Shafie Abdirahman Dirie

Maternal mortality remains a major public health challenge in Somalia and is among the highest globally despite recent progress. This narrative review aimed to synthesize evidence on the burden of maternal mortality and the health system challenges contributing to its persistence. A literature search was conducted using PubMed, Google Scholar, and relevant grey literature, including national surveys, policy documents, and reports from international organizations. The review found that maternal mortality in Somalia remains alarmingly high, accompanied by low utilization of antenatal care, skilled birth attendance, facility-based delivery, and postnatal care services. Financial constraints, geographic inequalities, insecurity, and socioeconomic disparities continue to limit access to maternal healthcare, particularly among rural and nomadic populations. Key health system challenges include inadequate healthcare financing, weak infrastructure, shortages of skilled health workers, limited implementation of the Essential Package of Health Services, and dependence on donor-supported services. Direct obstetric complications, including postpartum hemorrhage, hypertensive disorders of pregnancy, sepsis, obstructed labor, and unsafe abortion, remain major contributors to maternal deaths. Maternal mortality in Somalia is driven by a combination of limited maternal healthcare utilization and persistent health system weaknesses. Strengthening primary healthcare, expanding access to skilled birth attendance and emergency obstetric care, improving referral systems, and addressing socioeconomic barriers are essential to reducing preventable maternal deaths and improving maternal health outcomes.

Background: Early initiation of breastfeeding (EIBF) within one hour of birth is essential for neonatal survival, yet evidence from Somalia is limited. This study examined determinants of EIBF using nationally representative data. Methods: A secondary analysis of the 2020 Somali Demographic and Health Survey (SDHS) was conducted among 2,020 women with children aged 0–23 months. Sampling weights were applied. EIBF was analyzed as a binary outcome using bivariate and multivariate logistic regression. Statistical significance was set at p ≤ 0.05. Analyses were performed using SPSS version 27. Results: Overall, 75% of newborns were breastfed within the first hour after birth. In the multivariate analysis, mothers aged 30–39 years were more likely to initiate breastfeeding early compared with those aged 15–19 years (AOR = 1.65; 95% CI: 1.01–2.70). Urban residence was positively associated with EIBF (AOR = 1.31; 95% CI: 1.02–1.68), while nomadic residence was negatively associated (AOR = 0.52; 95% CI: 0.40–0.68). Mothers without radio exposure (AOR = 0.68; 95% CI: 0.47–1.00), unemployed mothers (AOR = 0.17; 95% CI: 0.04–0.85), and those whose husbands were unemployed (AOR = 0.75; 95% CI: 0.63–0.91) had lower odds of EIBF. Facility delivery significantly increased the likelihood of EIBF (AOR = 1.44; 95% CI: 1.03–2.00). Conclusion: EIBF in Somalia is influenced by maternal, socioeconomic, and health service related factors. Strengthening facility-based deliveries and expanding health education through mass media may improve EIBF practices.

Background: Breast cancer is a leading contributor to cancer-related illness and death among women worldwide. In Somalia, limited access to healthcare exacerbates the challenges faced by patients, making health-related quality of life (HRQoL) a vital concern. Objective: To assess health related quality of life among women with breast cancer in Mogadishu, Somalia. Methods: A hospital-based cross-sectional study was conducted from September to November 2024 involving 200 breast cancer patients. Data were collected using a structured questionnaire adapted from the validated European Organization for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-C30 and the breast cancer-specific module EORTC QLQ-BR23). These tools were used to assess multiple domains of health-related quality of life. Data were analyzed using SPSS version 27. Descriptive statistics were used to summarize participant characteristics. Pearson’s correlation examined relationships between HRQoL domains and socio-demographic or clinical variables. Multivariable linear regression was used to identify independent predictors of HRQoL, with significance set at p < 0.05. Results: In multivariable linear regression, advanced stage at diagnosis was associated with lower physical (β = – 0.109, 95% CI: – 0.202 to – 0.016, p = 0.021) and emotional HRQoL (β = – 1.192, 95% CI: – 1.330 to – 0.954, p = 0.007), and with higher financial burden (β = 1.41, 95% CI: 1.061 to 1.760, p = 0.021). Greater extent of surgery predicted lower physical HRQoL (β = – 0.469, 95% CI: – 0.587 to – 0.351, p < 0.001). Adequate social support was positively associated with conjugal well-being (β = 0.334, 95% CI: 0.020 to 0.649, p = 0.037), and stage at diagnosis was also positively linked with conjugal HRQoL (β = 0.343, 95% CI: 0.039 to 0.647, p = 0.027). Conclusion: Although emotional and social HRQoL were relatively preserved, physical, financial, and conjugal domains were more negatively affected especially among women with advanced cancer, extensive surgery, or longer time since diagnosis. These findings emphasize the urgent need for improved cancer care access and integrated psychosocial support in Somalia.

