Abdirahman Khalif Mohamud

Background: Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region. Methods: An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis. Results: Among 3455 participants (median age 29 years; 56.5% female), 94% ( n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers ( p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% ( n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% ( n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation. Conclusion: Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.

Background: Antiretroviral Therapy is an effective method against HIV, reducing mortality and opportunistic infections. In Somalia, high rates of these infections and low adherence to therapy have been reported. However, factors contributing to non-adherence remain unidentified. Therefore, The study aims to assess the magnitude of antiretroviral therapy non-adherence and identify associated factors for individuals living with HIV in Mogadishu, Somalia. Methodology: A hospital-based cross-sectional study was conducted using a questionnaire containing socio-demographic, behavioral, familial, psychosocial, clinical, and laboratory characteristics. Antiretroviral Therapy adherence was assessed by quantifying the number of prescribed pills taken in the past month. Those who adhered to ≥95% of the prescribed Antiretroviral Therapy drugs were considered adherent to Antiretroviral Therapy. Logistic regression was used to identify factors associated with Antiretroviral Therapy non-adherence at significance levels of p < 0.05. Results: Out of 453 participants, the magnitude of non-adherence to ART among people living with HIV in Mogadishu, Somalia, was 138 (30.5%) with its 95% CI: 26.3–34.9. The predominant reasons for missing ART were forgetting (7.3%), transportation issues (5.5%), side effects and being busy with other commitments (4.4%), stigma (3.8%), and ART facilities being distant from home (2.6%). In multivariable logistic regression, living alone (AOR=1.81, 95%CI:1.182–2.782), perceived stigma (AOR=3.19, 95%CI:1.784–5.720), smoking cigarettes (AOR=2.96, 95%CI:1.759–5.003), and living with a co-morbid chronic disease (AOR=1.80, 95%CI:1.155–2.813) were factors associated with ART non-adherence among people living with HIV in Mogadishu, Somalia. Conclusion: Individuals living with HIV in Mogadishu, Somalia suffer sub-optimal adherence to ART. Priority should be given to strategically addressing the needs of those living alone and individuals with co-morbid chronic conditions, eliminating HIV stigma, and discouraging substance abuse.

Background: Urolithiasis is a significant global health burden with varying prevalence rates across different regions. In Somalia, data on the prevalence and risk factors associated with urinary stone disease are limited. This study aimed to investigate the prevalence and associated factors of urolithiasis among patients undergoing CT scans at selected centers in Mogadishu. Methods: This cross-sectional study was conducted between January and May 2024 at three medical facilities in Mogadishu, Somalia. This study included 211 patients who underwent non-contrast abdominopelvic CT scans. Data were collected using a structured questionnaire that covered sociodemographic characteristics, lifestyle habits, dietary patterns, and clinical data. Statistical analysis was performed using R statistical software version 4.4.0, employing descriptive statistics, bivariate analyses, and logistic regression. Results: The study revealed a prevalence of 26.07% (95% CI: 20.28– 32.54%) for urolithiasis. Significant associations were found with marital status (married individuals showing higher risk, AOR 30.42, 95% CI 3.32– 278.58) and education level (higher education showing a protective effect). Dietary factors played a crucial role, with irregular dairy consumption (AOR 37.05, 95% CI 3.44– 398.62) and occasional meat consumption (AOR 3.58, 95% CI 1.41– 9.08) showing increased risk. Previous diagnosis of urolithiasis (AOR 5.2, 95% CI 1.19– 22.81) and history of UTIs (AOR 3.43, 95% CI 1.7– 6.95) were significant risk factors. Conclusion: This study identified a substantial prevalence of urolithiasis in Mogadishu, with significant associations between sociodemographic factors, dietary habits, and medical history. These findings emphasize the need for comprehensive screening programs and targeted interventions, particularly for high-risk individuals.

Introduction: Somalia is among the countries with a high burden of human papillomavirus (HPV) infection in Sub-Saharan Africa. In 2022, 660,000 infections are reported among women globally, out of which 350,000 died from the disease. Most of the studies on HPV reported from Somalia are based on cytologic analysis which is a subjective and suboptimal assessment. The recent World Health Organization (WHO) guidelines for HPV recommend DNA-based testing as a better alternative to the traditional pap smear test. Methodology: This study was undertaken to determine the prevalence of HPV based on the preferred HPV DNA assay on cervical samples of women of reproductive age in Mogadishu, Somalia. The HPV DNA detection was carried out using real-time quantitative polymerase chain reaction (RT-PCR) assays to identify high-risk oncogenic HPV16, HPV18, and other high-risk HPV types. Results: Overall, 31.7% (60/189) of cervical samples were positive for HPV DNA. Out of this, 19.6% were high risk-HPV (hrHPV), 13.8% were HPV16, and 5.3% were HPV18. Moreover, age, income and education level were found to be significant risk factors for HPV infection. Conclusions: These results provide further proof that HPV continues to be a serious public health challenge in Somalia with the risk of progressing to fatal cervical cancer.

