A 12-year-old Somalian girl presented with chronic kidney disease and died as a result of female genital mutilation- A case report.

The tradition of female genital mutilation (FGM) is practiced in many African countries, including Somalia. FGM is responsible for several short and long-term complications that can negatively influence vital and functional prognosis. We present a case of a 12-year-old girl subjected to FGM who developed urethral meatus stenosis, exacerbated by chronic renal failure and urine infection, leading to her death from a combination of complications. FGM complications, sometimes fatal, remain in developing nations. The fight against these practices must be stepped up, supported by public awareness, education, and communication efforts.

Clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia.

Objectives: Measles is a contagious disease associated with significant morbidity and mortality. This paper describes the clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia from January 2018 to December 2021. Methods: This retrospective study was conducted at Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital. Children aged 6 months to 17 years who were hospitalized with clinical signs and symptoms of measles and its complications were recruited. Results: In total, 110 participants were enrolled. The median age was 16 [interquartile range (IQR) 12-36] years, and 87 (79.1%) were male. All participants presented with fever, typical measles rash, cough and conjunctivitis, and 43 (39.1%) had received the measles vaccine. Overall, 104 (94.6%) participants were admitted with severe respiratory symptoms, and six (5.4%) were admitted due to poor feeding and/or significant dehydration. Overall, all-cause mortality was 1.8% (n=2). The median duration of hospitalization was longer among participants who died compared with those who survived [11 (IQR 8-14) vs 4 (IQR 2-6) days; P=0.046]. Unvaccinated participants were significantly younger than vaccinated participants [36 (IQR 24-72) vs 12 (IQR 9-16) months; P<0.001]. There was a trend towards higher mortality [0/43 (0%) vs 2/67 (3%); P=0.519] and longer length of hospitalization [3 (IQR 2-6) vs 4 (IQR 3-7) days; P=0.056] among unvaccinated participants compared with vaccinated participants. Both the median total leukocyte count [5.7 (IQR 3.9-8.5) vs 11.6 (IQR 5.9-46.3) x 109/L; P<0.001] and platelet count [239 (IQR 202-358) vs 308 (IQR 239-404) x 109/L; P=0.032] were significantly higher among unvaccinated participants compared with vaccinated participants. However, the median haemoglobin concentration was significantly higher among vaccinated participants compared with unvaccinated participants [11.1 (IQR 9.9-12.3) vs 10.1 (IQR 9.1-11.2) g/dL; P=0.006]. Conclusions: Patients with measles in Somalia have a short hospital stay, low mortality rate and low vaccination rate. Timely vaccination and the need for improved care of patients with measles, particularly vulnerable groups including children and those with undernutrition, are encouraged.

An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report from Somalia.

Background: There has been an increase in worldwide cesarean section rates, although they remain low in most Sub-Saharan African countries, including Somalia. The present is the first hospital-based study that analyzes the rate, indications, and associated maternal mortality of cesarean deliveries reported from Somalia. Methods: This retrospective study reviewed data of all deliveries from 2015 to 2021 using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications and the type of cesarean section, and the documented maternal mortality during the study period. Results: During seven years, there were 12,540 total deliveries. Among these, 2703 were cesarean sections giving an overall cesarean section rate of 21.6%. The mean age of the patients was 26.7±7.3 years [14-44 years]. Multiparous mothers constituted 67.7% during the study period. According to cesarean deliveries, nulliparous mothers (55.7%) underwent the maximum number of cesarean sections. Emergency cesarean section was the predominant intervention compared to elective C-sections (59.2% vs 40.8%). Primary CS was the most common predominant, while repeat CS increased timely, 77.7% vs 22.3%, respectively. Overall, previous C-sections and fetal distress were the two most common indications for cesarean delivery (22.3% and 22.1%), respectively. C-sections were predominant in women of younger age, Primiparity, having term deliveries, and did not receive regular antenatal care. The maternal mortality rate was 1.7%, and 61% was due to direct obstetric hemorrhage, including postpartum hemorrhage, Placenta abruption, and uterine rupture. Conclusion: The study findings showed a slight increase in cesarean delivery rates during the study period. This rate is higher than the 10-15% recommended by the WHO in developing countries. Policies and efforts to decrease unnecessary cesarean sections should be promoted and implemented at each health facility.

Frequency of cervical premalignant lesions in the gynecologic patients of a tertiary hospital in Mogadishu, Somalia.

