56; p\u0026thinsp;=\u0026thinsp;0.129) residence did not show statistically significant differences in the crude analysis. Several regions like Mudug (COR\u0026thinsp;=\u0026thinsp;5.39; p\u0026thinsp;=\u0026thinsp;0.026), Hiraan (COR\u0026thinsp;=\u0026thinsp;5.54; p\u0026thinsp;=\u0026thinsp;0.029), and Nugaal (COR\u0026thinsp;=\u0026thinsp;4.28; p\u0026thinsp;=\u0026thinsp;0.057), demonstrated higher odds of immunization relative to the reference region.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ebivariate analysis of factors associated with minimum immunization coverage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMinimum Immunization Coverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198 (92.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e656 (92.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 [0.49\u0026ndash;2.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e865 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43 [0.20\u0026ndash;0.93]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e542 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35 [0.15\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e417 (97.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26 [0.09\u0026ndash;0.73]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138 (97.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28 [0.05\u0026ndash;1.71]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (98.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23 [0.03\u0026ndash;1.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,349 (97.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e381 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.95 [2.38\u0026ndash;6.56]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (75.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.80 [6.25\u0026ndash;22.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (89.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.41 [1.38\u0026ndash;14.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,640 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.58 [1.26\u0026ndash;5.28]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.22 [0.16\u0026ndash;9.02]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLowest (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e616 (98.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e629 (98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.71 [0.67\u0026ndash;4.35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e526 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.45 [2.73\u0026ndash;15.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e630 (95.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.32 [1.83\u0026ndash;10.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e435 (89.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.73 [4.69\u0026ndash;24.51]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex of Household Head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,946 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e806 (94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 [0.77\u0026ndash;1.94]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to Health Facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig Problem (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,773 (96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot a Big Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,060 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.49 [0.97\u0026ndash;2.28]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e808 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,674 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.49 [0.87\u0026ndash;2.53]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNomadic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e354 (94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.56 [0.88\u0026ndash;2.75]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth West (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (98.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoqooyi Galbeed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (98.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76 [0.14\u0026ndash;4.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTogdheer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.31 [0.46\u0026ndash;11.70]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.25 [0.48\u0026ndash;10.41]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSanaag\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.39 [0.52\u0026ndash;10.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185 (96.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.94 [0.38\u0026ndash;9.94]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNugaal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.28 [0.96\u0026ndash;19.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMudug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188 (90.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.39 [1.22\u0026ndash;23.78]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGalgaduud\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.11 [0.65-15.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHiraan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (90.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.54 [1.19\u0026ndash;25.70]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle Shabelle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.61 [0.29\u0026ndash;8.86]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBanadir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e706 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.99 [0.44\u0026ndash;9.