Background: Pregnant women exhibit COVID-19 vaccine hesitancy due to concerns regarding potential risks to their babies, doubts about vaccine efficacy, and limited access to information. Therefore, this study aims to estimate COVID-19 vaccine uptake and factors associated with pregnant women in Mogadishu, Somalia. Methods: A cross-sectional study was conducted on pregnant women using a questionnaire covering socio-demographic information, pregnancy-related characteristics, perceptions about the COVID-19 vaccine, and vaccination status. Univariable and multivariable logistic regression analyses were utilized to identify factors associated with the outcome variable. Results: Among the 400 pregnant women who participated in this study, 26.8% had received a COVID-19 vaccine dose, with only 14.9% receiving it during pregnancy. Reasons for not receiving the vaccine included a lack of information about the vaccine (47.4%), concerns about its adverse effects on personal health (33.8%), misconceptions regarding impacts on fertility or menstrual cycles (14.3%), belief in the vaccine’s inefficacy (3.4%), and fears about adverse effects on their fetus. In multivariable logistic regression, pregnant women with a history of chronic diseases (AOR=3.27, 95% CI=1.992– 6.145), those who perceived themselves at risk of contracting COVID-19 (AOR=3.81, 95% CI=2.11– 5.10), those who believed that the vaccine was accessible to them (AOR=4.34, 95% CI=2.915– 6.165), and those who discussed the COVID-19 vaccine with their healthcare provider (AOR=3.91, 95% CI=2.123– 7.878) were more likely to receive the COVID-19 vaccine compared to their counterparts. Conclusion: Pregnant women in Mogadishu, Somalia, face challenges with sub-optimal covid-19 vaccine uptake. Implementations should improve awareness of COVID-19 risks and facilitate discussions between healthcare providers and pregnant women. In addition, efforts to provide reliable information about the vaccine, alleviate concerns about its adverse effects, and dispel misconceptions about fertility, menstrual cycles, efficacy, and foetal impact are crucial.

Background The Hepatitis B virus (HBV) is transmitted through contaminated blood or bodily fluids. Globally, over 81 million blood units are donated annually, a crucial therapeutic procedure without alternatives. However, blood-borne infections, including HBV, pose a significant hurdle to safe transfusions, especially in HBV-endemic regions like Somalia with limited screening. Therefore, this study aims to estimate the prevalence of Hepatitis B virus infection and identify risk factors associated with it among blood donors in Mogadishu, Somalia. Method A hospital-based cross-sectional study was conducted between February and April 2023. Research tools included a 5-ml blood sample and a structured questionnaire. The presence or absence of HB markers was determined using a multi-HB rapid test and CDC’s HB marker interpretation guideline. Logistic regression was used in univariate and multivariate models to identify risk factors associated with HBV infection, with significance set at a p-value < 0.05 in the final model. Result A total of 494 blood donors were recruited for this study; 93.9% were male, with a mean age of 31.5 (SD = 8.11). The prevalence of Hepatitis B virus (HBV) infection among blood donors was 9.7%, with a 95% CI of 7.1–12.3. In multivariable logistic regression, those with a monthly income of less than 200 USD (AOR = 5.20, 95% CI = 1.61–16.79), those with an income between 200 and 400 (AOR = 3.59, 95% CI = 1.38–9.34), Jobless blood donors (AOR = 3.78, 95% CI = 1.17–12.20), those in business occupations (AOR = 3.35, 95% CI = 1.24–9.08), those with a history of STDs (AOR = 4.83, 95% CI = 2.03–11.50), those without a history of HB vaccine (AOR = 13.81, 95% CI = 2.46–77.41), those with a history of tooth extraction (AOR = 6.90, 95% CI = 2.66–17.88), and those who shared sharp equipment (AOR = 2.90, 95% CI = 1.07–7.82) were more likely to become infected with the Hepatitis B virus (HBV) compared to their counterparts. Conclusion This study highlights a high prevalence of Hepatitis B virus (HBV) infection. Implementation efforts against HBV infection should specifically focus on low-income individuals, the jobless, and donors with a history of STD to mitigate the burden of HBV infection and promote safer blood donation. In addition, discouraging the sharing of sharp equipment, improving infection control practices during tooth extraction procedures, and enhancing HB vaccination uptake, particularly among individuals lacking a history of HB vaccine, is highly recommended.

