Multiple sclerosis in Somali Americans: Nature or nurture?

BACKGROUND: Differences in the MS course between White and Black populations is well accepted. The existence of a large Somali immigrant population in Minnesota facilitates a study of MS characteristics in this immigrant native African population. The objective of this study was to compare Somali American (SA), African American (AA), and White American (WA) persons with MS (pwMS) regarding clinical features and disease modifying therapy (DMT) use. METHODS: This single center (Mayo Clinic) geographically-restricted retrospective cohort study (residing within 250 miles of Rochester, MN, USA) included participants seen before May 2023. Age at immigration to the USA; age at MS onset; DMT use/type; MS phase/phenotype; age at progressive MS (PMS) onset; and proportion with severe MS (expanded disability status scale-EDSS ≥6) were examined. RESULTS: 18 SApwMS, 92 AApwMS, and 94 WApwMS were included. Of the 15 SApwMS not born in USA, 3/15 immigrated pre-puberty, 3/15 peri­puberty, 8/15 post-puberty, and 1/15 at an unknown date. SApwMS were younger at MS onset (median years, interquartile range (IQR)=25, 22-33 vs. AApwMS: 31, 25-38; p = 0.049 vs. WApwMS: 35, 27-41; p = 0.022). DMT use frequencies were 13/19 SApwMS, 69/92 AApwMS, 80/94 WApwMS (p > 0.05). SApwMS were treated with DMT earlier than AApwMS (HR 2.16, p = 0.012) and WApwMS (HR 1.86, p = 0.041). SApwMS were less commonly treated with natalizumab (SApwMS 0 %, AApwMS 13 %, WApwMS 25 %; p = 0.035) and anti-CD20 therapies (SApwMS 23 %, AApwMS 23 %, WApwMS 48 %; p = 0.005). PMS occurred in 3/19 SApwMS, 28/92 AApwMS and 29/94 WApwMS (p > 0.05). Age of PMS onset in SApwMS (47 years, 34-57) was similar to WApwMS (47 years, 31-71; p > 0.05) but older than AApwMS (41 years, 18-7; p = 0.008). CONCLUSIONS: SApwMS that recently immigrated to the USA have similar disease course to WApwMS, and better than AApwMS from the same geographical region.

Embodiment of structural vulnerability: illness experiences among Somali refugee women in urban displacement.

OBJECTIVES: Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population. DESIGN: Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya. RESULTS: Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement. CONCLUSIONS: Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.

The Somali Distress and Resilience Scale: Development of a novel measure for Somali adults.

Although resilience has been identified as an important mediator of negative mental health outcomes among refugee populations, there are few culturally specific measures of resilience among such communities and no such measure among Somalis. In this study we aimed to develop a culturally appropriate measure of resilience specific to Somali adults in San Diego, as an example of a vulnerable refugee community. A community-based, exploratory sequential mixed method investigation was conducted via focus group discussions (n = 4), cognitive interviews (n = 4), and iterative survey adaptation. Somali refugee adults in San Diego (N = 183) were surveyed with this novel scale, a standardized measure of resilience, and assessments of depression, anxiety, and PTSD. Results were analyzed via correlation coefficients and multivariate linear regression modeling. Qualitative findings supported the inclusion of items addressing both barriers and facilitators of good mental health, which resulted in the development of the Somali Distress and Resilience Survey (SDRS). Linear regression analysis revealed that the SDRS demonstrated significant associations with symptoms of depression and PTSD, while the standardized measure of resilience did not demonstrate associations with any of the mental health outcomes assessed. The SDRS identified obstacles to resilience among Somali individuals, placing them at risk of developing negative mental health outcomes. Our novel measure also demonstrated more robust relationships with these outcomes than a standardized measure of resilience, suggesting greater utility of the adapted scale. However, the SDRS's development raises larger questions about the limitations of developing and comprehensively evaluating novel resilience measures in a community-based setting.

Quality of life and associated factors among patients with epilepsy at selected public hospitals of Somali region, Eastern Ethiopia.

BACKGROUND: Epilepsy in low- and middle-income countries is linked to lower quality of life and premature death. Limited healthcare access and stigma in regions like Somali hinder effective management and lead to social isolation, affecting family relationships, education, and employment opportunities. Even though determining the status and factors affecting epileptic patients' quality of life is an initial step toward enhancing treatment outcomes, there is a scarcity of evidence-based information on epileptic patients' quality of life in the study area. OBJECTIVE: To assess the quality of life and its associated factors among patients with epilepsy at selected public hospitals of the Somali region, Eastern Ethiopia, from June 30 to July 30, 2023. METHOD: An institution-based cross-sectional study was undertaken on 422 epileptic patients in five public hospitals in the Somali region. A simple random sampling procedure was utilized to choose study participants. Face-to-face interviews were conducted with a pretested structured questionnaire, and data was analyzed using SPSS version 26. A multivariable logistic regression analysis with 95% confidence intervals was used to investigate the relationships between the dependent and independent variables. A P-value of less than 0.05 was used to declare the statistical significance of the observed relationships. RESULTS: Overall, 56.4 % of epileptic patients had good quality of life (95 % CI = 51.5-59.2 %) with 98.8 % response rate. Age in year ≥ 35 (AOR = 0.28; 95 %CI: 0.11, 0.71), family size (four to six, and greater than or equal to seven) (AOR = 0.12; 95 %CI: 0.04,0.33) and (AOR = 0.23; 95 %CI: 0.08, 0.68), poor drug adherence (AOR = 14.42; 95 %CI: 3.93, 52.95), lack physical activities (AOR = 0.33; 95 %CI: 0.17, 0.66), smoking (AOR = 0.41; 95 %CI: 0.18, 0.91), alcohol Consumption (AOR = 0.06; 95 %CI: 0.02), and absence of depression (AOR = 3.32;95 %CI: 1.35, 8.17) were significant association with quality of life among epileptic patients. CONCLUSIONS AND RECOMMENDATION: The magnitude of good quality of life among epileptic patients is lower, implying that poor quality of life among epileptic patients remains a public health concern in the study area. Drug adherence, physical activity, smoking, alcohol consumption, anxiety, and depression status were all modifiable factors that influenced quality of life. As a result, it would be ideal if all health practitioners prioritized health education and counseling on treatment adherence, comorbidity, and drug abuse prevention. Furthermore, screening for, identifying, and treating psychological illnesses on a regular basis would greatly benefit epilepsy sufferers' quality of life.