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.84 [0.68\u0026ndash;21.61]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBakool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.66 [0.56\u0026ndash;12.58]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGedo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.08 [0.16\u0026ndash;7.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Juba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.27 [0.44\u0026ndash;11.65]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultivariable Analysis of Maternal Determinants of Minimum Immunization Coverage\u003c/h2\u003e \u003cp\u003eAfter adjusting for all covariates (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), several predictors remained significantly associated with minimum immunization coverage. Maternal education persisted as a strong determinant. Compared with no education, the odds of a child receiving minimum immunization were significantly higher among mothers with primary education (AOR\u0026thinsp;=\u0026thinsp;2.45; p\u0026thinsp;=\u0026thinsp;0.003) and secondary education (AOR\u0026thinsp;=\u0026thinsp;7.24; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher education showed a positive but non-significant association (AOR\u0026thinsp;=\u0026thinsp;2.70; p\u0026thinsp;=\u0026thinsp;0.097). Marital status remained significant, with children of divorced women more likely to be immunized (AOR\u0026thinsp;=\u0026thinsp;2.17; p\u0026thinsp;=\u0026thinsp;0.020) compared with those of married women. Wealth status continued to demonstrate strong associations. Children in middle (AOR\u0026thinsp;=\u0026thinsp;6.05; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fourth (AOR\u0026thinsp;=\u0026thinsp;3.47; p\u0026thinsp;=\u0026thinsp;0.006), and highest wealth quintiles (AOR\u0026thinsp;=\u0026thinsp;7.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had significantly higher odds of receiving the minimum immunization package than those in the poorest households. Urban residence became statistically significant in the adjusted model, with children in urban households exhibiting higher odds of immunization (AOR\u0026thinsp;=\u0026thinsp;1.87; p\u0026thinsp;=\u0026thinsp;0.035). Nomadic residence, however, was not significant. Significant regional differences persisted. Compared with the reference region, higher odds of immunization were observed in Nugaal (AOR\u0026thinsp;=\u0026thinsp;11.03; p\u0026thinsp;=\u0026thinsp;0.005), Mudug (AOR\u0026thinsp;=\u0026thinsp;13.17; p\u0026thinsp;=\u0026thinsp;0.002), Galgaduud (AOR\u0026thinsp;=\u0026thinsp;7.54; p\u0026thinsp;=\u0026thinsp;0.028), and Hiraan (AOR\u0026thinsp;=\u0026thinsp;10.49; p\u0026thinsp;=\u0026thinsp;0.006). Distance to a health facility was not significantly associated with minimum immunization coverage in the multivariable model (AOR\u0026thinsp;=\u0026thinsp;1.14; p\u0026thinsp;=\u0026thinsp;0.572).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emultivariable analysis of determinants of minimum immunization coverage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMinimum Immunization Coverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198 (92.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e656 (92.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04 [0.46\u0026ndash;2.37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e865 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46 [0.19\u0026ndash;1.12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e542 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37 [0.15\u0026ndash;0.92]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e417 (97.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35 [0.11\u0026ndash;1.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138 (97.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50 [0.08\u0026ndash;3.35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (98.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25 [0.02\u0026ndash;3.37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,349 (97.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e381 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.45 [1.36\u0026ndash;4.42]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (75.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.24 [3.19\u0026ndash;16.40]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (89.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.70 [0.83\u0026ndash;8.72]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,640 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.17 [1.13\u0026ndash;4.18]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 [0.06\u0026ndash;10.31]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLowest (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e616 (98.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e629 (98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.76 [0.69\u0026ndash;4.48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e526 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.05 [2.54\u0026ndash;14.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e630 (95.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.47 [1.42\u0026ndash;8.49]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e435 (89.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.04 [2.80-17.71]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to Health Facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig Problem (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,773 (96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot a Big Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,060 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 [0.72\u0026ndash;1.