Background Childhood immunization is a critical public health intervention that significantly reduces child morbidity and mortality. However, despite global progress, disparities in immunization coverage persist, particularly in low-income and conflict-affected settings such as Somalia. Zero-dose immunization, defined as the complete absence of routine vaccinations, remains a major challenge, leaving children vulnerable to vaccine-preventable diseases. Understanding the prevalence and sociodemographic determinants of zero-dose immunization is essential for developing targeted interventions. Methods This study analyzed data from the 2020 Somalia Demographic and Health Survey (SDHS) to estimate the prevalence of zero-dose immunization among children aged 12–23 months and assess its distribution across key sociodemographic and geographic factors. The study defined zero-dose children as those who had not received the first dose of the diphtheria-tetanus-pertussis vaccine (DPT1). Descriptive statistical analyses were conducted to examine variations in zero-dose prevalence by maternal characteristics, household wealth, healthcare access, and geographic region. Results The prevalence of zero-dose immunization among Somali children was 44.0%, with significant disparities across socioeconomic and regional characteristics. Zero-dose prevalence was highest among children of younger mothers (54.0% for those aged 15–19 years) and those whose mothers had no formal education (49.0%). Household wealth was also a key determinant, with zero-dose prevalence reaching 53.0% in the poorest households compared to 29.0% in the wealthiest. Geographic disparities were evident in the administrative regions of Somalia, with the highest zero-dose prevalence recorded in Lower Juba (62.0%), Bay (62.0%), and Banadir (55.0%), while the lowest was observed in Togdheer (24.0%) and Sool (28.0%). Children residing in rural areas had lower immunization coverage, likely due to limited healthcare access. Conclusion The high prevalence of zero-dose immunization in Somalia underscores the urgent need for targeted interventions to improve vaccine uptake. Addressing disparities related to maternal education, household wealth, and geographic accessibility is crucial. Strengthening routine immunization services, expanding community outreach, and improving healthcare infrastructure in high-prevalence regions are necessary to reduce the proportion of zero-dose children and improve child health outcomes.

Fertility preferences significantly influence population dynamics and reproductive health outcomes, particularly in low-resource settings, such as Somalia, where high fertility rates and limited healthcare infrastructure pose significant challenges. Understanding the determinants of fertility preferences is critical for designing targeted interventions. This study leverages machine learning (ML) algorithms and Shapley Additive extensions (SHAP) to identify key predictors of fertility preferences among reproductive-aged women in Somalia. This cross-sectional study utilized data from the 2020 Somalia Demographic and Health Survey (SDHS), encompassing 8,951 women aged 15–49 years. The outcome variable, fertility preference, was dichotomized as either desire for more children or preference to cease childbearing. Predictor variables included sociodemographic factors, such as age, education, parity, wealth, residence, and distance to health facilities. Seven ML algorithms were evaluated for predictive performance, with Random Forest emerging as the optimal model based on metrics such as accuracy, precision, recall, F1-score, and the Area Under the Receiver Operating Characteristic Curve (AUROC). SHAP was employed to interpret the model by quantifying the feature contributions. The SHAP analysis identified the most influential predictors of fertility preferences as age group, region, number of births in the last five years, number of children born, marital status, wealth index, education level, residence, and distance to health facilities. Specifically, age group was the most significant feature, followed by region and number of births in the last five years. Women aged 45–49 years and those with higher parity were significantly more likely to prefer no additional children. Distance to health facilities has emerged as a critical barrier, with better access being associated with a greater likelihood of desiring more children. The Random Forest model demonstrated superior performance, achieving an accuracy of 81%, precision of 78%, recall of 85%, F1-score of 82%, and AUROC of 0.89. SHAP analysis provided interpretable insights, highlighting the nuanced interplay of sociodemographic factors. This study underscores the potential of ML algorithms and SHAP in advancing our understanding of fertility preferences in low-resource settings. By identifying critical sociodemographic determinants, such as age group, region, number of births in the last five years, number of children born, marital status, wealth index, education level, residence, distance to health facilities, and employment status, these findings offer actionable insights to inform evidence-based reproductive health interventions in Somalia. Future research should expand the application of ML to longitudinal data and incorporate additional cultural and psychosocial predictors to enhance the robustness and applicability of this model.

