Najib Isse Dirie

Background: Needlestick injuries (NSIs) remain a major occupational hazard among healthcare workers (HCWs), increasing the risk of exposure to blood‐borne infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Although largely preventable, NSIs continue to occur frequently in fragile and resource‐limited health systems, including Somalia. This study assessed healthcare workers’ knowledge, attitudes, and practices regarding NSIs in Mogadishu, Somalia, to identify existing gaps and inform occupational safety interventions. Methods: A facility‐based cross‐sectional study was conducted in Mogadishu, Somalia, from July 2024 to January 2025. A total of 422 healthcare workers from public and private health facilities were selected using stratified random sampling. Data were collected through a validated self‐administered electronic questionnaire covering sociodemographic characteristics and knowledge, attitudes, and practices related to NSIs. Scores for knowledge, attitude, and practice were categorized using Bloom's cut‐off criteria. Data were analyzed using descriptive statistics and multivariable logistic regression in SPSS version 20, with statistical significance set at p ≤ 0.05. Results: Overall, 82.94% of participants demonstrated good knowledge of needlestick injuries (NSIs), with a mean score of 8.15 ± 2.23. However, gaps remained in awareness of post‐exposure prophylaxis (PEP) and the recommended timing of follow‐up viral testing. Attitudes toward NSI prevention were generally positive, with 96.21% of participants classified as having a positive attitude. Nevertheless, some respondents continued to prioritize patient care over healthcare worker safety. Preventive practices were less satisfactory, with only 44.79% of participants reporting good practice. Underreporting of injuries and delayed uptake of PEP were also notable concerns. In the adjusted analysis, healthcare workers aged 18–30 years were less likely to report good preventive practices than those aged over 40 years (AOR = 0.30, p = 0.001). In contrast, nurses (AOR = 3.29, p = 0.002) and specialists (AOR = 2.67, p = 0.048) were more likely to report good preventive practices than laboratory technicians. Estimates from the attitude model were unstable because of sparse outcome data and should therefore be interpreted cautiously. Conclusion: Despite relatively high knowledge and generally positive attitudes toward NSI prevention, important gaps in preventive practice remain among healthcare workers in Mogadishu. Underreporting of injuries and inadequate post‐exposure management highlight a persistent gap between awareness and action. Targeted interventions aimed at younger healthcare workers, improved reporting systems, better access to PEP, and stronger institutional safety practices are needed to reduce the burden of NSIs in resource‐limited settings.

Occupational safety is a fundamental concern in healthcare settings, where inadequate knowledge, attitudes, and practices (KAP) can increase the risk of infection and other workplace hazards. This study aimed to assess the KAP of healthcare professionals at Dr. Sumait Hospital, SIMAD University, Mogadishu, Somalia, in order to identify strengths and areas requiring improvement in occupational safety practices. A cross-sectional study was conducted between January and February 2025 among 87 healthcare professionals. Data were collected using a structured questionnaire that assessed demographic characteristics as well as participants’ knowledge, attitudes, and practices related to occupational safety. Descriptive statistical analyses were performed using SPSS version 20. Overall, 74.71% of participants recognized occupational safety as a critical issue, and 88.51% acknowledged their responsibility for implementing safety measures. Knowledge of personal protective equipment (95.40%) and infection transmission (89.66%) was high, while awareness of healthcare waste segregation (71.26%) and post-exposure prophylaxis (73.60%) was comparatively lower. Attitude assessment showed strong support for safety precautions (96.55%) and mandatory vaccination (91.95%). However, only 58.62% of respondents reported the availability of infection prevention guidelines in their departments. In terms of practice, most participants adhered to hand hygiene (98.9%) and PPE use (98.9%); however, 74.7% reported recapping needles, which represents an unsafe practice. Despite generally high levels of knowledge and positive attitudes toward occupational safety, notable gaps in safety practices persist, particularly regarding needle handling and infection control. Targeted interventions, including enhanced training, reinforcement of safety policies, and improved access to infection prevention guidelines, are essential to strengthen workplace safety at Dr. Sumait Hospital.