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e808 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,674 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.87 [1.04\u0026ndash;3.35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNomadic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e354 (94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.52 [0.78\u0026ndash;2.98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth West (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (98.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoqooyi Galbeed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (98.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07 [0.17\u0026ndash;6.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTogdheer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.39 [0.58\u0026ndash;19.85]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.23 [0.59\u0026ndash;17.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSanaag\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.80 [0.52\u0026ndash;15.18]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185 (96.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.15 [0.71\u0026ndash;24.12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNugaal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.03 [2.07\u0026ndash;58.81]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMudug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188 (90.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.17 [2.55\u0026ndash;67.91]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGalgaduud\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.54 [1.25\u0026ndash;45.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHiraan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (90.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.49 [1.94\u0026ndash;56.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle Shabelle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.27 [0.50-21.42]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBanadir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e706 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.41 [0.47\u0026ndash;12.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.33 [0.66\u0026ndash;28.26]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBakool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.80 [0.86\u0026ndash;26.66]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGedo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.36 [0.41\u0026ndash;27.33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Juba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.31 [0.56\u0026ndash;19.55]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the prevalence and determinants of minimum immunization coverage among children aged 12 to 23 months in Somalia using nationally representative SDHS 2020 data. The findings demonstrate extremely low uptake of basic childhood vaccines, with only 4 percent of children receiving the minimum recommended doses. This level is substantially lower than regional averages in sub-Saharan Africa and far below the global target of 90 percent coverage articulated in the Global Vaccine Action Plan (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The persistent low coverage reflects long-standing challenges within Somalia's health system, including insecurity, limited access to services, human resource shortages, and socioeconomic inequalities that disproportionately affect vulnerable populations (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study identified several maternal and household factors that significantly predict minimum immunization coverage. Maternal education emerged as one of the most influential determinants. Children of mothers with primary or secondary education had significantly higher odds of being immunized compared with children of mothers with no formal schooling. This pattern is consistent with evidence from multiple low-income settings where education increases health literacy, improves understanding of vaccine benefits, and enhances mothers' ability to navigate the health system (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The particularly strong effect of secondary education underscores the importance of interventions aimed at improving girls' access to formal education as a long-term strategy to enhance population health outcomes.\u003c/p\u003e \u003cp\u003eHousehold wealth was also strongly associated with immunization status. Children from middle, fourth, and highest wealth quintiles had significantly higher odds of completing basic immunization than those from the poorest households. Wealth-related disparities are well documented in immunization research and often reflect differences in transportation costs, opportunity costs of seeking care, and affordability of indirect health expenses (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In Somalia, where health service infrastructure remains unevenly distributed and many communities rely on private or informal providers, economic constraints may further impede access. These findings highlight the need for targeted strategies that reduce financial barriers, such as community outreach, mobile clinics, and integration of immunization with other essential maternal and child health services.\u003c/p\u003e \u003cp\u003eUrban residence significantly increased the likelihood of immunization in the adjusted model, consistent with studies from Ethiopia, Kenya, and Nigeria showing that urban populations benefit from closer proximity to facilities and more consistent service availability (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, Somalia's unique nomadic populations remain particularly underserved, which contributes to the observed rural\u0026ndash;urban inequalities. Strengthening immunization delivery in hard-to-reach and mobile communities should therefore be a policy priority.