Sharmake Gaiye Bashir

Background: Tuberculosis (TB) remains a major public health challenge in Somalia, where fragile health systems, delayed care-seeking, limited health literacy, and stigma may undermine TB prevention and treatment. This study assessed TB awareness, treatment-related beliefs, care-seeking intentions, and factors associated with belief in completing the full course of TB treatment among households in Mogadishu. Methods: A community-based cross-sectional study was conducted among 403 adult household respondents in Mogadishu, Somalia. Data were collected using a structured questionnaire covering sociodemographic characteristics, TB awareness, treatment-related perceptions, care-seeking intentions, and household preventive practices. Descriptive statistics were used to summarize participant responses. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with belief in completing the full course of TB treatment. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: Most respondents had heard of TB (85.4%), recognized coughing or sneezing as a mode of transmission (87.1%), and identified persistent cough as a symptom (86.4%). Overall, 83.1% believed in completing the full course of TB treatment, while only 48.6% correctly identified bacteria or germs as the cause of TB and 49.4% reported discomfort living with a person with TB. In the adjusted analysis, treatment completion belief was positively associated with having no formal education (AOR = 7.91, 95% CI: 2.27–27.54), recognizing persistent cough as a TB symptom (AOR = 15.03, 95% CI: 4.02–56.20), encouraging others to seek care at a health facility (AOR = 12.97, 95% CI: 3.65–46.12), and being comfortable living with a person with TB (AOR = 3.84, 95% CI: 1.38–10.64). Believing that TB is curable when diagnosed early showed an inverse adjusted association (AOR = 0.24, 95% CI: 0.06–0.87). Conclusions: Although TB awareness and treatment completion beliefs were generally high, important gaps in biomedical knowledge and stigma-related perceptions remained. Community-based TB education should strengthen the understanding of disease causation, symptom recognition, timely healthcare seeking, treatment completion, and supportive attitudes toward people affected by TB. The unexpected associations observed in the adjusted model warrant cautious interpretation and further investigation.

Background: Maternal mortality remains a major public health challenge in fragile and conflict-affected settings, where access to skilled birth attendance is uneven. In Somalia, home delivery continues to predominate despite efforts to expand maternal health services. National averages, however, obscure substantial geographic and contextual disparities, and limited evidence integrates spatial and multilevel determinants of delivery location over time. Objectives: This study aims to answer the following research question: What are the individual, community, and regional determinants of home delivery in Somalia, and how have the spatial clustering and inequalities of this practice evolved between 2006 and 2020? Design: A retrospective, population-based cross-sectional design. Methods: We conducted a retrospective, population-based cross-sectional analysis using nationally representative data from the 2006 Multiple Indicator Cluster Survey and the 2020 Somalia Health and Demographic Survey. Place of delivery was dichotomized as home versus health-facility delivery. Exploratory spatial data analysis was performed using Empirical Bayes smoothing, Global Moran’s I, Geary’s C, Local Indicators of Spatial Association, and Getis-Ord Gi* statistics. Ordinary kriging was applied to generate continuous risk surfaces, and spatiotemporal changes were assessed between 2006 and 2020. Multilevel logistic regression models were fitted to identify individual- and regional-level determinants of home delivery. Results: Home delivery declined nationally over the study period (from 90.15% in 2006 to 79.40% in 2020) but remained highly prevalent, with pronounced regional heterogeneity. Significant positive spatial autocorrelation indicated non-random clustering of home delivery, particularly in southern and central regions, and spatial clustering intensified over time despite overall improvement (Global Moran’s I increased from 0.34 in 2006 to 0.54 in 2020). At the individual level, higher household wealth (AOR = 0.12, 95% CI: 0.09–0.15) for highest quintile and adequate antenatal care utilization (AOR = 0.30, 95% CI: 0.25–0.35) for ≥ 4 visits were associated with lower odds of home delivery, whereas no school attendance (AOR = 1.95, 95% CI: 1.70–2.24) and higher parity (AOR = 1.28, 95% CI: 1.10–1.50) were associated with higher odds. Mudug and Gedo had markedly higher adjusted odds than Awdal. The fully adjusted intraclass correlation coefficient was 0.118, indicating substantively important residual regional variation. Conclusion: Home delivery in Somalia is shaped by intersecting socioeconomic and geographic factors, with persistent and intensifying spatial inequalities. Region-specific strategies addressing structural barriers, such as deploying mobile midwifery outreach in southern hotspots like Mudug and Gedo, are essential to improve equitable access to facility-based childbirth.

Universal health coverage (UHC) requires both access to needed services and protection from financial hardship, yet Somalia's health system depends heavily on out-of-pocket (OOP) payments. This narrative review synthesizes recent evidence on the magnitude, drivers, and consequences of OOP spending in Somalia and identifies policy options to strengthen financial protection. OOP payments account for 44.9% of total health expenditure, far above the global (18.6%) and sub-Saharan African (35.7%) averages, while government financing and insurance coverage of about 3.5% remain minimal. Weak public financing, a dominant and largely unregulated private sector, and fragmented donor aid sustain this reliance. Roughly 24% of households experience catastrophic health expenditure, commonly resorting to borrowing, asset sales, and reduced consumption, and many forgo care altogether. These burdens fall disproportionately on the poor, women, rural populations, and internally displaced persons, leaving Somalia with the lowest UHC index among 120 countries at 33.5. Experiences from Rwanda, Ghana, and Ethiopia show that reducing OOP reliance depends on increased public financing, pooled prepayment, and pro-poor subsidies rather than insurance laws alone, supporting a phased, subsidy-backed reform agenda.

