Determinants of counseling on neonatal danger signs among women in Somalia: a multilevel mixed-effects logistic regression analysis of the 2020 SDHS

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Background: Neonatal mortality remains a major public health challenge in low- and middle-income countries, including Somalia, where access to maternal health services is limited. Although counseling on neonatal danger signs is essential for early recognition and timely care-seeking, evidence on its coverage and determinants in Somalia remains scarce, particularly using nationally representative data. Methods: A cross-sectional study was conducted using data from the 2020 Somalia Demographic and Health Survey (SDHS). A total of 6,413 women aged 15-49 years with a recent birth were included. A multilevel mixed-effects logistic regression model was employed to identify individual- and community-level determinants of receiving counseling. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were reported. Results: Only 4.35% of women reported receiving counseling on neonatal danger signs. Women in the highest wealth quintile were significantly more likely to receive counseling (AOR = 2.77; 95% CI: 1.60-4.80). Adequate antenatal care utilization was associated with increased odds (AOR = 2.10; 95% CI: 1.40-3.13), while facility-based delivery was the strongest predictor (AOR = 4.49; 95% CI: 3.28-6.14). Conclusion: Counseling on neonatal danger signs in Somalia remains critically low and is characterized by substantial socioeconomic and healthcare access inequalities. Strengthening antenatal care services, promoting facility-based delivery, and addressing equity gaps in access to maternal health services are essential to improve maternal knowledge and neonatal outcomes.

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