\u003c/p\u003e \u003cp\u003eThe analysis also revealed substantial regional disparities. Children in Mudug, Nugaal, Galgaduud, and Hiraan were significantly more likely to be immunized than those in the reference region, although absolute levels remained very low in all areas. Regional differences in immunization uptake in Somalia may be influenced by variations in security conditions, humanitarian presence, vaccine supply chains, and functionality of district-level health systems. Previous studies have similarly shown marked geographic heterogeneity in coverage across Somalia\u0026rsquo;s federal member states (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These findings underscore the importance of tailored subnational programming that considers local barriers and opportunities.\u003c/p\u003e \u003cp\u003eContrary to expectations, perceived distance to a health facility was not significantly associated with immunization coverage after adjustment. This may reflect measurement limitations, as perceived distance may not accurately capture travel time, security constraints, or transportation availability. Prior studies have demonstrated that structural and security-related factors can be stronger barriers to care in fragile settings than geographic distance alone (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrated that minimum immunization coverage among children aged 12 to 23 months in Somalia remains critically low, with only four percent of children receiving the recommended basic vaccinations. Maternal education, household wealth, urban residence, and regional location were significant determinants of immunization uptake, while factors such as perceived distance to a health facility showed no independent association after adjustment. The findings highlight persistent inequalities in vaccine access and underscore the need for strategies that strengthen routine immunization services, expand outreach to underserved rural and nomadic populations, and address socioeconomic barriers. Investments in female education and targeted subnational programming are essential to improving coverage and achieving national and global immunization goals. Strengthening the health system and ensuring reliable vaccine delivery across regions should be prioritized to reduce preventable childhood morbidity and mortality.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eA major strength of this study is the use of nationally representative SDHS 2020 data, which enhances the generalizability of the findings across all regions of Somalia. The application of appropriate sampling weights and adjustment for the complex survey design improves the accuracy of the estimates. The study also examined a comprehensive set of maternal and household factors, providing valuable insights into socioeconomic and geographic inequalities in immunization coverage.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be acknowledged. First, the analysis relied on cross-sectional data, which limits causal inference. Second, immunization status was determined partly by maternal recall when vaccination cards were unavailable, which may introduce recall bias and lead to misclassification. Third, the study did not include health system factors such as vaccine supply reliability, service readiness, or security constraints, which are known to influence immunization uptake in fragile settings. Despite these limitations, the findings offer important evidence to guide policy interventions aimed at improving childhood immunization coverage in Somalia.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was based on secondary analysis of the 2020 Somalia Health and Demographic Survey (SDHS) dataset. The SDHS protocol was approved by the relevant national ethics committees, and informed consent was obtained from all participants during the original data collection. The dataset used in this study is fully anonymized and publicly accessible. Permission to use the data was obtained through the DHS Program. All analyses were conducted in accordance with the Declaration of Helsinki and relevant ethical guidelines for secondary data use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Somalia Health and Demographic Survey (SHDS) 2020 dataset analyzed in this study is publicly available from the Somali National Bureau of Statistics (SNBS) microdata portal at https://microdata.nbs.gov.so/index.php/catalog/50 upon request and approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMMM contributed to the conception and design of the study, data acquisition, and interpretation of results. JS contributed to methodology design, conducted data analysis, and performed the initial manuscript drafting. Both MMM and JS participated in data acquisition and manuscript preparation. AA, AMH, and MMM contributed to methodology development, provided critical intellectual input, and assisted with review and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the DHS Program and the Government of Somalia for granting access to the 2020 SDHS dataset. The authors also acknowledge the women and households who participated in the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views expressed in this manuscript are solely those of the authors and do not necessarily reflect the views of the DHS Program, the Government of Somalia, or any affiliated organizations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eImmunization coverage [Internet]. [cited 2025 Feb 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage\u003c/li\u003e\n\u003cli\u003eGlobal childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated \u0026ndash; WHO, UNICEF [Internet]. [cited 2025 Nov 22]. Available from: https://www.who.int/news/item/15-07-2025-global-childhood-vaccination-coverage-holds-steady-yet-over-14-million-infants-remain-unvaccinated-who-unicef\u003c/li\u003e\n\u003cli\u003eIncreases in vaccine-preventable disease outbreaks threaten years of progress, warn WHO, UNICEF, Gavi [Internet]. [cited 2025 Nov 22]. Available from: https://www.who.int/news/item/24-04-2025-increases-in-vaccine-preventable-disease-outbreaks-threaten-years-of-progress--warn-who--unicef--gavi\u003c/li\u003e\n\u003cli\u003eLubanga AF, Bwanali AN, Kangoma M, Matola Y, Moyo C, Kaonga B, et al. Addressing the re-emergence and resurgence of vaccine-preventable diseases in Africa: A health equity perspective. Hum Vaccin Immunother. 