Dietary diversity and iron deficiency anemia among women of reproductive age in Mogadishu (Banaadir), Somalia: a descriptive secondary analysis of published 2019 Somalia micronutrient survey estimates

Background Anemia and iron deficiency threaten women’s health and reproductive outcomes in Somalia, and dietary diversity is widely used as a population-level proxy for micronutrient adequacy. Methods This descriptive secondary analysis used published aggregate estimates from the 2019 Somalia Micronutrient Survey (SMS 2019) to (1) describe minimum dietary diversity for women (MDD-W), anemia, iron deficiency, and iron deficiency anemia (IDA) in Mogadishu (Banaadir) alongside national estimates; (2) summarize national outcomes by MDD-W status; and (3) reproduce published national estimates by other characteristics. No individual-level data were available, so no participant-level analysis, adjustment, or testing of Banaadir against national estimates was possible. Results In Banaadir, 54.6% (95% CI 46.9–62.1) of pregnant and non-pregnant women met MDD-W versus 37.1% (31.9–42.5) nationally. Among non-pregnant women, anemia was 54.3% (47.3–61.2) versus 40.2% (36.2–44.4), iron deficiency 50.5% (42.4–58.6) versus 49.7% (45.4–54.0), and IDA 34.2% (26.4–42.9) versus 26.3% (22.9–30.1). The published intervals did not overlap for MDD-W or anemia but did overlap for iron deficiency and IDA; these contrasts are descriptive and untested, and Banaadir contributes to the national estimate. Nationally, IDA was 26.1% among women consuming 0-4 food groups and 26.6% among those meeting MDD-W (published p = 0.8825); anemia and iron deficiency likewise did not differ significantly (published p = 0.7546 and 0.1162). Anemia was more common among iron-deficient (56.0% vs. 21.7%) and vitamin A-deficient (55.2% vs. 36.8%) women. Conclusion MDD-W and biomarker estimates refer to different women, so the findings describe co-existing population indicators, not a relationship within the same women. The biomarker definitions listed in the survey report are inconsistent and unconfirmed, so absolute iron deficiency and IDA prevalence should be interpreted cautiously. MDD-W did not detectably distinguish iron-related outcomes, and high dietary diversity in Banaadir coexisted with high anemia; MDD-W alone should not be relied on as a proxy for iron status. Individual-level analyses of Banaadir are needed to examine reproductive history, socioeconomic position, inflammation, and other micronutrient deficiencies.