Empowering Young Lives: Tackling Health Challenges Among School-Aged Children in Somaliland (EMPHASIS)

project summary

Anaemia is a major public health concern in low- and middle-income countries, with particularly high prevalence in the WHO African Region. In Somaliland, anaemia affects an estimated 43.4% of children under five and 23.1% of school-aged children. Despite this burden, the specific causes and consequences of anaemia in school-aged children remain poorly understood.
Anaemia in this context is multifactorial, involving nutritional deficiencies, parasitic and bacterial infections, genetic haemoglobinopathies, and socio-economic challenges. Malaria and intestinal helminths are presumed common due to poor sanitation and limited healthcare access, contributing to chronic blood loss and impaired red blood cell production. Bacterial infections, such as *Salmonella* and *Staphylococcus*, may further exacerbate anaemia by disrupting production and increasing red cell destruction. Genetic conditions such as sickle cell disease and thalassemia also contribute to anaemia’s complexity. These biological factors are intensified by poverty, food insecurity, and limited access to health services.
Moreover, anaemia in school-aged children is not only a health issue but also a developmental one. Evidence from other sub-Saharan African countries suggests that anaemia and related infections can impair motor and cognitive development, with long-term consequences for educational attainment and quality of life. However, such data is lacking for Somaliland.
To address these gaps, we propose an interdisciplinary research project between the University of Hargeisa and research institutions in Denmark. The study will investigate the prevalence and aetiology of anaemia among school-aged children in selected school settings using a range of methodologies, including state-of-the-art Nanopore sequencing. It will assess the contribution of infections, genetic factors, and socio-economic conditions, and examine the impact of anaemia on motor and cognitive development. The project includes a strong capacity-building component, aiming to strengthen local research infrastructure and expertise across methodologies.
Findings from this study will inform the design of a pilot pre- and post-intervention study targeting anaemia reduction in school-aged children. Ultimately, the aim is to provide evidence-based recommendations for public health policy and school health programs in Somaliland, contributing to improved educational and developmental outcomes for children in the region.