20(1):2375081. \u003c/li\u003e\n\u003cli\u003eHalane S, Ahmed AM, Ahmed MM, Mohamud AM, Hersi MD, Sani J, et al. Barriers and Disparities in Maternal and Child Vaccination Coverage in Galmudug State, Somalia: A Descriptive Study. Sage Open Pediatrics. 2025 Feb 1;12:30502225251388171. \u003c/li\u003e\n\u003cli\u003eNikoloski Z, Mohamoud MM, Mossialos E. Universal health coverage in fragile and conflict-affected States: insights from Somalia. Int J Equity Health. 2025 May 7;24(1):125. \u003c/li\u003e\n\u003cli\u003ePrevalence and associated factors of immunization among under-five children in Somalia | BMC Public Health | Full Text [Internet]. [cited 2025 Nov 22]. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-22122-7\u003c/li\u003e\n\u003cli\u003eMohamud AM, Abdi MA, Abdullahi AM, Abdi AM, Osman MM, Mohamed MA, et al. Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia. IJID Regions. 2025 Mar 1;14:100507. \u003c/li\u003e\n\u003cli\u003eAhmed A, Ahmed M, Hersi M, Sani J, Halane S, Mohamed \u0026middot;, et al. Assessing Prevalence and Regional Disparities in Zero-Dose Immunization Among Children Aged 12-23 Months in Somalia. Journal of Epidemiology and Global Health. 2025 Apr 14;15. \u003c/li\u003e\n\u003cli\u003eFrontiers | Trends and projections of age-appropriate vaccination coverage in 41 low- and middle- income countries in Asia and Sub-Saharan Africa, 2000\u0026ndash;2030 [Internet]. [cited 2025 Nov 22]. Available from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1371258/full\u003c/li\u003e\n\u003cli\u003eMahachi K, Kessels J, Boateng K, Jean Baptiste AE, Mitula P, Ekeman E, et al. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine. 2022 Sept 2;40(37):5433\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eDimitrova A, Carrasco-Escobar G, Richardson R, Benmarhnia T. Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage. PLoS Med. 2023 Jan 17;20(1):e1004166. \u003c/li\u003e\n\u003cli\u003eFactors influencing childhood immunisation uptake in Africa: a systematic review | BMC Public Health | Full Text [Internet]. [cited 2025 Nov 22]. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11466-5\u003c/li\u003e\n\u003cli\u003eSani J, Halane S, Ahmed MM, Ahmed AM, Hersi MD. Regional Disparities and Maternal Sociodemographic Determinants of Full Immunization Coverage Among Children Aged 12\u0026ndash;23 Months in Nigeria: Insights from NDHS 2018. Pediatric Health Med Ther. 2025 July 8;16:157\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eMohammed Y, Reynolds HW, Waziri H, Attahiru A, Olowo-okere A, Kamateeka M, et al. Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine: X. 2024 Oct 1;20:100563. \u003c/li\u003e\n\u003cli\u003eOzawa S, Yemeke TT, Evans DR, Pallas SE, Wallace AS, Lee BY. Defining hard-to-reach populations for vaccination. Vaccine. 2019 Sept 3;37(37):5525\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eJean Simon D, Kondo Tokpovi VC, Dianou K, Okonji OC, Kiragu A, Olorunsaiye CZ, et al. Regional, subregional and country-level full vaccination coverage in children aged 12\u0026ndash;23 months for 34 countries in sub-Saharan Africa: a global analysis using Demographic and Health Survey data. BMJ Glob Health. 2025 Mar 15;10(3):e018333. \u003c/li\u003e\n\u003cli\u003eVaccination and Immunization Statistics - UNICEF DATA [Internet]. [cited 2025 Nov 22]. Available from: https://data.unicef.org/topic/child-health/immunization/\u003c/li\u003e\n\u003cli\u003eNikoloski Z, Mohamoud MM, Mossialos E. Universal health coverage in fragile and conflict-affected States: insights from Somalia. Int J Equity Health. 2025 May 7;24:125. \u003c/li\u003e\n\u003cli\u003eAbdi Y, Abdi M, Bashir S, Ahmed N, Abdullahi Y. The State of Public Health in Somalia: Top 5 Challenges and Strategies for Improvement. Public Health Challenges. 2025 Oct 9;4. \u003c/li\u003e\n\u003cli\u003eBalogun SA, Yusuff HA, Yusuf KQ, Al-Shenqiti AM, Balogun MT, Tettey P. Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status. Pan Afr Med J. 2017 Apr 24;26:217. \u003c/li\u003e\n\u003cli\u003eAbigail E. Maternal Education as a Key Factor in Reducing Vaccine Hesitancy in Low-Income Regions. 2025 Mar 30; \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neill S, Grieve R, Singh K, Dutt V, Powell-Jackson T. Persistence and heterogeneity of the effects of educating mothers to improve child immunisation uptake: Experimental evidence from Uttar Pradesh in India. Journal of Health Economics. 2024 June 1;96:102899. \u003c/li\u003e\n\u003cli\u003eSacre A, Bambra C, Wildman JM, Thomson K, Bennett N, Sowden S, et al. Socioeconomic inequalities in vaccine uptake: A global umbrella review. PLoS One. 2023 Dec 13;18(12):e0294688. \u003c/li\u003e\n\u003cli\u003eBobo FT, Asante A, Woldie M, Dawson A, Hayen A. Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities. Vaccine. 2022 Jan 3;40(1):141\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eAsmare G, Madalicho M, Sorsa A. Disparities in full immunization coverage among urban and rural children aged 12-23 months in southwest Ethiopia: A comparative cross-sectional study. Hum Vaccin Immunother. 