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Article History

Received: 11 March 2021

Accepted: 15 December 2021

First Online: 9 February 2022

Declarations

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: Ethical permissions for the survey were obtained from the ethical review committees of the Federal Ministry of Health (Ref: MOH&HS/DGO/0999/Jun/2018) and the Ministries of Health in Somaliland (Ref: MOHD/DG:2/699/2018) and Puntland (MOH/PL/DGO/0277/18).All household heads were provided an information sheet that detailed the written informed consent process, the objectives of the survey, and the data collection procedures. This information sheet also noted that participation in the survey was voluntary. This information sheet was read aloud to all household heads in Somali or the Somaliland dialect.Written informed consent was obtained from the household head for the administration of the survey. If the household head was illiterate, the consent form was read out loud to him/her, and a fingerprint was taken as evidence of consent instead of a signature. As part of this written informed consent form, the household head consented to a) answer the questions in the household questionnaire or permit another knowledgeable adult to answer the questions, and b) permit selected women and children in the household to participate or refuse to participate in the survey. Written informed consent for the household did not compel selected women and children within the household to participate in the survey. For children 0–59 months of age, the mother or legal guardian provided verbal consent for the child to participate in the survey. Verbal consent was also provided by the caretakers of women 15–17.9 years of age; women 18–49 years of age provided verbal consent for themselves. This individual-level verbal consent procedure was suggested and insisted by the ethical review committees of the Federal Ministry of Health (Ref: MOH&HS/DGO/0999/Jun/2018) and the Ministries of Health in Somaliland (Ref: MOHD/DG:2/699/2018) and Puntland (MOH/PL/DGO/0277/18) to account for Somalia’s cultural context, as they considered individual-level written informed consent culturally appropriate. Specifically, they felt the need for an individual-level written informed consent unnecessary, expressing serious concerns that household heads would not permit women to sign the consent forms, and that requiring individual-level written informed consent could potentially result in conflict within the household and limit participation in the survey. Of note, prior biomedical surveys in Somalia use verbal consent exclusively, and thus, the consent procedure used by the SMS 2019 was the most viable approach to obtain written informed consent, albeit only at the household level. This procedure to have a written informed consent, albeit only at the household level, from the household head, and verbal consent at the individual-level was approved by the ethical review committees of the Federal Ministry of Health and the Ministries of Health in Somaliland and Puntland.If diagnosed with malaria, severe acute malnutrition, and/or severe anemia, survey participants were referred to local health facilities for treatment. No blood was taken from children younger than 6 months of age to avoid injury. All anthropometric and blood collection procedures, and all other methods were carried out in accordance with standard guidelines and regulations.

: Not applicable.

: The authors declare no competing interests. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of UNICEF.