University of Hargeisa

Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD − 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD − 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.

Biological invasions, driven by the spread of non-native species, have become a critical global issue because of their far-reaching ecological and socioeconomic impacts. Effective communication of the risks of biological invasions is essential for implementing robust policy and legislation and gaining public support for conservation efforts. However, current policies often suffer from fragmentation and ineffectiveness, largely due to inadequate risk communication and complex multi-level governance. To address this challenge, we develop a global framework designed to enhance clearer communication about biological invasion risks. The framework contextualizes key terms across three domains in invasion science: species invasiveness, risk analysis, and decision support tools. Using both diffusion-of-English and ecology-of-language paradigms, and following a three-step process involving preliminary consensus, AI querying, and ground-truthing with final consensus, we validate the framework in 70 non-English languages which, together with English, have official status in at least one country and collectively cover all 195 countries worldwide. Our findings reveal that while terminology for risk analysis is well established, terminology for species invasiveness and, especially, for decision support tools remains underdeveloped in many languages, hindering effective communication and policy implementation. Our framework underscores the importance of cultural and political neutrality. By promoting clearer risk communication among scientists, policymakers, and the public globally, we aim to reduce policy fragmentation and foster enhanced collaboration in risk mitigation. We recommend expanding multilingual decision support tools to include the full risk analysis process: risk identification, risk assessment, and risk management. This will support intergovernmental mitigation efforts and promote a unified global response to biological invasions.

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.

Multimorbidity is a growing public health concern globally, yet remains under-researched in fragile and conflict-affected settings, including Somalia, a country in the Horn of Africa with limited health infrastructure. This study investigates the prevalence, regional patterns, and individual- and contextual-level determinants of multimorbidity among women aged 15–49 years in Somalia. A cross-sectional analytical study design was applied using nationally representative data from the 2020 Somalia Demographic and Health Survey (DHS). The final sample included 8,172 women after excluding cases with missing or incomplete information. Multimorbidity was defined as the presence of ≥ 2 self-reported chronic conditions. Bayesian multilevel logistic regression was employed to account for hierarchical data structure— individuals (Level 1) nested within regions and residence types (Level 2). Random intercept and slope models were compared using Deviance Information Criterion (DIC), with posterior distributions estimated via Markov Chain Monte Carlo (MCMC) simulation. Associations were assessed using odds ratios (ORs) and 95

IntroductionIn many countries, the consent for caesarean section (CS), when indicated, is made by the woman herself. However, in Somaliland, the family (husband, father, or other close male family member) are required to make the consent for CS to be performed, a process that can be time-consuming and result in adverse outcomes. This study aimed to investigate the barriers to and facilitators of timely family consent in caesarean sections at the national referral hospital in Somaliland.MethodologyA convergent mixed-methods study with a parallel sampling method was conducted at the national referral hospital in Somaliland. Quantitative data was collected on timely vs. late family consent for CS, as well as sociodemographic and obstetric characteristics. Data were analysed using binary and multivariable logistic regression. In addition, in-depth interviews were conducted and analysed using thematic analysis.ResultsOf the 516 women included in the quantitative phase of the study, 16 participated in the in-depth interviews. The quantitative results showed that women with hypertensive disorders (aOR 8.491; 95% 1.076-66.991) and obstetric haemorrhage (aOR 3.209; 95% CI 1.159-8.887) had higher odds of late family consent compared to women without hypertensive disorders and obstetric haemorrhage respectively. The themes that emerged on barriers to timely family consent for CS were poor communication and understanding, delayed informed choice for CS, differences in understanding between family members on the indication for CS, and absence of the person providing formal consent. The themes that emerged on facilitators of timely family consent were the husband's autonomous decision making for CS and adequate disclosure of all relevant information about CS.ConclusionA standard counselling package can be designed on educating family members on the importance of timely CS consent during the antenatal period with male involvement. A policy should be developed that gives women the autonomy to make health decisions and give consent in maternal health emergencies. Healthcare providers need training on effective communication when requesting CS consent, with a focus on the elements of informed consent.