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Research
Conflict in Somalia: impact on child undernutrition
  1. Damaris K Kinyoki1,
  2. Grainne M Moloney2,
  3. Olalekan A Uthman3,
  4. Ngianga-Bakwin Kandala4,5,6,
  5. Elijah O Odundo7,
  6. Abdisalan M Noor1,8,
  7. James A Berkley8,9
  1. 1 INFORM Project, Spatial Health Metrics Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
  2. 2 Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country Office, UN Complex Gigiri, Nairobi, Kenya
  3. 3 Warwick Medical School, Health Sciences Research Institute, University of Warwick, Warwick Evidence, Gibbet Hill, Coventry, UK
  4. 4 Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
  5. 5 Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
  6. 6 Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  7. 7 Food Security and Nutrition Analysis Unit (FSNAU) - Somalia, Food and Agriculture Organization of the United Nations, Ngecha Road Campus, Nairobi, Kenya
  8. 8 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, UK
  9. 9 Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
  1. Correspondence to Damaris K Kinyoki, I; dkinyoki{at}kemri-wellcome.org

Abstract

Introduction In Somalia, protracted conflict and drought have caused population displacement and livelihood destruction. There is also widespread childhood undernutrition. We aimed to determine the independent effects of conflict on wasting and stunting among children aged 6–59 months nationwide in Somalia.

Methods Data were from household surveys during 2007–2010, including 73 778 children in 1066 clusters, the Armed Conflict Location and Event Data project database and remote sensing. We used Bayesian hierarchical spatial-temporal regression to examine the effects of conflict on wasting and stunting. Models included individual, household and environmental covariates and recent (<3 months) or longer term (3–12 months) conflict events.

Results 15 355 (21%) and 22 739 (31%) observations were from wasted and stunted children, respectively. The conflict was associated with undernutrition independently of the individual, household and environmental factors, and its inclusion improved model performance. Recent conflict was associated with wasting (OR 1.37, 95% credible interval (CrI): (1.33, 1.42) and attributable fraction (AF) 7.6%)) and stunting (OR 1.21, 95% CrI (1.15, 1.28), AF 6.9%). Longer term conflict had greater effects on wasting (OR 1.76, 95% CrI (1.71, 1.81), AF 6.0%) and stunting (OR 1.88, 95% CrI = (1.83, 1.94), AF 7.4%). After controlling for conflict, the harmful effect of internal displacement and protective effects of rainfall and vegetation cover on undernutrition were enhanced.

Conclusion Conflict and internal displacement have large effects on undernutrition in ways not fully captured by simply measuring individual, household and environmental factors or drought.

  • Undernutrition
  • wasting
  • stunting
  • conflict
  • Somalia
  • spatial-temporal modelling

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2016-000262

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    Footnotes

    • Contributors DKK, JAB, AMN, GMM, OAU and N-BK were responsible for the concept and design of the study. DKK led the development of the model, data assembly process, data analysis and interpretation of results. GMM and EOO were responsible for conducting the surveys, cleaning and archiving the data. JAB, AMN, OAU and N-BK were responsible for overall scientific oversight. All authors reviewed the manuscript and contributed to the final submission.

    • Competing interests None declared.

    • Patient consent The study does not involve patients and therefore there is no personal medical information reported in the article.

    • Ethics approval Ministry of Health Somalia, Transitional Federal Government of Somalia Republic, Ref: MOH/WC/XA/146/07, dated 02/02/2007.

    • Provenance and peer review Not commissioned; externally peer reviewed.