Barriers for full immunization coverage among under 5 years children in Mogadishu, Somalia.

BACKGROUND: Immunization is amongst the most cost-effective public health interventions for reducing childhood morbidity and mortality. However, globally 9 million deaths of children occur as a result of vaccine-preventable diseases in which 4.4 million are from the sub-Saharan region. Therefore, this study aimed to assess barriers for complete vaccination coverage among under five years children in Mogadishu, Somalia. METHODS: A community-based cross-sectional study was conducted between April to July 2019 in Mogadishu-Somalia. Two-stage cluster sampling with systematic random sampling was used to select a sample of 820 households. Data was collected through a structured, interviewer administrator questionnaire. In case more eligible children found at a single selected household, one child was randomly selected and the information related to immunization was interviewed from his/her caregiver. RESULTS: The overall, fully vaccinated under 5 years children were found to be 45.2%. Immunization was found to be increased by being a younger caregiver (ß=-0.024, P-Value=0.019) being father with secondary and above education (AOR = 1.755, 95% CI = 1.161-2.655, P-Value = 0.008), being a young child (ß = -0.018, P-value = 0.011), being children from birth order of fifth and above (AOR = 1.539, 95% CI = 1.011-2.343, P-value = 0.044), being a married caregiver (AOR = 4.101, 95% CI=1.062-15.835, P-Value = 0.041), increased monthly family income (ß =0.003, P-value = 0.000), availability of vaccine at the time of visit (AOR = 6.147, 95% CI = 1.943-19.441, P-value = 0.002), cost affordability of vaccine (AOR = 1.951, 95% CI = 1.238-3.076, P-value = 0.004), being born at health facility (AOR = 1.517, 95% CI = 1.104-2.086, P-value = 0.010), having good knowledge on immunization (AOR = 1.125, 95% CI = 1.070-1.181, P-value = 0.001), having good practice on immunization (AOR = 2.756, 95% CI = 2.233-3.402, P-value = 0.001) and having good perception on vaccine (AOR = 4.976, 95% CI = 2.183-11.340, P-value = 0.001). CONCLUSION: The result of this study has revealed that the proportion of fully immunized under-5 children in Mogadishu is very low. Several factors were found to the barriers achieving full immunization coverage. Steps to promote health education and vaccine availability should be lounged.

Access to HIV Care and Resilience in a Long-Term Conflict Setting: A Qualitative Assessment of the Experiences of Living with Diagnosed HIV in Mogadishu, Somali.

BACKGROUND: Human Immunodeficiency Virus (HIV) continues to take a heavy toll on the lives of many people, with the worst impact on health and wellbeing for the affected individuals in fragile states. The HIV situation in Somalia is not clearly known and experiences of the people living with HIV in this war-torn region are often unexpressed. This pilot qualitative study sought to explore the experiences of people diagnosed with HIV living in Mogadishu, and their resilience in access to care and social support. METHODS: Participants were recruited through drug dispensers at the HIV clinic in Banadir Hospital. Face-to-face in-depth interviews were conducted in Somali in May 2013 among patients who were receiving antiretroviral therapy (ART) from the HIV clinic in Mogadishu. These were tape-recorded, transcribed, and translated for content analysis. RESULTS: Three women and four men who were living with HIV shared the following narratives. Their perception was that they had either got HIV from their spouses or through health care contamination. They were very knowledgeable about the realities of HIV, how the medication works, nutritional requirements, and drug adherence. They were always willing to go an extra mile to secure a good life for themselves. However, the external HIV stigma impacted their access to care. They faced challenges in their homes and at work which compelled them to seek support from non-governmental organizations (NGOs) or close family members. This stigma often affected their disclosure to the wider community due to the uncertainty of the repercussions, leading to a life of extreme loneliness and financial difficulties. The participants' coping mechanisms included living together and starting their own NGO for support with very strong optimism about their prognosis. CONCLUSIONS: The people diagnosed with HIV living in Mogadishu are highly knowledgeable about HIV transmission, the realities of living with a diagnosed HIV infection, and the efficacy of HIV treatment. Our small sample suggests adequate access to ART through NGOs. However, widespread HIV stigma limits HIV status disclosure to families and communities, which creates a risk of self-isolation and ill health. Still, affected individuals have developed resilient mechanisms for managing the risks. They strive to remain employed for economic security, adhere to HIV treatment, engage in support groups, and maintain the utmost optimism about their prognosis.

Health in a fragile state: a five-year review of mortality patterns and trends at Somalia's Banadir Hospital.

BACKGROUND: The recurrent civil conflict in Somalia has impeded progress toward improving health and health care, with lack of data and poor performance of health indicators. This study aimed at making inference about Banadir region by exploring morbidity and mortality trends at Banadir Hospital. This is one of the few functional hospitals during war. METHODS: A retrospective analysis was conducted with data collected at Banadir Hospital for the period of January 2008-December 2012. The data were aggregated from patient records and summarized on a morbidity and mortality surveillance form with respect to age groups and stratified by sex. The main outcome was the number of patients that died in the hospital. Chi-square tests were used to evaluate the association between sex and hospital mortality. RESULTS: Conditions of infectious origin were the major presentations at the hospital. The year 2011 recorded the highest number of cases of diarrhea and mortality due to diarrhea. The stillbirth rate declined during the study period from 272 to 48 stillbirths per 1,000 live births by 2012. The sum of total cases that were attended to at the hospital by the end of 2012 was four times the number at the baseline year of the study in 2008; however, the overall mortality rate among those admitted declined between 2008 and 2012. CONCLUSION: There was reduction in patient mortality at the hospital over the study period. Data from Banadir Hospital are consistent with findings from Banadir region and could give credible public health reflections for the region given the lack of data on a population level.