Introduction: Cervical cancer is the second most frequent cancer among Somali women, with approximately 1,055 diagnoses and 812 deaths annually; however, evidence to guide control efforts is scarce. This systematic review synthesizes the burden, screening findings, and knowledge gaps to inform policy and practice in Somalia’s resource-limited settings. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Embase, ScienceDirect, DOAJ, Cochrane Library, and Google Scholar without date limits for English, peer-reviewed studies from Somalia reporting prevalence, incidence, knowledge, screening, and prevention. Two reviewers independently extracted the data and performed the JBI critical appraisal for cross-sectional studies. Given the heterogeneity, we conducted a narrative synthesis. Results: Seven cross-sectional studies (2019–2024) with 3,797 participants from Mogadishu, Hargeisa, and Bosaso were included in this review. Across facility-based studies, cervical cancer accounted for 6.7% of all cancers and 13.3% of female cancers, while screening positivity among women attending screening services ranged up to 15.7%. The prevalence of cervical cancer ranged from 6.7% to 15.7%. Among 189 women sampled in Mogadishu (clinic-based), 31.7% were HPV DNA-positive, including 19.6% high-risk types (HPV16 13.8%, HPV18 5.3%); these findings may not represent national HPV prevalence. Among healthcare professionals, 73% had good theoretical knowledge; however, only 24% had treated a cervical-cancer patient, 22% reported receiving specific training, and only 2% of female providers had undergone Pap testing. Women’s awareness varied widely (43.7–97.7%), and misconceptions were common. In one facility-based screening study, VIA positivity was 7.6% compared with 5.1% for Pap smear ( p = 0.004). Among women who were VIA-positive and underwent confirmatory assessment, 73.9% had CIN on colposcopy/biopsy; however, biopsy-confirmed CIN2+/cancer outcomes by each test and verification pathways were not fully reported, limiting direct comparison of diagnostic performance. Conclusions: Somalia faces a high burden of cervical cancer and HPV infection, compounded by limited screening coverage, training gaps among providers, and misinformation among women about HPV vaccination. Priority actions include establishing a national cancer registry, expanding HPV vaccination, scaling context-appropriate screening (VIA and HPV testing), delivering targeted public education, and strengthening provider training especially for female frontline staff using culturally sensitive approaches to improve uptake and outcomes.

Bullet embolism is an uncommon consequence of gunshot wounds, with venous migration to the right heart reported sporadically in the literature. Diagnostic

Background: Somalia′s healthcare system faces significant challenges due to limited infrastructure and physician density (2.5 per 10,000 population). Telemedicine is a promising solution, particularly given the country′s mobile phone penetration rate of 54%. This study evaluated the implementation and impact of Baano Healthcare Technology′s integrated telemedicine platform in Somalia, while also situating its utilization within the broader disparities in healthcare access, internet coverage, and socioeconomic context. Methods: A descriptive quantitative analysis of operational data from Baano Healthcare Technology telemedicine services was conducted between July and October 2024. These services were delivered through an integrated digital platform that linked video consultations, hospital bookings, and interactive voice response self‐management services within a single telemedicine system. Data were collected through three primary channels: digital consultation, hospital bookings, and IVR self‐management services. Statistical analysis was performed using R programming software Version 4.4.0, and descriptive statistics and frequency distributions of service utilization patterns were calculated. Demographic data for digital users included age, sex, and residence, whereas IVR records lacked user‐level metadata, which limited stratification. Results: This study analyzed 610 users of video consultation and hospital booking services, along with 157,660 interactive voice response system interactions. The analysis revealed that 63.44% of users were aged 1–30 years, with a balanced sex distribution (50.82% male and 49.18% female). Hospital bookings constituted 73.61% of the services, whereas online consultations accounted for 26.39%. The Banadir region accounted for 80.49% of all users in the study. Dental services were the most requested specialty (42.98%), reflecting the scarcity of licensed dentists outside Mogadishu and the platform′s role in facilitating access to rare specialties in the region. The IVR system was substantially used for chronic condition management (47%), with diabetes management being the most frequently accessed topic (23%). Conclusion: The implementation of integrated telemedicine services in Somalia demonstrates promising potential for expanding healthcare access, particularly in urban areas. However, its reach remains constrained by geographic and digital divides, with rural areas facing compounded barriers of poverty, provider scarcity, and low internet use. The platform′s success in urban areas provides a model for expansion, although addressing infrastructure limitations and regulatory frameworks remains important.

Intestinal parasitic infections and Helicobacter pylori are prevalent in low-resource settings, especially in overcrowded areas with poor sanitation and limited healthcare access. These conditions are notably pronounced in internally displaced people (IDP) camps nationwide. Children in such environments are at increased risk of multiple coinfections due to environmental exposures and inadequate preventive measures. Endemic parasites such as Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Hymenolepis nana, and Entamoeba spp. are commonly found alongside chronic bacterial infections like Helicobacter pylori, which are associated with gastritis, peptic ulcers, and nutritional deficiencies. The shared transmission routes and risk factors of these pathogens exacerbate the disease burden, particularly in malnourished children, leading to adverse health outcomes. This report describes a six-year-old Somali girl from an IDP camp in Mogadishu who presented with chronic gastrointestinal symptoms and was diagnosed with severe polyparasitism and active H. pylori infection based on laboratory investigations. She was successfully treated with a tailored multidrug regimen targeting both helminths and bacteria, resulting in clinical and parasitological recovery. The case highlights the urgent need for integrated diagnostic, therapeutic, and educational interventions in humanitarian settings. Addressing these coinfections through comprehensive strategies is crucial not only for improving individual health but also for alleviating the broader public health burden in displaced and resource-limited communities.

