Abstract:
Background: Anemia is a worldwide public health problem that occurs in all age groups but, 
under five years children are mostly affected. However, Anemia among children under five in 
Somalia is a critical public health issue with multifaceted causes and significant consequences. 
there is no factual data on Garowe Puntland Somalia that can support intervention of under-five 
children issues like anemia and their associated factors so There are currently no studies in 
Puntland, particularly in Garowe, that concentrate on under-five children anemia and related 
issues. As a result, this study will identify the prevalence of anemia in children as well as the 
factors.
Objective: To assess the prevalence of anemia and its associated factors among children under 5 
years of age in Garowe, Puntland, Somalia from April, 20 to May 20, 2022.
Method and materials: An institutional-based cross-sectional study was conducted among 308 
children aged 6-59 months attending selected health institutions in Garowe city. Data was collected 
through face-to-face interviews with the mother/caretaker, nutritional assessment, stool 
examination, blood film for malaria, and dietary diversity score. Anemia was assessed by 
hemoglobin measurement using HhemocueHB201.Bivariable and multivariable logistic 
regression was performed to identify factors associated with anemia, thereby controlling the 
possible confounding factors. The level of statistical significance was declared at P-value < 0.05.
Result: The overall prevalence of anemia in this study was 19.81% (61/308) (95% CI: 15.5, 24.7).
The magnitude of severe, moderate, and mild types of anemia were 3.2% (2/61) (95% CI:
0.4,11.4), 40.9% (25/61) (95% CI: 28.6,54.3)) and 55.7% (34/61) (95% CI: 42.5,68.5), 
respectively. Mother educational status (AOR=5.21; 95 CI:1.33,20.29), monthly family income 
(AOR=3.17; 95% CI 1.16,8.64), intestinal parasite infection (AOR= 5.95; 95% CI: 2.49,14.20) 
and malaria (AOR 4.36; 95% CI:1.44,13.19) were negative associations while only this one is 
preventive fathers’ educational status (AOR 0.23;95% CI: 0.06,0.88), so all these factors 
associated anemia among under 5 children at Garowe, Puntland, Somalia.
Conclusion: In this study, anemia has mild public health significance according to a range of 
WHO Mothers with read-and-write education and a family having a monthly income of 230 
dollars, intestinal parasite, and infection malaria infection were positively identified factors 
associated with anemia among under 5 children. While preventive factors were only the father 
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with secondary education. Therefore, screening for anemia is advised for children under five who 
visit a health facility with identified factors.