Attachments
EXECUTIVE SUMMARY
Galkayo, a strategic urban center in central Somalia, is mired in a prolonged humanitarian crisis driven by conflict, climate shocks and chronic poverty. The high concentration of internally displaced persons (IDPs) has overwhelmed basic services, including food security, health, and nutrition systems. Among children under five, the risk of acute malnutrition remains elevated due to inadequate infant and young child feeding (IYCF) practices, limited dietary diversity, and insufficient access to healthcare and clean water.
According to the IPC Acute Food Insecurity and Acute Malnutrition Analysis (January–June 2025), both IDP and urban populations in Galkayo are classified in IPC Phase 3 (Crisis) for food insecurity and malnutrition. Global Acute Malnutrition (GAM) among IDPs is alarmingly high at 19.1%, with Severe Acute Malnutrition (SAM) at 2.4%, compounded by maternal undernutrition and widespread household hunger. The Mass MUAC screening conducted by Development and Empower for Humanity (DEH) in November 2024 in its programming sites revealed proxy GAM, SAM, and MAM rates of 17.4%, 3.1%, and 14.3%, respectively underscoring the urgent need for targeted interventions.
DEH, supported by the Somalia Humanitarian Fund, has been delivering community-based nutrition programs since August 2024 across eight villages in Galkayo. A KAP survey was conducted in February 2025 to assess caregiver knowledge, attitudes, and practices on breastfeeding, complementary feeding, and maternal nutrition. The survey aimed to inform evidence-based interventions by identifying behavioral gaps, cultural barriers, and nutritional risks, ultimately strengthening IYCF programming, enhancing community resilience, and improving nutrition outcomes for vulnerable children under two. Two stage cluster sampling was used with data collected across 149 households over seven days using KoBo Toolbox, pretested tools and strict ethical and data quality protocols (informed consent, confidentiality and GBV/child protection referrals). Twelve rigorously trained enumerators collected quantitative and qualitative data under close supervision and random spot checks to ensure accuracy and integrity.
Across the sampled 149 households, 91% of the respondents were mothers, with the remainder being grandmothers, siblings or other relatives. Families were large (81% with five or more members) and split nearly 60/40 between male and female headed households, reflecting both traditional norms and displacement driven shifts. Of 135 mothers interviewed, 58.5% were lactating and 25.2% pregnant, underscoring the ongoing need for maternal nutrition support and infant and young child feeding (IYCF) counseling. Most caregivers (84.6%) were married and nearly all had Madrasa education, suggesting strong faith-based entry points for behavior change efforts.
Breastfeeding practices were encouraging: 91.3% of children had been breastfed, 80.9% within one hour of birth, and 81.8% exclusively breastfed to five months—far exceeding the national average. Nearly half of households (42.3%) experienced food shortages in the prior week, often borrowing food or cutting meals, risking long term health consequences. WASH conditions further compound risks: 44.3% rely on unprotected water pans, only 52.3% treat their water (mainly by boiling), 24.2% lack latrines and just 45.5% wash hands at all five critical moments.
Child level data revealed a slight male predominance (53.7%) and extremely high acute malnutrition: among 134 children older than six months, 48.5 % screened as acutely malnourished (10.4 % SAM, 38.1 % MAM). Immunization coverage fell short—BCG 69.1 %, Pentavalent 78.6 %, measles 71.8 %—while vitamin A supplementation reached 60 % and deworming 65–72 %. In the two weeks before the survey, 20 % of children fell ill (mostly fever and diarrhea), yet 27 % received no care and only half of those with diarrhea received zinc. Although 76.5 % of births occurred in health facilities, 20.8 % were home deliveries often attended by traditional birth attendants. These gaps point to urgent opportunities to strengthen routine immunization, malnutrition treatment, maternal newborn services and integrated water, sanitation, hygiene and IYCF interventions to ensure timely, equitable access to lifesaving support.
The KAP survey findings reveal a complex interplay of knowledge, socio economic barriers, cultural norms, and service delivery gaps that hinder the adoption of optimal health, nutrition, and hygiene practices in Galkayo. Although awareness of interventions like exclusive breastfeeding, complementary feeding, antenatal care, immunization, and handwashing is relatively high, actual uptake remains erratic, impeded by food insecurity, limited-service access, reliance on informal healthcare, and pervasive misconceptions. To bridge the “know–do” gap, DEH is committed to moving beyond awareness raising and adopting a more comprehensive, multi sectoral approach. In the immediate term, this includes strengthening OTP TSFP service delivery, integrating WASH interventions into nutrition sites, expanding mobile outreach, and enhancing IYCF counseling. In the short term, DEH will link nutrition interventions with food assistance, promote hygiene practices, and empower community health workers to lead early detection and adherence support. Over the medium to long term, DEH will address the root causes of malnutrition through initiatives like kitchen gardens, vocational training, and social protection. To achieve sustainable improvements in child nutrition and overall health, DEH will employ cross cutting strategies such as social behavior change communication, improved access to health services, targeted infrastructure upgrades, and robust community accountability mechanisms. DEH will also engage in advocacy with government authorities, donors, and humanitarian coordination bodies to secure increased policy support, funding, and integration of nutrition priorities into local planning processes.