Abdirashid M. Yousuf

Audiovisual impairments, encompassing both vision and hearing difficulties, significantly impact an individual’s quality of life and societal development, particularly in low- and middle-income countries. While the global burden of these conditions is significant, research on their prevalence and associated risk factors in Somalia and the Horn of Africa remains limited. This study, utilizing data from the nationally representative Somali Health and Demographic Survey (SHDS) 2020, investigates the prevalence and determinants of audiovisual impairment within the Somali population. Employing a multilevel statistical analysis framework, we analyzed data from 52,154 individuals, exploring the influence of individual and community-level factors. Our findings revealed that 3.35% of the Somali population reported experiencing audiovisual impairment. Notably, significant demographic and socio-economic associations were identified, with higher rates of impairment observed among older individuals, females, and those with lower educational attainment. Furthermore, the multilevel analysis highlighted the importance of regional differences, type of residence, and community-level factors in shaping the risk of impairment, with rural and nomadic lifestyles emerging as potential protective factors, indicating a unique interplay between environment and disability experience. To address these findings, we recommend the Somali Ministry of Health to implement targeted interventions, including: (1) establishing community-based screening programs for early detection of audiovisual impairments, particularly among older adults and women in high-risk regions; (2) strengthening primary healthcare services in rural and nomadic areas by providing mobile clinics and training healthcare workers to identify and manage sensory impairments; and (3) developing culturally appropriate educational materials to promote awareness of risk factors and preventive measures. This study provides critical baseline data for Somalia, contributing to a broader understanding of audiovisual impairment within a low-income context. Our findings offer valuable insights for informing public health policies and interventions aimed at improving access to healthcare, promoting early detection and rehabilitation, and fostering inclusive environments for individuals with disabilities

This study empirically investigates the short- and long-term impacts of climatic and non-climatic factors on wheat yield in Somalia from 1986 to 2019, a region facing severe food insecurity exacerbated by climate variability and prolonged conflict. Utilizing the Autoregressive Distributed Lag (ARDL) modeling approach, robust for small sample sizes and mixed orders of integration, we establish a significant long-run cointegrating relationship. Long-run analysis indicates a positive, albeit modest, impact of CO2 emissions on wheat yield, consistent with the CO2 fertilization effect, yet caution is warranted given the concurrent negative effects of other climatic stressors. Crucially, short-run results reveal that both increasing temperature and rainfall significantly reduce wheat yield, suggesting that erratic precipitation and extreme heat events pose immediate threats to production. Interestingly, political instability showed a counter-intuitive positive short-run coefficient, highlighting the complex and possibly localized dynamics of conflict on agriculture in Somalia that demand further nuanced investigation. This finding departs from conventional literature emphasizing conflict’s detrimental role in food systems. The study’s novel contribution lies in providing the first comprehensive quantitative analysis for Somalia, integrating a broad spectrum of drivers within a dynamic framework. This offers critical empirical evidence for policymakers and international partners, underscoring the urgent need for climate-smart agricultural adaptations, improved water management, and sustained peacebuilding efforts to build a resilient and food-secure future for Somalia.

Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis, predominantly affecting the lungs but also capable of affecting other organs.1 Over the past decade, TB has had a s...

Maternal health utilization in fragile states is hindered by complex social and structural barriers. This study examined socio-digital stratification and explored the threshold effects of digital inclusion on antenatal care (ANC) utilization in Somalia. Using data from the 2020 Somalia Demographic and Health Survey (N = 8,940), we constructed a Digital Inclusion Index (0-3) and employed survey-adjusted logistic regression models to estimate the odds of achieving four or more ANC visits (ANC 4+). Only 8.4% of the women achieved the ANC 4+ threshold, with pronounced disparities between urban (14.0%) and rural/nomadic (5.5%) residents. Evidence consistent with a threshold effect was observed, whereby the initial transition from digital exclusion to basic connectivity (score = 1) was associated with the largest marginal gain in health seeking probability (OR = 1.55, p = 0.013). While mobile money penetration is high (85.2%), internet access remains deeply stratified by wealth (22.0% among the rich versus 1.0% among the poor). Interaction analysis suggests that digital inclusion complements but does not substitute for physical health infrastructure, partially mitigating distance-related barriers without eliminating the need for physical proximity to healthcare facilities. Digital inclusion is a critical entry point for improving maternal health access in Somalia. Policies should prioritize universal basic connectivity and SMS-based interventions, while simultaneously addressing persistent physical and socioeconomic inequities.

