Sanaag and Sool are two remote regions in Somaliland with limited access to health service and high burden of HIV/AIDS. The aim of this study was to identify the predictors of HIV/AIDS awareness among women of reproductive age in underserved regions of Somaliland using data from the 2020 Somaliland Demographic and Health Survey through a cross-sectional analysis.

A cross-sectional study using Somaliland Demographic and Health Survey data.

The study was conducted in the Sanaag and Sool regions of Somaliland. These areas are characterised by underserved communities and ongoing internal conflict, which has significantly undermined the delivery of health services. Consequently, there is a high HIV/AIDS burden in these regions. The study focused on women of reproductive age, using data from the 2020 Somaliland Demographic and Health Survey for the analysis.

The outcome variable of the study was awareness about HIV/AIDS and independent variables including education, media exposure, place of residence and wealth index were considered.

The proportion of poor HIV/AIDS awareness is high in Sool and Sanaag, with 38.8% and 26.6% of women respectively having no awareness about HIV/AIDS. Findings indicate that women who had primary and above level of education (adjusted OR, AOR=2.25; 95% CI 1.99 to 2.53) and media exposure including radio (AOR=2.31; 95% CI 1.99 to 2.68) and television (AOR=3.94; 95% CI 3.45 to 4.5) are strong predictors of HIV/AIDS awareness. Women in urban areas (AOR=2.83; 95% CI 2.25 to 3.57) were more likely to have HIV/AIDS awareness compared with women in rural and nomadic settings.

Inadequate awareness about HIV/AIDS was associated with education, residence and mass media exposure. Targeted health education programmes, promoting women’s education status and media campaigns could help improve HIV/AIDS awareness, which in turn enables reproductive age women to take protective measures against exposure.

Antenatal care (ANC) plays a critical role in improving maternal and neonatal health outcomes. However, incomplete ANC attendance in Somaliland is associated with adverse maternal and birth outcomes. Barriers to ANC attendance may increase the risk of pregnancy-related complications, including maternal morbidity, mortality and poor neonatal health outcomes. Understanding the effect of ANC attendance on maternal and birth outcomes is crucial for informing policies and interventions aimed at reducing these risks. Hence, this study aimed to assess the effect of ANC attendance on maternal and birth outcomes in Somaliland.

A prospective cohort study was conducted among 1205 pregnant women enrolled by systematic sampling method.

The study was conducted in the Republic of Somaliland, which is situated in the Horn of Africa. Baseline data were collected at recruitment, and participants were followed up to delivery for the collection of outcome variables. The number of ANCs was considered to be a dichotomous independent variable; incomplete attendance (≤ 3 visits) and complete attendance (≥4 visits). The risk of pregnancy outcome among those with incomplete ANC was assessed using multi-variable logistic regression.

The outcome variables of the study were the maternal and birth outcomes. The independent variables included socio-demographic characteristics, such as age, residence, educational status, occupation, family size, wealth index and marital status, and reproductive factors, such as parity, gestational age at first ANC visit, current pregnancy desirability and previous pregnancy history.

Out of the total participants, 43.3% of women had complete attendance. The incidence of postpartum haemorrhage was 10.0% (95% CI 8.6 to 12.3); antepartum haemorrhage, 3.6% (95% CI 2.6 to 4.7); caesarean section, 14.8% (95% CI 12.9 to 16.8); preterm delivery, 13.7% (95% CI 11.7 to 15.4); low birth weight, 25.8% (95% CI 23.4 to 28.1); and stillbirth, 3.2% (95% CI 2.3 to 4.2). Complete attendance to ANC significantly reduced the risk of antepartum haemorrhage, caesarean section, preterm delivery and admission to the neonatal intensive care unit and stillbirth.

Nearly more than half of women in Somaliland had less than four ANC visits. The incidence of maternal and birth complications is higher among pregnant women who attended