Background: Tetanus remains a significant public health concern, particularly in regions with low vaccination rates and prevalent traditional healing practices. Guboow, a Somali traditional healing practice involving intentional skin burns using heated objects, poses a high risk of infections, including tetanus, due to nonsterile conditions. This case highlights the complications arising from Guboow and emphasizes the importance of vaccination and culturally sensitive healthcare interventions. Case presentation: A 35-year-old Somali male, unvaccinated against tetanus, developed an infection 10 days after undergoing Guboow. The patient presented with respiratory distress, muscle stiffness, and trismus. Clinical examination revealed opisthotonus, burn ulcers, and autonomic instability. Laboratory investigations confirmed hypoxemia and mild hypernatremia. The patient was admitted to the intensive care unit and managed with mechanical ventilation, tetanus immunoglobulin, antibiotics, and wound care. Supportive intensive care unit management, including treatment for muscle spasms and autonomic dysfunction, led to a significant clinical improvement. By day 14 (post intensive care unit), the patient was successfully weaned off the ventilator, transferred to the general ward, and discharged without residual symptoms on day 24 (post intensive care unit). Conclusion: This case underscores the dangers of unsafe traditional healing practices and highlights the critical role of vaccination in tetanus prevention. There is an urgent need for culturally tailored public health education and collaboration with traditional healers to reduce the health risks associated with these unsafe practices. Further research is essential to assess the impact of traditional healing methods on infectious disease outcomes.

The World Health Organization (WHO) surgical safety checklist (SSC) is a crucial tool for improving patient safety in surgical settings. This study aimed to assess the knowledge and attitudes towards WHO SSC among healthcare professionals in Mogadishu, Somalia, and identify factors associated with these outcomes. This cross-sectional study was conducted from April to July 2024 among 422 healthcare professionals in Mogadishu. Data were collected using a structured questionnaire adapted from the WHO SSC, consisting of sociodemographic information, knowledge assessment (12 items), and attitude assessment (7 items). Descriptive statistics and binary logistic regression were used for the data analysis. The study revealed that 81.04% of participants demonstrated good knowledge of SSC (score > 60%), with a mean knowledge score of 9.59 out of 12 (SD 2.92). However, only 13.51% exhibited a positive attitude towards SSC (score > 60%), despite 87.6% agreeing that SSC improves patient safety. Higher knowledge was significantly associated with professional roles in medicine and surgery (p < 0.001), nursing (p < 0.001), and having a master’s degree (p = 0.039). Attitudes were significantly more positive among professionals in medicine and surgery (p < 0.001) and nursing (p = 0.001), but not significantly influenced by education level or years of experience (p > 0.05). While knowledge levels of WHO SSC among healthcare professionals in Mogadishu are generally good, attitudes towards the checklist are mixed, with a low proportion demonstrating positive attitudes. Targeted interventions, including comprehensive training programs and addressing workflow concerns, are recommended to enhance SSC implementation and use in Somali healthcare settings.

Background: Somalia’s health system remains among the world’s most fragile, with a Universal Health Coverage index of only 25% and a critical health workforce density of 0.11 clinicians per 1000 population. While previous national strategies such as NDP-9 and HSSP III provided broad frameworks, the National Transformation Plan (NTP) 2025– 2029 represents a paradigm shift toward multi-stakeholder engagement and evidence-based priority-setting for health system transformation. Aim: This roundtable aimed to identify priority areas and implementation strategies for the NTP health pillar through structured stakeholder consultation, moving beyond traditional top-down planning approaches to incorporate diverse perspectives from Somalia’s fragmented health landscape. Methods: A qualitative multi-stakeholder roundtable was conducted in Mogadishu with 30 purposively sampled participants representing federal and state ministries, universities, public and private providers, non-governmental organizations, and civil society. Ethical approval was waived, and informed consent was obtained. Audio-recorded discussions were transcribed, translated, and analyzed thematically according to the four NTP health domains. Results: Thematic analysis identified four critical priorities. Participants emphasized that primary health care expansion should prioritize female community health workers and rural facility rehabilitation to increase service coverage beyond the current 25%. Participants emphasized that health workforce constraints, with only 0.11 clinicians per 1000 population, require regional training hubs and rural deployment incentives. Participants emphasized that regulation and governance through the newly established National Health Professionals Council need sustainable funding and federal-state accountability frameworks. Participants emphasized that public-private partnerships and digital health integration could leverage telemedicine and private sector capacity for underserved areas. Conclusion: The roundtable produced actionable strategies linking community-centered primary care, workforce development, regulatory strengthening, and technology-enabled partnerships. However, implementation faces significant constraints, including limited domestic financing, weak governance coordination, and ongoing fragility. Success will require sustained political commitment and innovative approaches adapted to Somalia’s unique post-conflict context.