Background: Skin bleaching is the cosmetic use of hazardous substances or skin lightening agents to change one’s natural skin pigment. Skin bleaching products contain substances such as corticosteroids, hydroquinone, mercury salts, and other compounds that decrease the melanin. Objective: To assess the prevalence of skin bleaching and identify the motivating factors among female university students in Mogadishu, Somalia. Design and methods: This cross-sectional study included 317 female university students in Mogadishu, Somalia, from February to July 2024. Structured questionnaires were used for data collection. Data analysis was performed using IBM SPSS Statistics version 27.0, reporting categorical variables as frequencies and percentages; significance was determined at p < 0.05 for both crude odds ratios in univariate analyses and adjusted odds ratios (AORs) in multivariate analyses. Results: Almost 77.3% of participants showed awareness of skin bleaching, with main information sources mentioned as media (39.7%) and friends (34.1%). Two-thirds (63.4%) reported experiencing skin conditions like acne (27.1%). Univariate and multiple logistic regression analyses were conducted. From the results, only female students with a monthly income between USD 50 and 100 were 1.21 (AOR = 1.21, 95% confidence interval: 1.102–1.6341) more likely to bleach their skin compared to those with an income less than USD 50. Conclusions: The study reveals a high prevalence of skin bleaching practices among female university students despite widespread awareness. Media and peer influence play a major role, and many participants reported adverse skin effects. Monthly income emerged as the key factor associated with skin bleaching, underscoring the need for targeted public health education and interventions.

Introduction: Vaccine hesitancy is a global barrier to childhood immunization and a significant challenge in fragile health systems like Somalia, making it crucial to identify associated factors for effective interventions. Objectives: To identify factors associated with VH among mothers of children under 2 years in Mogadishu Methods: A cross-sectional study of 548 mothers in Mogadishu, Somalia Results: VH prevalence was 37.4% (n = 205). Mothers without formal education (AOR = 4.31, 95% CI: 2.012-9.109) and fathers without education (AOR = 2.74, 95% CI: 1.514-5.311) were more to report VH. Longer waiting times were associated: 15 to 30 minutes (AOR = 0.40, 95% CI: 0.229-0.699), 31 to 60 minutes (AOR = 0.25, 95% CI: 0.138-0.465), and >60 minutes (AOR = 0.44, 95% CI: 0.230-0.854), compared to <15 minutes. Conclusion: VH is common in Mogadishu and is linked to parental education and service-related factors

Background: Health-related Quality of Life (HRQoL) is a concept covering social, physical, psychological, and environmental factors. This study aimed to evaluate the HRQoL of medical students in Mogadishu, Somalia, using the WHOQOL-BREF instrument. Methods: This is a cross-sectional study design to assess QOL among medical students in Mogadishu, Somalia, between August and November, 2024 at selected public and private universities offering undergraduate medical programs. Data were collected using a structured self-administered questionnaire comprising socio-demographic variables (Gender, Age, Residence, Marital Status, Academic Year, and GPA). The WHOQOL-BREF instrument consists of 26 items grouped into 4 domains: physical, psychological, social, and environmental. Data were analyzed using descriptive statistics, ANOVA, and Regression with p < 0.05 were statistically significant. Results: The majority of students (57%) reported their overall QOL as “good,” while 22% reported it as “very good.” A significant association was found between age and psychological health ( p = 0.011), with students above 25 scoring highest (76.82 ± 13.88) compared to those aged 21–24 (69.41 ± 15.27) and 18–20 (71.51 ± 15.90). Academic year showed a significant association with social health ( p = 0.026), highest in years 3–4 (73.48 ± 20.72), followed by years 1–2 (71.46 ± 21.06), and lowest in years 5–6 (65.85 ± 27.29). In multivariate Age 21–24 years had association with the Psychological domain (β = –0.858, 95% CI: –1.672, –0.045). Conclusions: The study demonstrates that medical students in Mogadishu generally report a good QOL; however, it underscores the necessity for interventions aimed at improving psychological resilience and social support systems.

Introduction: Child mortality is a critical global health indicator, reflecting a nation’s development and healthcare quality. Despite significant progress in reducing child mortality globally, Somalia continues to experience high rates, particularly among infants and young children, due to preventable and treatable conditions. Malnutrition, birth complications, and infectious diseases are the leading causes of death. This study aims to analyze the demographic and mortality patterns of hospitalized children at Banadir Hospital in Mogadishu, Somalia, to identify key factors contributing to pediatric mortality and propose actionable solutions. Objective: To assess and analyze the trends in pediatric mortality over the past two years at a national referral hospital in Mogadishu, Somalia. Design: A retrospective cross-sectional study Setting: Pediatric department at Banadir hospital in Mogadishu Somalia Participants: 1,443 children admitted to the pediatric department Results: The overall pediatric mortality rate during the study period was 5.3%. Male children accounted for 56.5% of deaths, while females represented 43.5%. Infants under one year were disproportionately affected, contributing to the majority of deaths. The primary causes of death were birth asphyxia (10.33%), severe acute malnutrition (29.04%), and preterm (13.65%). The majority of deaths occurred between two to five days and within the first 24 hours after admission, respectively. Mortality was significantly associated with younger age groups, particularly neonates. Conclusions: In order to reduce Somalia’s high rate of pediatric mortality, the results highlight the urgent need for better healthcare services and focused interventions. Enhancing maternal and neonatal healthcare, strengthening pediatric emergency care, and addressing malnutrition through community-based programs are critical. Increasing vaccination coverage and improving timely referral systems are also essential to prevent deaths from avoidable conditions. These strategies, if implemented effectively, can contribute to a substantial decline in preventable child deaths in Somalia.