Hargeisa Group Hospital

Introduction The ongoing conflict between the Somali National Army and non-state armed actors has led to an increase in mass casualty incidents (MCIs) which burden the fragile Somali healthcare system. Hospitals often become overwhelmed during MCIs, which can lead to increased mortality. To address this gap in mass casualty management (MCM), the WHO developed the MCM course to help hospitals address MCIs through the creation of individualized MCM plans. This study evaluated the effect of the WHO MCM course on participants’ knowledge of MCM concepts and self-reported confidence in managing MCIs in trauma hospitals in Somalia. Methods A prospective pre-post educational study was conducted with healthcare teams from trauma hospitals across Somalia in October 2023. The four-day MCM course utilized lectures and interactive tabletop exercises to introduce MCM concepts, simulate MCI scenarios, and help participants develop MCM plans. Participants’ knowledge was assessed using multiple choice pre- and post-tests. Confidence was evaluated using a 4-point Likert scale surveys, feedback forms were used to assess course acceptability. Paired t-tests and Cohen’s d were used to analyze pre-post changes. Results The MCM course was completed by 23 participants from 3 regions across Somalia. They had an average of 8.5 years of clinical experience and 3 years of MCM experience. The mean post-course test scores (78.9%) showed a significant improvement (p<0.001; Cohen's d=1.82) compared to pre-course test scores 47.9% (28%-72%). There was also an improvement in self-reported confidence in the implementation and activation of MCM plans (d=0.49), understanding of MCM roles and responsibilities (d=0.55). The largest gains were in operational readiness (d=1.42), including clearing the emergency unit, documentation, and triage planning. Conclusion The MCM course improved participant’s knowledge of key MCM concepts and self-reported confidence in managing MCIs. Although limited by small sample size and reliance on self-reported outcomes, findings suggest the course may support improved MCM readiness in conflict-affected settings.

Introduction Emergency care is critical in regions affected by humanitarian crises. Somalia’s prolonged conflict has strained the health system, leaving health workers under-prepared and limiting access to training. The Basic Emergency Care (BEC) course was developed to address gaps in emergency care by training healthcare providers to stabilize critically ill and injured patients. This study evaluates the implementation of BEC in Somalia, focusing on strategies to adapt this course to a conflict-affected setting. Methods Two consecutive 5-day BEC courses and a 1-day Training-of-Trainers course were conducted in Mogadishu, Somalia (October 2023). Participants were doctors and nurses providing first-contact emergency care at health facilities in Mogadishu, Jowhar, Baidoa, and Gaalkayo, selected by the Somalia Federal Ministry of Health (FMOH) in collaboration with International Medical Corps (IMC). Knowledge was assessed with multiple choice pre- and post-course exams, and confidence was assessed with pre- and post-course Likert-scale surveys. Data were analysed using paired t-test and McNemar’s test. Qualitative feedback was analyzed thematically. Results A total of 55 participants enrolled in BEC, 54 completed the post-test and were included in paired pre/post knowledge analyses. Post-course examination scores (90.6 %) showed a significant improvement (p < 0.001) compared to pre-course examination scores (53.6 %). Self-reported confidence in providing emergency care increased across multiple domains (p < 0.05). Participants expressed strong interest in conflict-related injury modules and recommended extending the duration of the course. Conclusion The BEC course increased emergency care knowledge and confidence among Somali health workers. Centralized training, peer-teaching, and the integration of conflict-related modules can address issues of feasibility, sustainability, and relevance in a conflict setting. Further studies are needed to evaluate the conflict-related injury modules, assess the clinical impact of BEC training in this setting, and determine the effectiveness of sustainability strategies.

Background:Prune Belly Syndrome (PBS), also known as Eagle-Barrett syndrome, is an uncommon congenital disorder characterized by a combination of abdominal wall hypoplasia, urinary tract malformations, and bilateral cryptorchidism. The condition predominantly affects males and is frequently associated with significant neonatal morbidity and mortality related to renal and pulmonary complications. Congenital urinary fistula formation represents a particularly rare and complex manifestation of this syndrome. Case Presentation:We report a case of a 2-day-old male neonate presenting to a hospital in a resource-limited setting with respiratory distress and passage of urine via the umbilicus. The patient was born at term via spontaneous vaginal delivery to a mother with no antenatal care. Physical examination revealed a critically ill neonate with a classic "prune-like" abdomen, bilateral cryptorchidism, urine flow from an infected umbilical cord, and associated anomalies including polydactyly and clubfoot. Ultrasonography confirmed bilateral gross hydronephrosis and a urinary fistula communicating with the umbilicus. Conclusion:This case highlights a classic presentation of PBS, unusually complicated by a congenital urinary fistula. It underscores the profound challenges in managing this complex syndrome in settings with limited resources, where definitive surgical intervention is unavailable. The report emphasizes the critical importance of prenatal diagnosis and the need for a multidisciplinary approach to improve outcomes, which was not feasible in this context. Ultimately, management was restricted to supportive care and antibiotics, illustrating the dire consequences of diagnostic and therapeutic limitations in such environments.The patient was stabilized and referred to a higher center; however, long-term outcome was not available.