Background: In September 2022, a new Ebola outbreak was reported in Uganda, East Africa, and 142 confirmed cases, including 19 Healthcare workers (HCWs) reported. Ebola is not endemic in Somalia, but the country is at a reasonable risk of the virus being introduced due to the direct connection with daily flights from Uganda without border health control and prevention activities. Therefore, evaluating HCWs' Knowledge and attitude is crucial since this is the first time being evaluated in Somalia. The study's objective is to evaluate the HCWs' Knowledge and attitude toward the Ebola virus disease in Somalia.Method: An online self-administrated cross-sectional survey was conducted among HCWs (n = 1103) in all six federal member states of Somalia using a validated, reliable, well-structured questionnaire. Data we analyzed using descriptive statistics and Logistic regression were used to determine sociodemographic characteristics associated with poor Knowledge and negative attitude.Result: Over one-third (37.3%) of HCWs had poor Knowledge; the mean knowledge score was 7.97 SD ± 2.15. Almost 40.1% of the HCWs had a negative attitude; the mean attitude was 27.81 SD ± 8.06. Low-income HCWs (AOR = 2.06, 95%CI:1.01–4.19), Married HCWs (AOR = 1.39, 95%CI: 1.110–1.963), Midwives (AOR = 2.76, 95%CI: 1.74–4.39), Lab technicians (AOR = 2.43, 95%CI: 1.43–4.14), HCWs work in Jubaland state of Somalia (AOR = 3.69, 95%CI: 2.39–5.70), Galmudug state (AOR = 8.50, 95%CI: 4.59–15.77), Hirshabelle state (AOR = 3.18, 95%CI: 2.15–4.71) were more likely to have poor Knowledge compared to their counterparts. HCWs who work in Hirshabelle state (AOR = 5.44,95%CI: 3.58–8.27), Jubaland state (AOR = 8.47, 95%CI: 4.69–15.29), and Galmudug state (AOR = 4.43, 95%CI: 3.03–6.48) was more likely to have a negative attitude than those working in the Banadir region administration.Conclusion: Most Somali healthcare workers showed good Knowledge and a positive attitude toward the Ebola virus. The implementation to enhance Knowledge and attitude must specifically focus on low-income HCWs, Midwives, Lab technicalities, and those who work in Hirshabelle, Jubaland, and Galmudug states of Somalia.

Background: Measles is endemic in Somalia; recurrent outbreaks are reported annually. Under-five children are the most affected due to low immunization coverage, vitamin A deficiency, and malnutrition. The study aims to evaluate the demographical, clinical, and complication variations between vaccinated and unvaccinated hospitalized children with measles in the study hospital. Method: A hospital-based retrospective cohort study was implemented between 10 October and 10 November 2022 by reviewing case record files following a well-structured checklist of admitted clinical features, demographic characteristics, history of measles immunization, and measles complication status. Descriptive statistics were used by presenting frequency and percentage for categorical and the mean score for continuous variables. χ² and Fisher’s exact test at P =0.05 were used to identify the proportions differences between vaccinated and unvaccinated cases. Result: A total of 93 hospitalized measles children participated in the study. Over half were boys, the mean age in months was 20.9 (SD±7.28), and over two-thirds of the mothers/caregivers did not have formal education. Almost 9.7% of hospitalized measles children had one dose of the measles-containing vaccine, while none had two doses. The vaccinated cases had fewer ill with fewer complications than the unvaccinated cases. Fever, cough, rash, and Koplik’s spots were clinical features associated with measles immunization status. Conclusion: Around one in ten hospitalized children had one dose of the measles vaccine. Vaccinated cases had fewer illnesses with few complications than unvaccinated cases. The paper highly emphasizes providing booster doses, improving vaccine logistics and storage, and following immunization schedules. In addition, conducting further multicentral high sample-size studies is highly required to identify whether vaccine inadequacy was due to host-related or vaccine-related factors.

Background: Depression is the most common psychiatric disorder in HIV/AIDs patients, and its prevalence is three times higher in HIV/AIDs patients. Globally, over 35 million people were living with HIV/AIDs, 24.7 million were in Sub-Saharan Africa. The study aims to estimate the prevalence and determine factors associated with depression among HIV/AIDs adult patients in the ART unit at Banadir Hospital Mogadishu, Somalia. Method: A hospital-based cross-sectional study was conducted between 1 May and 1 July 2022. Samples were recruited from the HIV/AIDs adult patients attending in ART unit at Banadir Hospital, Mogadishu, Somalia. A validated research tool, including sociodemographic, behavioral, clinical, and psycho-social characteristics, three items social support scale, an 11-item HIV stigma scale, and patient health questions-9 (PHQ-9) were used. The interview was conducted privet room in the ART unit. Logistic regression was used to determine factors associated with depression at the significance level a = 0.050. Result: The overall prevalence of depression among HIV/AIDs patients was 33.5% (95%CI = 28.1–39.0). In the multivariable logistic regression, three factors were associated with depression; the odds of depression were 3.415 times (95%CI=1.465–7.960) greater for those with poor social support than those with moderate-strong social support. Those with moderate and poor treatment adherence had 14.307 times (95%CI=5.361–38.182) greater odds of depression than those with good treatment adherence. Those who use substances had 3.422 times (95%CI=1.727–6.781) greater odds of having depression than those who did not. Conclusion: People living with HIV in Mogadishu, Somalia, suffer from depression. The implementation to reduce depression should be focused on empowering social support, developing an appropriate approach to increase treatment adherence, and reducing or eliminating substance use.