Background: Antenatal care (ANC) is critical for maternal survival, yet utilization in postconflict Somalia remains among the lowest globally. This study identifies the individual, household, and regional determinants associated with both the initiation and frequency of ANC visits among Somali women. Materials and Methods: We analyzed the 2020 Somali Health and Demographic Survey, focusing on 8220 women (ages 15–49) with a live birth in the preceding 5 years. To account for the high proportion of nonvisitors (66%), we evaluated four count regression models. The zero-inflated Poisson (ZIP) model was selected based on the Akaike information criterion and parsimony. Results: Only 34.12% of women attended at least one ANC visit, and just 8% reached the World Health Organization-recommended four-visit minimum. The ZIP model revealed a “regional lottery” of care. Nomadic status significantly reduced visit frequency (incidence rate ratio [IRR] = 0.75; 95% confidence interval [CI]: 0.70–0.80). Wealth was the primary driver of visit frequency (highest quintile IRR = 1.56; 95% CI: 1.40–1.74), while higher education (AOR = 0.32; 95% CI: 0.16–0.63) and mass media exposure (AOR = 0.53; 95% CI: 0.44–0.63) were the strongest predictors for breaking the barrier to initial care entry. Physical distance remained a persistent structural barrier to frequent attendance (IRR = 1.06; 95% CI: 1.01–1.12). Conclusions: ANC utilization is driven by regional stability, nomadic mobility, and socioeconomic status. To achieve universal coverage, policies must transition from static clinic models to nomadic-sensitive “tent-based” mobile units and implement financial protection schemes, such as transport vouchers, to mitigate wealth-based inequities.

Background: Women’s healthcare decision-making autonomy in Somalia is essential for empowerment and viewed as a fundamental human right. In fragile states, local socio-cultural structures and gatekeeping norms uniquely influence the typical drivers of agency, such as education and wealth. This study provides the first national analysis of the levels and determinants of healthcare autonomy among married women using data from the 2020 Somalia Demographic and Health Survey (SDHS). Methods: We analyzed a nationally representative sample of 7,492 married women. A multilevel mixed-effects binary logistic regression model was employed to account for the hierarchical structure of the data, with individuals nested within primary sampling units (PSUs). Autonomy was conceptualized using a relational framework and defined as meaningful participation in healthcare decisions (either alone or jointly). Results: Overall, 67.1% of women reported healthcare autonomy. A “Permission Paradox” was identified: women reporting that obtaining permission was a major barrier had significantly higher odds of autonomy (AOR = 1.79; 95% CI: 1.43–2.23; p < 0.001), suggesting that agency in this context is a negotiated process. Conversely, an “Education Anomaly” was observed, whereby secondary education was associated with a 41% reduction in the odds of autonomy (AOR = 0.59; p = 0.001). Regional context emerged as the strongest predictor; women in Bakool had nearly 4.5 times higher odds of autonomy (AOR = 4.47; p = 0.001) compared to those in Awdal. Conclusion: Healthcare autonomy in Somalia represents a negotiated agency embedded in geospatial heterogeneity. One-third of women remain entirely excluded from health-related decisions. Policy responses should move beyond individualistic models toward decentralized, culturally grounded interventions that address structural gatekeeping and regional disparities to advance meaningful health equity. Trial registration: Not applicable.