AIMTo provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.METHODSA systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.RESULTSTwenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: < 1 year old, 61.54% (95%CI: 40.14% to 79.24%); 1-10 years old, 91.91% (95%CI: 87.76% to 94.73%); 11-19 years old, 96.31% (95%CI: 92.84% to 98.14%); 20-39 years old, 91.3% (95%CI: 83.07% to 95.73%); and > 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups < 20 years old, 20-39 years old and > 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate am...

Background. Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia. Methods. This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients’ sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system. Results. A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31–50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer. Conclusions. Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Globally, hepatocellular carcinoma is the second amongst all causes of cancer deaths and it is one of the common malignancies in both developing and developed countries. The causes are variety all of the world ranging from geography, life style and advanced medical care that is available in those countries either developing such as Somalia or developed countries. Somali contributes to global burden of hepatitis B which is a known risk factor for HCC and has categorized to the world a part of high prevalence of hepatitis B which is greater than 10%, while there is no more available data of hepatitis C in Somalia that contributes the world. Diagnoses of hepatocellular carcinoma are now forward in many countries of developed world, but reality are different from developing countries such as Somalia which is now out for civil war and has a lack of medical experts in all fields of medicine such as physician, surgeons, pathologists, radiologists and the experts of the laboratory field, even if we have these medical personal who are few or they are elder than above 60 years old plus medical equipment (such as imaging and laboratory equipment). All these challenges, the author of this manuscript has faith in the diagnosis of hepatocellular carcinoma that can be rationally made to consider the clinical presentation of this disorder and to maximize use of offered diagnostic tools and to refer the few medical experts in the country.

Toxoplasmosis and brucellosis are zoonotic diseases of worldwide distribution. They both cause abortion and infertility in human and animals. Limited data are available about these pathogens in Somali people and their animals. Hence, this study has evaluated the prevalence of anti-Toxoplasma gondii and anti-Brucella spp. antibodies in pregnant women in Mogadishu, Somalia. Serum samples from 307 pregnant women from Mogadishu, Somalia were tested for anti-T. gondii antibodies by Latex Agglutination Test (LAT) and anti-Brucella spp. antibodies by Rose Bengal Plate Test (RBPT) and a commercial competitive-ELISA (cELISA). A total of 119/307 (38.76%) pregnant women had a prior history of abortion. A total of 159/307 (51.79%; 95% CI: 46.2–57.35%) pregnant women were seroreactive for T. gondii by LAT at different stages of pregnancy. For Brucella spp., when RBPT and cELISA were combined 4/307 (1.30%; 95% CI: 0.36–3.30%) pregnant women were seroreactive to anti-Brucella spp. antibodies, being 2/307 (0.65%; 95% CI: 0.18–2.34%) by RBPT and 3/307 (0.98%; 95% CI: 0.33–2.83%) by cELISA. Two women were seroreactive for both agents. A high seropositivity to T. gondii and low seropositivity to Brucella spp. have been found in pregnant women from Mogadishu, Somalia. Considering the high number of abortions in the country associated to the fact that awareness on other zoonotic abortifacient pathogens in Somalis is very low, further studies should be conducted to evaluate the potential causes of abortions.

Background Hepatitis A is one of the most common infectious causes of acute hepatitis, and currently, a neglected global public health problem necessitating an urgent response in Somalia. Hepatitis A infection and its rare complication of acute liver failure in children are largely based on very limited data. The aim of the study was therefore to investigate the Hepatitis A infection and its rare complication of acute liver failure in children in Somalia. Methods This retrospective study was conducted on children aged 0–18 years who were admitted to the pediatric departments of the Somalia Mogadishu-Turkey Training and Research Hospital, Somali, from June 2019 and December 2019. Patients who were tested for hepatitis A infection during the study period and had complete data were included. Children with chronic disease, primary or secondary immunodeficiency, blood transfusion history, and missing data were excluded. Abstracted data including patients' demographics, clinical presentation, laboratory results, ultrasonographic findings, length of hospital stay, clinical course and outcome were retrieved from the hospital database system. Results Of the 13,047 children, 219 were analyzed. Of the 219 Hepatitis A cases, 25 (11%) were diagnosed with pediatric acute liver failure (PALF). The mean age of children with Hepatitis A was 6.7 years. The majority of cases were reported in the 5–9 (39.7%) year age range. Hepatic encephalopathy, length of hospital stay, levels of albumin, and values of PT, aPPT, and INR were significantly higher in children with acute live failure. The presence of cholecystitis and cholecystitis with ascites in the sonographic evaluation were poor prognostic markers for acute liver failure. Conclusions This study revealed hepatitis A virus infection and its related acute liver failure among hospitalized children in Somalia of which 11% had PALF. Hence, the introduction of Hepatitis A vaccination, which is the main public health tool, into the national immunization program, the improvement of hygiene conditions, raising awareness of the disease, and increasing health literacy are necessary to prevent the consequence of the Hepatitis A virus in children.