Access to Water, Sanitation, and Hygiene (WASH) practices and their associations with waterborne diseases and malnutrition in Ibrahim Kodbuur District, Hargeisa, Somaliland: a cross-sectional study.

backgroundIn low-resource environments like Somaliland, where insufficient infrastructure leads to high rates of hunger and waterborne illnesses, access to water, sanitation, and hygiene (WASH) is crucial for health. WASH practices in Ibrahim Kodbuur District, Hargeisa, were evaluated in this study in order to find gaps, guide solutions that support Sustainable Development Goal 6, and their links to health outcomes, including child malnutrition.

methodsNinety-seven households chosen through multi-stage cluster sampling participated in a cross-sectional community-based survey that was carried out between June and August 2025. Data on sociodemographic, WASH access, and health outcomes were collected using WHO-adapted questionnaires and visual assessments. Nutritional status was evaluated via mid-upper arm circumference (MUAC) for rapid screening of acute malnutrition in under-fives and BMI z-scores, as per WHO standards, to capture WASH-related vulnerabilities. Descriptive statistics, principal component analysis (PCA), and multiple linear regression (MLR) analysed associations with waterborne diseases and malnutrition.

resultsAmong 38.10% of families reported round-trip water collection times exceeding 15 min (indicating moderate to high access burden), 22.70% stored it exposed, and only 13.40% of households had piped water access, with 61.90% depending on communal taps and 24.70% on unprotected wells. Although 60.80% of people used boiling, sanitation was inadequate, with 77.30% disposing of liquid waste in open pits, 14.40% using septic tanks, and 15.50% using dry latrines. Handwashing facilities were available in 32%. Waterborne illnesses affected 39.20% in the past two weeks, primarily diarrhoea. Among under-fives, 53.60% had moderate wasting (MUAC yellow), 12.50% severe (red), 35.70% wasting, and 17.90% severe malnutrition (BMI z-scores). PCA revealed a dominant socioeconomic-WASH deprivation factor (eigenvalue > 1). For malnutrition, MLR found that education (p = 0.002) and water sources (p = 0.003) were predictors, while income (p < 0.001), handwashing (p < 0.001), and distance to source (p = 0.006) were predictors of illnesses. Hence, WASH practices were substantially linked to health outcomes (malnutrition and waterborne illnesses), regardless of sociodemographic but in a multifactorial setting.

conclusionDue to socioeconomic obstacles, Ibrahim Kodbuur's subpar WASH feeds the cycles of illness and malnutrition. Evidence from analogous low-resource settings indicates that targeted interventions-such as Biosand filters (reducing diarrheal risks by 25-58%), subsidized infrastructure, and hygiene education-could substantially mitigate these cycles, fostering equitable health gains in comparable peri-urban Somaliland environments, while more extensive multi-district research is required for wider generalizability.