Despite efforts to improve its uptake, contraceptive use in Nigeria remains low. Understanding regional disparities and sociodemographic determinants of contraceptive intention is crucial for developing effective family planning strategies. This study aimed to investigate these factors in women of reproductive age in Nigeria. This cross-sectional study analysed data from 36,179 women aged 15–49 participating in the 2018 Nigerian Demographic and Health Survey (NDHS). Bivariate and multivariable logistic regression analyses were conducted to assess the association between sociodemographic factors and contraceptive use intention. The overall prevalence of contraceptive intentions was 39.18%, with significant regional variation. South East had the highest intention at 44.85%, while North East had the lowest intention at 34.76%. Education was a strong predictor, with those with higher education showing 2.657 times greater odds of using contraception (AOR: 2.657, 95% CI: 2.339–3.019, p < 0.001). Muslim women and rural residents exhibited lower odds of intention, while women aged 20–24 years had the highest odds (AOR: 1.305, 95% CI: 1.187–1.435, p < 0.001). There were significant regional disparities and complex sociodemographic patterns in contraceptive intention among Nigerian women. Tailored interventions addressing educational, religious, economic, and geographical barriers are required to increase contraceptive uptake and improve reproductive health outcomes.

Background: Childhood immunization is crucial for reducing morbidity and mortality from vaccine-preventable diseases. Despite global efforts, Nigeria faces persistently low immunization uptake with significant regional and socioeconomic disparities. This study investigated the prevalence, regional disparities, and sociodemographic determinants of full immunization coverage among children aged 12– 23 months in Nigeria. Methods: This secondary analysis utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS), focusing on 2453 mothers with children aged 12– 23 months. Full immunization coverage was defined per World Health Organization (WHO) guidelines. Descriptive statistics, bivariate analysis, and multivariable logistic regression identified predictors of coverage. Results: Only 26% of children were fully immunized nationwide. Marked regional disparities were observed, with the North West (13%) and North East (18%) exhibiting the lowest rates, while the South East (42%) and South South (41%) had the highest. Multivariable analysis revealed that maternal education, household wealth, and region of residence were significant predictors. Children of mothers with higher education were more likely to be fully immunized (AOR: 1.87, 95% CI: 1.10– 3.18, p = 0.022), as were those from the richest households compared to the poorest (AOR: 3.20, 95% CI: 1.95– 5.25, p < 0.001). Children in the South East (AOR: 2.00, 95% CI: 1.16– 3.46, p = 0.013) and South South (AOR: 1.73, 95% CI: 0.99– 3.02, p = 0.052) also showed significantly higher odds of full immunization compared to the North West. Conclusion: Full immunization coverage in Nigeria remains critically low, driven by pronounced regional and socioeconomic inequities. Targeted interventions focusing on improving maternal education, expanding equitable healthcare access in underserved regions, and providing financial support to low-income families are essential. Policy efforts must prioritize these vulnerable groups to enhance child health outcomes and achieve universal immunization coverage in Nigeria.

Contraceptive use is vital to improve maternal and child health, promote economic stability, and empower women. Despite global progress in family planning, Somalia faces unique challenges due to cultural, economic, and infrastructural barriers, resulting in low contraceptive use. This study investigated the prevalence and determinants of the intention to use contraceptives among women of reproductive age in Somali. Using data from the 2020 Somali Demographic and Health Survey (SDHS), this study analyzed a sample of 7,967 women aged 15–49. Contraceptive intention was categorized as “intent to use” versus “no intent to use.” The SDHS questionnaire assesses intention to use contraceptives in the next 12 months, which aligns with standard DHS definitions. Bivariate and multivariable logistic regression analyses were conducted to assess the association between contraceptive intention and sociodemographic factors. Choropleth maps and bar charts illustrate regional disparities. Overall, only 7.6% of the women intended to use contraception, with substantial regional variation. Woqooyi Galbeed reported the highest prevalence of contraceptive intention at 18.4%, while Gedo had the lowest at 1.1%. Significant predictors of contraceptive intention included higher education (AOR: 2.34, 95% CI: 1.21–4.56), secondary education (AOR: 1.91, 95% CI: 1.12–3.26). Women residing in nomadic communities had significantly lower odds of intending to use contraception (AOR: 0.40, 95% CI: 0.23–0.68). Since nomadic residence often implies reduced healthcare access, this finding suggests logistical and cultural barriers to contraceptive intentions. Cultural and geographic factors significantly influence contraceptive intentions. Regional, educational, and socioeconomic variations affect contraceptive intentions in Somalia. Addressing these disparities through targeted educational and healthcare access interventions could improve family planning and utilization, ultimately enhancing maternal and child health outcomes.