Trends in Stunting Prevalence and Sex-based Disparities among Children under Five in Somalia, 2000–2024: A Secondary Analysis of WHO Model-based Estimates

BACKGROUND: This study aimed to describe the 24-year trajectory (2000-2024) of stunting prevalence among children under five years of age and quantify the magnitude and temporal stability of sex-based disparities in chronic malnutrition using WHO model-based estimates. METHODS: A cross-sectional trend analysis was performed using model-based estimates extracted from the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) version 7.0. This study analysed annual stunting prevalence disaggregated by sex and utilized inequality metrics, including the difference (D), ratio (R), Population Attributable Fraction (PAF), and Population Attributable Risk (PAR), to quantify health inequities over time. RESULTS: Stunting prevalence in Somalia decreased from 33.6% in 2000 to 23.9% in 2024, reflecting an overall reduction of 9.7 percentage points. However, sex-based disparities persisted across the study period, with males consistently experiencing higher stunting prevalence than females. In 2024, the prevalence was 25.7% (95% CI: 15.8-39.1) among males and 22.0% (95% CI: 13.0-34.8) among females. The inequality ratio remained nearly unchanged at 0.86-0.87, suggesting persistent relative inequality despite improvements in the national prevalence of stunting. CONCLUSION: Somalia has achieved notable reductions in chronic malnutrition over the last two decades; however, the prevalence of stunting remains a medium-to-high public health concern. The enduring vulnerability of male children to stunting highlights the need for targeted sex-sensitive nutritional interventions. To meet international health targets, policymakers must implement multisectoral strategies that address modifiable risk factors, such as maternal education, household wealth, and climate resilience.