18(6):2101316. \u003c/li\u003e\n\u003cli\u003eGebrehiwot GT, Tilahun M, Gebrehiwot H, Kahsay H, Gebregziabher G, Haddis S, et al. Prevalence and determinants of child immunization coverage in Ethiopia: Evidence from the 2019 mini-demographic and health survey. Human Vaccines \u0026amp; Immunotherapeutics. 2025 Dec 31;21(1):2478707. \u003c/li\u003e\n\u003cli\u003eOgero M, Orwa J, Odhiambo R, Agoi F, Lusambili A, Obure J, et al. Pentavalent vaccination in Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County. BMC Public Health. 2022 Dec;22(1):826. \u003c/li\u003e\n\u003cli\u003eEvans MV, Andr\u0026eacute;ambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, et al. Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Glob Public Health. 2022 Dec 27;2(12):e0001028. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Childhood immunization, Minimum immunization coverage, Vaccine uptake, Maternal determinants, Somalia, Health inequalities, DHS, Routine immunization","lastPublishedDoi":"10.21203/rs.3.rs-8232528/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8232528/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eImmunization remains one of the most effective strategies for preventing childhood morbidity and mortality, yet coverage in Somalia continues to be among the lowest globally. Persistent insecurity, population mobility, and systemic health system challenges limit the uptake of routine childhood vaccines. Given the extremely low levels of full immunization coverage reported nationally, this study assessed minimum immunization coverage, defined as receipt of at least one dose of BCG, pentavalent, oral polio (excluding birth dose), and measles vaccines. The objective was to estimate the prevalence of minimum immunization coverage and examine maternal and household determinants among children aged 12 to 23 months.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study analyzed nationally representative data from the 2020 Somalia Health and Demographic Survey. A total of 2,969 children aged 12 to 23 months were included. Weighted descriptive statistics were used to summarize population characteristics, while bivariate and multivariable logistic regression analyses identified factors associated with minimum immunization coverage. All analyses accounted for the complex sampling design, and statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOnly 4 percent of children received the minimum recommended vaccinations. Significant disparities were observed across regions, with coverage ranging from 1 to 9 percent. In the adjusted analysis, maternal primary (AOR\u0026thinsp;=\u0026thinsp;2.45, p\u0026thinsp;=\u0026thinsp;0.003) and secondary education (AOR\u0026thinsp;=\u0026thinsp;7.24, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), higher household wealth (middle: AOR\u0026thinsp;=\u0026thinsp;6.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; fourth: AOR\u0026thinsp;=\u0026thinsp;3.47, p\u0026thinsp;=\u0026thinsp;0.006; highest: AOR\u0026thinsp;=\u0026thinsp;7.04, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and urban residence (AOR\u0026thinsp;=\u0026thinsp;1.87, p\u0026thinsp;=\u0026thinsp;0.035) were independently associated with greater odds of minimum immunization. Children living in Nugaal, Mudug, Galgaduud, and Hiraan also had significantly higher odds of being immunized compared with the reference region.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMinimum immunization coverage among Somali children remains critically low, reflecting persistent inequities in access to routine vaccination services. Maternal education, household wealth, place of residence, and regional location were key determinants of uptake. Strengthening routine immunization systems, expanding outreach to underserved and mobile populations, and addressing socioeconomic barriers are essential to increase vaccine coverage and reduce preventable childhood mortality in Somalia.\u003c/p\u003e","manuscriptTitle":"Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-31 09:38:26","doi":"10.21203/rs.3.rs-8232528/v1","editorialEvents":[{"type":"communityComments","content":1},{"type":"decision","content":"Revision requested","date":"2026-03-06T11:52:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T22:45:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271451197867410724387510896839717988364","date":"2026-02-19T15:23:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-18T18:43:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65648535394985525410755425506668714028","date":"2026-02-15T11:00:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191576207539376869972704945686288632746","date":"2026-02-15T08:52:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103916708892030934653151326302903871696","date":"2026-02-13T13:59:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T11:43:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291049895291678998554526692648572288668","date":"2026-02-10T09:02:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-22T20:28:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36189719033827473126635053963748998714","date":"2025-12-30T16:15:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-29T13:38:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-02T13:16:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T13:13:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-11-28T17:39:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8fa14acf-e6a8-4380-9d46-396f1014eca8","owner":[],"postedDate":"December 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T13:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-31 09:38:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8232528","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8232528","identity":"rs-8232528","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}