Magnitude and associated factors of safe child feces disposal in Somalia using multilevel analysis of the 2020 demographic and health survey

Safe child feces disposal is vital for preventing disease and achieving Sustainable Development Goal target 6.2. In Somalia, unhygienic child feces disposal practices persist despite public health efforts. This study analyzed data from the 2020 Somalia Demographic and Health Survey, involving a sample of 17,420 mother-child pairs. Multilevel logistic regression models were employed to examine the influence of individual and community-level factors on disposal practices. Overall, 69.03% of disposal practices were safe, while 30.97% were unsafe. Older maternal age (40–44 years: AOR 1.61, 95% CI 1.24–2.09), urban residence (AOR 1.46, 95% CI 1.26–1.67), and nomadic residence (AOR 1.62, 95% CI 1.40–1.88) were significantly associated with higher odds of safe disposal. Conversely, primary education (AOR 0.69, 95% CI 0.60–0.80), infrequent radio listening (AOR 0.84, 95% CI 0.70-1.00), middle wealth status (AOR 0.70, 95% CI 0.60–0.83), and high community poverty (AOR 0.59, 95% CI 0.40–0.86) were associated with lower odds of safe disposal. Unexpectedly, improved water sources (AOR 0.83, 95% CI 0.75–0.93) were also associated with lower odds of safe disposal. Significant regional disparities were observed. Unsafe child feces disposal remains a significant challenge in Somalia. The unexpected links between higher education/wealth and unsafe disposal suggest that interventions must be regionally tailored and Somalia’ context-specific. Further qualitative research is needed to explore the complex sociocultural determinants influencing these behaviors.