The Associations of cerebral blood flow and white matter hyperintensities with tau and amyloid-beta across the Alzheimer's disease spectrum.

Despite notable improvement in maternal survival between 2000 and 2015, progress plateaued during the early years of the Sustainable Development Goal (SDG) period []. By 2023, the global maternal mortality ratio (MMR) was 197 deaths per 100 000 livebirths [], indicating that the world is not on track to achieve SDG target 3.1, which aims to reduce the global MMR to less than 70 per 100 000 livebirths by 2030 []. Although the global MMR has declined overall, it conceals significant regional disparities, particularly in sub-Saharan Africa (SSA), which accounted for approximately 70% of global maternal deaths in 2020 [,]. In this region, the MMR fell from 802 to 536 deaths per 100,000 live births between 2000 and 2020, yet it remains more than twice the global average. Consequently, none of the SSA countries are projected to achieve the global benchmark by 2030 []. Persistent disparities in maternal mortality ratios between wealthy and poor populations highlight deep inequalities in the quality of maternal health care []. These regional and socioeconomic variations in MMR are further reflected in substantial differences in the lifetime risk of maternal deaths [], underscoring that maternal mortality is not only a major public health crisis but also a critical indicator of national development, reflecting entrenched social and economic inequities between nations []. Such inequalities are most acute in fragile settings like Somalia, a low-income country with one of the highest MMR of 692 deaths per 100,000 live births in 2020 [], where recurrent disease outbreaks, ongoing conflict, and frequent public health emergencies exacerbate systemic weakness. These challenges heighten pregnancy-related risks, disrupting already weak health infrastructure and restricting access to essential maternal care services such as antenatal care (ANC), facility delivery, and postnatal care (PNC) []. Beyond these structural barriers, individual and community-level determinants strongly influence maternal health service utilisation. In Somalia, women’s use of maternal health services and their choice of delivery location are shaped by socio-economic characteristics, educational attainment, geographical location, women’s autonomy, cultural norms, quality of services, and physical accessibility to health facilities, particularly the distance to care and the availability of transportation []. However, empirical evidence from Somalia remains sparse. Recent analysis using Somalia’s SHDS data has advanced understanding of maternal health service utilisation but is mostly descriptive, focusing on poverty determinants [] or individual service component [] such as delivery location alone [,]. Other studies have examined service coverage patterns rather than socioeconomic and regional determinants [,] or have been confined to subnational analysis, limiting generalisability [,]. Consequently, little is known about how socioeconomic status, geography, and women’s empowerment jointly influence maternal health service utilisation care within national representative framework. This study addresses this evidence gap identifying the social, economic, and geographic determinants of three maternal health outcomes: (i) antenatal care (ANC), (ii) facility delivery, and (iii) early PNC (within 2 days) using SHDS 2020 data. The findings will provide evidence on how socioeconomic status, regional disparities, and women’s empowerment jointly shape inequalities in maternal service utilisation in Somalia, offering policy-relevant insights for advancing national health goals and global commitments under SDG 3.1 (maternal mortality reduction) and SDG 5 (gender equality and women’s empowerment).