Determinants of Severe Acute Malnutrition Among Children Aged 6–23 Months Attending Public Hospitals in the Benadir Region, Somalia: An Unmatched Case–Control Study

ABSTRACT Background and Aims Severe acute malnutrition (SAM) remains a leading cause of morbidity and mortality among children under 2 years in Somalia. This study aimed to identify determinants of SAM using a hospital‐based unmatched case–control design. Methods An unmatched case–control study was conducted from February to May 2025 at two public hospitals in Mogadishu. A total of 255 children (85 cases and 170 controls) aged 6–23 months were included. Statistical comparisons between groups were performed using chi‐square tests, and multivariable logistic regression identified independent predictors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results Significant differences between cases and controls were observed across several variables. Large family size (AOR = 1.92; 95% CI: 1.24–4.08), short birth interval < 2 years (AOR = 4.11; 95% CI: 2.98–17.19), unprotected water source (AOR = 2.24; 95% CI: 1.37–4.11), and use of traditional cooking fuel (AOR = 6.48; 95% CI: 2.18–19.24) were independent predictors. Early (< 6 months) and delayed (> 6 months) complementary feeding were analyzed separately, both showing increased risk, with delayed initiation demonstrating a stronger association. Presence of comorbid illness (AOR = 1.96; 95% CI: 1.07–3.84) was also associated with SAM. Conclusion SAM is influenced by multifactorial determinants including household, environmental, and feeding practices. Targeted interventions are essential to reduce malnutrition burden.