{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:45:18Z","timestamp":1791989118824,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anemia in pregnancy is a severe public health problem in low\u2010 and middle\u2010income countries, yet the uptake of recommended iron supplementation remains critically low. In a post\u2010conflict and resource\u2010constrained setting like Somaliland, there is a significant evidence gap regarding the factors that determine whether pregnant women use these essential supplements. This study aimed to identify the individual and community\u2010level factors associated with the uptake of iron supplements during pregnancy in Somaliland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional analysis of data from the 2020 Somaliland Demographic and Health Survey (SLDHS), including a nationally representative weighted sample of 2577 women aged 15\u201349 years who had a live birth in the 5 years preceding the survey. A multilevel binary logistic regression model was used to identify determinants of iron supplement uptake while accounting for the hierarchical data structure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The uptake of iron supplements was alarmingly low, with only 37.08% of women reporting use during their most recent pregnancy. The strongest predictor was attending four or more antenatal care (ANC) visits (adjusted odds ratio [AOR]\u00a0=\u00a06.20; 95% confidence interval [CI]: 4.70\u20138.19). Other significant positive determinants included belonging to a rich household (AOR\u00a0=\u00a01.93; 95% CI: 1.43\u20132.60), having a husband\n                      <jats:bold>\n                        <jats:italic>in paid employment<\/jats:italic>\n                      <\/jats:bold>\n                      (AOR\u00a0=\u00a02.13; 95% CI: 1.71\u20132.66), and exposure to television. Conversely, women whose husbands had no formal education had significantly lower odds of uptake (AOR\u00a0=\u00a00.68; 95% CI: 0.51\u20130.91). Significant regional disparities were observed, with markedly lower uptake in the Sool and Sanaag regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Iron supplement uptake in Somaliland is critically deficient and driven by profound inequities in healthcare access and socioeconomic status. A multipronged strategy is urgently needed, focusing on strengthening ANC services, leveraging mass media and mHealth for targeted health promotion, addressing socioeconomic barriers, and engaging male partners to improve maternal and child health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70427","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:55:08Z","timestamp":1791986108000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Uptake of Iron Supplement During Pregnancy Among Women of Reproductive Age in Somaliland: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"5","author":[{"given":"Awo Mohamed","family":"Kahie","sequence":"first","affiliation":[{"name":"College of Health Sciences School of Medicine and Surgery Amoud University  Borama Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2389-8717","authenticated-orcid":false,"given":"Mohamed Said","family":"Hassan","sequence":"additional","affiliation":[{"name":"College of Health Sciences School of Medicine and Surgery Amoud University  Borama Somalia"},{"name":"School of Postgraduate Studies and Research Amoud University, Amoud Valley  Borama Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4450-5081","authenticated-orcid":false,"given":"Suhaib Mohamed","family":"Kahie","sequence":"additional","affiliation":[{"name":"College of Health Sciences School of Medicine and Surgery Amoud University  Borama Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdikadir Abdillahi","family":"Husein","sequence":"additional","affiliation":[{"name":"College of Health Sciences School of Medicine and Surgery Amoud University  Borama Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0776-2406","authenticated-orcid":false,"given":"Asma","family":"Abdirahman","sequence":"additional","affiliation":[{"name":"School of Postgraduate Studies and Research Amoud University, Amoud Valley  Borama Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"WHO Global Anaemia Estimates","author":"WHO","year":"2025"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(13)70001\u20109"},{"issue":"1","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13690-025-01765-3","article-title":"Determinants of Newborn Birth Size in Somaliland: An Ordinal Logistic Regression Analysis","volume":"83","author":"Ibrahim A. O.","year":"2025","journal-title":"Archives of Public Health"},{"key":"e_1_2_14_5_1","volume-title":"WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience","author":"World Health Organization","year":"2016"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/ijwh.s410489"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.13254","article-title":"Risk Factors of Anaemia and Iron Deficiency in Somali Children and Women: Findings From the 2019 Somalia Micronutrient Survey","volume":"18","author":"Wirth J. P.","year":"2022","journal-title":"Maternal & Child Nutrition"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.cegh.2024.101565","article-title":"Magnitude and Determinants of Adherence to Iron\u2010Folic Acid Supplementation Among Somaliland Pregnant Women in Ahmed\u2010Dhagah District: A Facility Based Cross\u2010Sectional Study","volume":"26","author":"Mohamed A. I.","year":"2024","journal-title":"Clinical Epidemiology and Global Health"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010020\u20102835\u20100"},{"key":"e_1_2_14_10_1","unstructured":"SLHDS The Somaliland Health and Demographic Survey 2020(Central Statistics Department Ministry of Planning and National Development Somaliland Government 2020) https:\/\/www.somalilandcsd.org\/somaliland\u2010health\u2010and\u2010demography\u2010survey\u2010slhd2020\/."},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v28i1.1"},{"issue":"9","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"5460","DOI":"10.1002\/fsn3.3503","article-title":"Adherence to Iron Supplement Intake During Pregnancy and Associated Factors in Ethiopia: Further Analysis of a National Population\u2010Based Study","volume":"11","author":"Demie T. G.","year":"2023","journal-title":"Food Science & Nutrition"},{"key":"e_1_2_14_13_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.978084","article-title":"Iron\u2010Folic Acid Adherence and Associated Factors Among Pregnant Women Attending Antenatal Care at Metema District, Northwest Ethiopia","volume":"10","author":"Yismaw A. E.","year":"2022","journal-title":"Frontiers in Public Health"},{"issue":"1","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/s12884-024-06539-3","article-title":"Prevalence of Anemia and Associated Factors Among Pregnant Women at Hargeisa Group Hospital, Somaliland","volume":"24","author":"Abdilahi M. M.","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.25259\/jch_59_2024"},{"key":"e_1_2_14_16_1","unstructured":"B.Genet Adherence to Iron Folate and Associated Factors Among Pregnant Women Attending Antenatal Clinic in Holeta Town Public Health Facilities West Shewa Oromia Ethiopia2024(Doctoral dissertation Ambo University)."},{"issue":"1","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s44155-025-00301-6","article-title":"Determinants of Deworming During Pregnancy in Somaliland: A Binary and Multivariate Logistic Regression Analysis","volume":"5","author":"Mohamed A. A.","year":"2025","journal-title":"Discover Social Science and Health"},{"issue":"2","key":"e_1_2_14_18_1","first-page":"319","article-title":"Associated Factors and Compliance With Iron\u2010Folic Acid Therapy Among Pregnant Women of Karachi, Pakistan","volume":"43","author":"Kessani L.","year":"2018","journal-title":"Rawal Medical Journal"}],"container-title":["Public Health Challenges"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/puh2.70427","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/puh2.70427","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/puh2.70427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:55:12Z","timestamp":1791986112000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/puh2.70427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/puh2.70427"],"URL":"https:\/\/doi.org\/10.1002\/puh2.70427","archive":["Portico"],"relation":{},"ISSN":["2769-2450","2769-2450"],"issn-type":[{"value":"2769-2450","type":"print"},{"value":"2769-2450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"2025-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70427"}}