Background and Aims: Internally displaced women in Somalia face major barriers to skilled maternal care. This study estimated the prevalence of skilled birth attendance (SBA) and identified factors associated with SBA among women living in internally displaced persons (IDP) camps in Mogadishu. Methods: A community‐based cross‐sectional study was conducted among women aged 15–49 years in IDP camps in Deynile, Kahda, and Garasbaaley districts, Mogadishu, in February 2026, using multistage sampling and interviewer‐administered questionnaires. The outcome was SBA at the most recent birth. Multivariable logistic regression estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs); tests were two‐sided (α = 0.05). Results: Of 384 women interviewed, 382 were eligible. SBA was reported by 68 of 381 women (17.8%; 95% CI: 14.3–22.0); 295 (77.4%) were assisted by traditional birth attendants and 255 of 382 (66.8%) delivered at home. Only 42 of 370 women (11.4%) received any antenatal care (ANC). In the adjusted model (n = 366; 67 events), SBA was associated with ANC attendance (AOR 3.17; 95% CI: 1.27–7.94) and Quranic education compared with no education (AOR 3.13; 95% CI: 1.61–6.10). Estimates for primary education (6 women; AOR 6.13; 95% CI: 1.05–35.91) and public transport (31 women; AOR 0.14; 95% CI: 0.02–0.77) were imprecise. The model discriminated well (AUC 0.79) but had few events per parameter (4.5). Conclusion: SBA was very low among displaced women in these camps. ANC attendance and basic education were associated with SBA. Given the cross‐sectional design, the sampling of selected camps, and imprecise subgroup estimates, these associations should not be interpreted as causal or generalized to all displaced populations in Somalia.

Health information systems (HISs) are essential for achieving universal health coverage (UHC), yet Somalia's health sector remains constrained by fragmented data systems, weak interoperability, limited infrastructure, workforce shortages, and poor governance. This commentary examines the challenges undermining Somalia's digital health transformation and argues that fragmented information systems perpetuate fragmented healthcare delivery. Despite emerging reforms and adoption of digital platforms, such as DHIS2, progress toward UHC remains limited. This commentary draws on a narrative synthesis of published evidence and policy documents to identify priorities for strengthening integrated and resilient HISs in Somalia. Strengthening integrated, resilient, and interoperable HIS is critical for improving health security, equity, outbreak preparedness, and healthcare delivery in Somalia.

Oral health is a fundamental but neglected component of public health, with important consequences for nutrition, communication, dignity, quality of life, and noncommunicable disease (NCD) prevention. In Somalia, oral health remains poorly integrated into health policy and service delivery within a context shaped by health‐system fragility, displacement, humanitarian pressures, and limited workforce capacity. This perspective synthesizes available Somalia‐specific evidence alongside modeled national estimates and relevant regional evidence to examine the burden, determinants, access barriers, and policy gaps surrounding oral health. It identifies major knowledge gaps, particularly the absence of comprehensive nationally representative oral health surveillance and limited evidence among rural, displaced, and other underserved populations. The article's contribution is to distinguish documented Somali evidence from regional inference while situating oral health within the country's broader universal health coverage, NCD, and humanitarian priorities. Strengthening surveillance, integrating essential oral health services into primary and humanitarian care, expanding preventive programs, and improving workforce and policy capacity are necessary to reduce avoidable oral disease and inequity in Somalia.

Antimicrobial resistance (AMR) has emerged as one of the defining public health crises of the twenty-first century. In 2021, bacterial AMR was associated with an estimated 4.71 million deaths globa...

Background: Bacterial antimicrobial resistance (AMR) was directly responsible for an estimated 1.27 million deaths in 2019, with the burden. Antimicrobial susceptibility testing (AST) is essential for guiding targeted therapy and stewardship, yet the specific economic mechanisms that prevent its scale-up in low-resource settings remain poorly understood and inadequately addressed in policy. Methods: A narrative review was conducted following SANRA guidelines and PRISMA transparency principles. PubMed/MEDLINE, Scopus, and Google Scholar were searched (01 January 2026– 30 April 2026) using Boolean combinations of terms across three domains: AST and diagnostics; economic and health-system barriers; and AMR and stewardship. Studies published 2019– 2026 addressing economic barriers to AST, prescribing behaviour, resistance patterns, or financing strategies in LMICs were eligible. Evidence was synthesized thematically. Findings: Economic barriers to AST operate at three levels: patient-level out-of-pocket costs and transport; laboratory-level infrastructure deficits, reagent shortages, and workforce gaps; and health-system-level underinvestment and donor dependency. These barriers sustain broad-spectrum empirical prescribing, amplify selection pressure, and drive the emergence of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, and carbapenem-resistant organisms. Consequences include treatment failure, catastrophic household expenditure, and threats to universal health coverage. Effective responses require subsidized diagnostics, insurance coverage for microbiology services, tiered laboratory strengthening, and integration of diagnostic stewardship with antimicrobial stewardship. Conclusion: Economic barriers to AST are a structural, multi-level contributor to AMR in LMICs. Sustainable AMR control requires financed national action plans that explicitly fund accessible, quality-assured AST alongside prescribing reform.

The 2026 Ebola situation is a reminder that Africa now faces recurrent filovirus risk with stronger technical preparedness than in 2014, but not yet with preparedness systems that consistently conv...