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Time to Death and Its Determinants of Under-Five Children in Somaliland: Utilization of Cox Proportional Hazards

Abdisalam Amin Esse¹, Abdisalan Ahmed Osman², Abdikadir N Abdi¹

¹Amoud University, Borama, Somaliland.

Sage Open Pediatrics

|November 3, 2025

Abstract

Objectives:

To identify determinants of under-five child mortality in Somaliland using Cox Proportional Hazard models, focusing on socioeconomic, environmental, and maternal factors influencing survival time.

Introduction:

Under-five mortality is a critical health issue in Somaliland. This first-of-its-kind study investigated local risk factors.

Methods:

A retrospective analysis of the 2020 Somaliland Demographic and Health Survey (SLDHS) data was conducted. Cox Proportional Hazards models were employed to assess factors associated with time-to-death in children under 5.

Results:

Significant risk factors included reliance on wells (Adjusted HR = 3.96, P = .034) or other non-piped water (AHR = 3.31, P = .016), male-headed households (AHR = 2.29, P = .036), female child sex (AHR = 6.24, P = .024), and later birth order (AHR = 3.34, P = .012). Conversely, older maternal age (25-49 years) was strongly protective (P < .001).

Conclusion:

The study highlights the factors of under-five mortality. Interventions targeting interventions focusing on improving access to clean water, gender equity, and support for young mothers to reduce child mortality in Somaliland.

Keywords:

Somaliland clean water access cox proportional hazards model gender disparities maternal age socio-demographic factors under-five mortality

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