Background Breast cancer is a leading cause of cancer-related morbidity and mortality among women worldwide. Early detection through screening methods such as breast self-examination (BSE) is critical, particularly in low-resource settings where access to mammography is limited. Healthcare professionals play a key role in promoting breast cancer awareness, yet their own knowledge, attitudes, and practices of BSE in Somaliland remain understudied. This study aimed to assess the knowledge, attitudes, and practices regarding breast self-examination and to identify associated factors among female healthcare professionals at selected hospitals in Hargeisa, Somaliland. Methods An institution-based cross-sectional study was conducted from March to July 2025 among 171 female healthcare professionals (nurses, midwives, doctors, and pharmacy technicians) working in five hospitals in Hargeisa. Participants were selected using proportionate stratified random sampling. Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, knowledge (17 items), attitudes (10 Likert-scale statements), and BSE practices (10 items). Knowledge was categorized using Bloom's cut-off points, attitude by median split, and practice as good (≥6) or poor (<6). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with BSE practice. Results The mean age of participants was 28.4 years (SD = 6.2). Overall, 67 (39.2%) had good knowledge, 39 (22.8%) had average knowledge, and 65 (38.0%) had poor knowledge. A favorable attitude toward BSE was observed among 93 (54.3%) participants. However, only 44 (25.7%) reported ever practicing BSE, and merely 30 (17.5%) demonstrated good practice. Among those who practiced, most used correct techniques. In multivariate analysis, good knowledge (AOR = 1.96, 95% CI: 0.95–4.02, p = 0.041), favorable attitude (AOR = 2.14, 95% CI: 1.01–4.54, p = 0.046), and prior training on BSE (AOR = 3.62, 95% CI: 1.65–7.93, p = 0.001) were significantly associated with BSE practice. Conclusion Despite moderate knowledge and favorable attitudes, BSE practice among female healthcare professionals in Hargeisa is low. Training, knowledge, and positive attitudes are key predictors of practice. There is an urgent need for targeted educational interventions and regular BSE training programs within healthcare institutions to improve personal screening behaviors and enhance community health education.

Introduction: noncommunicable diseases (NCDs) are rising in Somaliland, yet evidence on implementing effective prevention and control in resource-limited settings remains scarce. In 2022, Somaliland launched its first pilot NCD clinic at Hargeisa Group Hospital, modelled after package of essential noncommunicable (PEN-plus) in Rwanda, treating heart failure, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and asthma. It is staffed by nurses and general practitioners under the supervision of an Internal Medicine specialist and has enrolled over 2000 patients. We evaluate the clinic´s impact on hypertension control to inform improvements and national scale-up. Methods: a quasi-experimental pre-post design with mixed-effect models was used, analyzing data from 2022-2024. The outcome was a change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from initial to follow-up visits among hypertensive patients with at least one follow-up. Results: three hundred and forty-eight (348) patients (56.6 years and 60% female) were included and had a median follow-up of 3 visits (IQR 3) over 114 days (IQR 185). Baseline mean BP was 148.6/96.0 mmHg (95% CI: 139.0-158.3 / 91.9-100.9). Clinic attendance was associated with a significant reduction in SBP, ranging from 10.3 mmHg (95% CI: -12.8, -7.7) at first follow-up to 17.3 mmHg (95% CI: -23.4, -11.1) at last follow-up; DBP dropped 5.6 mmHg (95% CI: -7.1, -4.1) to 8.0 mmHg (95% CI: -11.6, -4.3). Conclusion: the NCD clinic markedly improved hypertension control. Sustaining this reduction in BP could contribute to reducing the risk of major cardiovascular disease events and overall NCD-related mortality in Somaliland. Lessons from this pilot will guide the national scale-up of NCD clinics in Somaliland.