Spatial distribution of short birth intervals and associated factors among reproductive-age women in Somalia, 2020: a spatial and multilevel analysis

Abstract

Short birth interval (SBI) is a major contributor to maternal and child morbidity and mortality. In Somalia, a nation experiencing high fertility rates alongside protracted conflict and humanitarian crises, evidence on birth spacing patterns is scarce. This study investigates the prevalence, determinants, and spatial distribution of SBI to guide evidence-based policy and targeted health interventions. This study analyzed data from a weighted sample of 26,990 reproductive-age women (aged 15–49 years) from the 2020 Somalia Demographic and Health Survey. To ensure national representativeness, the analysis incorporated complex survey design elements, including individual sample weights, clustering, and stratification. We employed multilevel logistic regression to assess individual and community-level factors associated with SBI (defined as a birth-to-birth interval < 33 months). Spatial analysis using Global Moran’s I and Getis-Ord Gi statistics was performed to identify significant geographic clustering and regional hotspots. The national prevalence of SBI was 77.50%. Multilevel analysis revealed that older maternal age was a significant protective factor (AOR = 0.47; 95% CI: 0.43–0.51 for ages 30–39; AOR = 0.31; 95% CI: 0.28–0.34 for ages 40–49) compared to those under 30. Conversely, and paradoxically, women with higher education had significantly increased odds of SBI (AOR = 1.88; 95% CI: 1.07–3.30) compared to those with no formal education. Spatial analysis confirmed significant clustering of SBI (Moran’s I = 0.50, p = 0.003), with hotspots concentrated in southern Somalia, specifically in the Gedo, Jubbada Hoose, Bay, and Bakool regions. SBI in Somalia is a widespread public health crisis with a prevalence of 77.50%, showing distinct geographical patterns driven by a complex interplay of demographic and community factors. Health interventions should prioritize young women (< 30 years) and be geographically targeted toward the identified southern hotspots. The counterintuitive finding on education highlights the need for context-specific research to inform effective reproductive health programming in post-conflict settings.