BACKGROUND: Cervical cancer is the fourth most common cancer worldwide and is the most frequently diagnosed cancer in 23 countries and the most common cause of death in 36 countries, mostly from Sub-Saharan African countries. Cervical screening is a key element to reduce the incidence and mortality of cervical cancer. Cancer screening is low in Sub-Saharan Africa. This study aims to provide information about cervical premalignant lesions frequency in Somalia. METHODS: The pathology results of cervicovaginal smear samples obtained from patients aged 25-65 years who applied to the gynecology outpatient clinic between October 5 and December 5, 2021 were analyzed retrospectively. SPSS 22.0 was used for the statistical analysis of the data. RESULT: Among the 497 results, 63 premalignant lesions were detected. The rate of premalignant lesions (63/497) was found to be 12.3%. The most common premalignant lesion was atypical squamous cells of undetermined significance (ASC-US). CONCLUSION: In this study, the frequency of cervical premalignant lesions in Somalia was found to be higher than in the literature. Vaccination, screening, and early diagnosis are the most important components in the fight against cervical cancer. Access to vaccination, screening, and early diagnosis, which are the most important components in the fight against cervical cancer in Somalia, will be possible with the cooperation of the national health system and international organizations.

Prevalence of Human Immunodeficiency Virus Among Pregnant Women.

Background: While the prevalence of human immunodeficiency virus shows a decreasing trend globally, it is reported that the frequency of the infection and the associated mortality has increased in Somalia. HIV infection also plays an important role in maternal mortality and morbidity. Objective: It is aimed to determine the HIV prevalence in pregnant women by observing the general population. Methods: It was a quantitative, retrospective study conducted to examine the records of anti-HIV antibody test results of all patients. The sample size was calculated as 664 with a 99% confidence interval (CI) and a 5% margin of error. Anti-HIV results of selected patients in the electronic database were obtained. Mean, standard deviation, minimum and maximum values were calculated for the age. Percentages were calculated for prevalence. Results: A total of 7959 pregnant were tested and 17 pregnants were found to be positive (0.2%). The results of 199,936 patients were analyzed. A total of 699 patients were found to be positive (0.3%). Of the 699 positive cases, 293 (41.9) were female and 406 (58.1%) were male. HIV seroprevalence in men and women was 0.3% and 0.4%, respectively. Conclusion: Within the scope of WHO's global HIV elimination goal, Somalia needs effective national and international initiatives.

Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). A Case Report and Review of the Literature.

Background and Importance:  Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome. Case Presentation:  The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days. Conclusion:  Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.

Management approach of a postmenopausal woman with a completely massive molar pregnancy: A case report.

Introduction and importance: Molar pregnancy typically manifests in the first trimester and is associated with several symptoms, including vaginal bleeding and larger than expected uterine size. The hallmark symptoms of this disorder are rapid uterine growth, nausea and vomiting, and an unusually high quantitative bhCG level. Ultrasonography is a reliable and sensitive technique for the diagnosis of complete molar pregnancy, which showed a "snow storm" pattern as a result of hydropic degeneration in chorionic villi.Total hysterectomy is the best treatment option for older-age women who do not desire to have children. It appears to greatly minimize the risk of later GTN. Case presentation: In this case study, we present a 46-year-old female patient who presented with vaginal bleeding and weakness. A transvaginal Ultrasound revealed a mixed solid and cystic mass-like structure in her pelvis. A total abdominal hysterectomy was performed on the patient due to severe vaginal bleeding.After three months, the beta-HCG level had entirely stabilized. During the follow-up, no symptoms of gestational trophoblastic neoplasia were found. Clinical discussion: A case report of postmenopausal women with a completely massive molar pregnancy with significant grape-like bleeding is a rare case of life-threatening conditions that may be discovered as a result of persistent significant vaginal bleeding. Conclusions: complete hysterectomy should be performed to avoid significant complications such as bleeding, hypovolemic shock, and risk of GTN.

First recorded spontaneous quintuplets born in Somalia: A case report.

INTRODUCTION AND IMPORTANCE: Quintuplets conceived spontaneously are a rare occurrence. As compared with singleton pregnancies, quintuplets are associated with high rates of obstetric complications and significant prenatal morbidity and mortality. To our knowledge, here we reported the first case of spontaneous quintuplet pregnancy faced by a practicing clinician in an underdeveloped country (Somalia) with a Successful outcome. CASE PRESENTATION: A 32-year-old woman presented in her third trimester of gestation at 30 weeks feeling pain and uterine contractions. CLINICAL FINDINGS AND INVESTIGATIONS: Ultrasound examination showed multiple pregnancies with four alive intrauterine pregnancies, but quintuplets could not be ruled out. Fetal heart activities were present, and the amniotic fluid was normal in amount. INTERVENTIONS AND OUTCOME: Extensive preparations made included four sets of ventilators. We did an emergency cesarean section under spinal anesthesia: five alive infants, three boys and two girls delivered in cephalic and breech presentations. CONCLUSIONS: Quintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist. RELEVANCE AND IMPACT: The takeaway lesson from this case would be that Pregnancy with multiples is considered a high-risk pregnancy; with more complications observed as the number of fetuses increases, their effective follow-up requires early diagnosis with regular monitoring. Through this case, we would like to highlight the urgent need to focus on the delivery of women's health care services in Somalia, along with the need to recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives that are lost each year could be reduced. This case report has been reported according to the SCARE Criteria (Agha et al., 2020).