Determinants of deworming during pregnancy in somaliland: a binary and multivariate logistic regression analysis

Soil-transmitted helminth (STH) infections during pregnancy pose a significant threat to maternal health and perinatal outcomes. The low uptake of preventive deworming in high-burden settings, such as Somaliland, suggests systemic gaps in service delivery that require urgent attention. This study aims to identify the determinants of deworming among pregnant women in Somaliland to inform targeted public health strategies. This cross-sectional study analyzed data from 3038 women who had a pregnancy in the five years preceding the 2020 Somaliland Demographic and Health Survey (DHS). The DHS employs a two-stage stratified sampling design to ensure a nationally representative sample. Our analysis accounted for this complex survey design by applying the provided sampling weights. We used multivariate logistic regression to identify factors associated with receiving deworming medication during a past pregnancy. The overall prevalence of deworming was critically low at 1.9%, a stark contrast to the 75% WHO global coverage target. After adjusting for confounders, the analysis revealed that ‘structural barriers’—physical and financial obstacles to healthcare access—were the primary determinants. Women in rural (Adjusted Odds Ratio [AOR] = 0.35; 95% CI 0.15–0.82) and nomadic (AOR = 0.12; 95% CI 0.03–0.51) areas had significantly lower odds of being dewormed compared to urban women. Conversely, women in the highest wealth quintile had nearly six times the odds of receiving treatment compared to those in the lowest (AOR = 5.85; 95% CI 1.28–26.7). The alarmingly low deworming coverage in Somaliland appears to be driven by geographic and socioeconomic inequities. Our findings suggest that in this setting, structural factors have a stronger association with service uptake than individual-level characteristics. By prioritizing outreach services and addressing barriers to access, public health strategies can significantly improve the uptake of this essential care, improving maternal and child health outcomes.