Medical Returnees: Somali Canadians Seeking Psychosocial and Spiritual Care in East Africa.

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.

Comparing tooth development timing between ethnic groups, excluding nutritional and environmental influences.

The timing of dental development in ethnic Finns and Somalis, who were born and living in Finland, was compared, with efforts to minimize environmental bias. The developmental status of seven lower left permanent teeth were staged according to Demirjian et al., using panoramic radiographs from 2,100 Finnish and 808 Somali females and males, aged 2 to 23 years. For each tooth, a continuation-ratio model was constructed to analyze the allocated stages as a function of sex and ethnic origin. Several statistically significant differences in mean age of certain tooth developmental stage transitions were revealed. While Somalis generally displayed stage transitions at younger age, none of the seven teeth consistently showed earlier stage transitions in Somalis compared to Finns. Within each tooth, the lowest (or highest) mean age of stage transition varied without any discernible pattern between the two ethnic groups. Overall, the observed differences in mean age of stage transition between the groups was minimal, suggesting a low impact on clinical and forensic age assessment practice. In conclusion, the studied ethnic Finn and Somali groups with equal nutritional and /or environmental conditions exhibit similar timing in the development of all lower left permanent teeth.

"If the nurse tells me this is a good thing, I trust her completely" - Exploring health system enablers of MMR vaccine uptake in the Finnish Somali community: A mixed method study.

BACKGROUND: Globally, migrant populations usually experience lower vaccine coverage than the general population. In Finland, the MMR vaccination coverage of Somalis has not been studied specifically, but existing evidence suggests that the MMR vaccination coverage is high. The aim of this study was to examine both vaccination coverage of Somali children and factors associated with the MMR vaccine uptake of Somali children living in Finland. METHODS: Twenty-seven mothers and seventeen public health nurses were interviewed using a semi-structured interview protocol. Audio-recorded interviews were transcribed and translated and analysed thematically after coding. The personal identity code of Somali children born in 2015 and 2020 were extracted from the Population Information System (PIS), and their vaccination coverage data was extracted from the national vaccination register (NVR) to calculate MMR vaccination coverage for Somali children. RESULTS: 96 % of Somali children born in 2015 and 81 % of those born in 2020 received their MMR vaccination. In contrast, the national average MMR vaccine uptake for children born in 2015 was 95 %, while 94 % of those born in 2020 were vaccinated against MMR. Somali mothers had poor knowledge of the MMR vaccine and the diseases it protects against. Trust towards the Finnish healthcare system, perceived benefits of vaccinating, positive attitudes towards vaccines, nurses' systematic approach to vaccine introduction, and nurses taking into account the cultural background of the clients were recognised as enablers positively affecting MMR vaccination uptake. CONCLUSION: Despite limited knowledge of vaccines, Somali immigrant mothers believe in the benefits of vaccination, and they displayed strong trust towards public health nurses. Further investigation is needed to understand why MMR vaccination coverage has declined among the younger Somali population.

Dental caries status and related factors among 12-year-old Somali school children in Hargeisa.

OBJECTIVES: There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland. METHODS: A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA. RESULTS: The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16-2.12) and having many previous dental visits (95% CI 1.22-2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning. CONCLUSION: Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

Seroprevalence of brucellosis and associated risk factors in camels and its herders in selected districts of Somali Pastoral Region, Eastern Ethiopia.

Brucellosis poses a major public and animal health problem in many parts of the world, particularly in pastoral settings, however, seroepidemological studies are scarce. A cross-sectional study was conducted from December 2021 to April 2022 to estimate the prevalence of brucellosis and to identify the associated risk factors for camels and occupational individuals from three purposively selected districts of the Somali pastoral region in Eastern Ethiopia. Serum samples were serially diluted using the Rose Bengal Plate Test (RBPT) as a screening test and a competitive Enzyme-Linked Immunosorbent Assay (cELISA) test as a confirmatory test. From a total of 450 camels and 250 human serum samples tested, the overall seroprevalence was confirmed to be 2.9 % (95 % CI, 1.5-4.9) in camels and 2.0 % (95 % CI, 0.2-3.7) in humans. In camels, abortion and retained fetal membrane (RFM) were significant risk factors for Brucella seropositivity (p<0.05). However, in humans, RFM disposal differed significantly (p<0.05). The fact that brucellosis is found in both camels and humans highlights the importance of implementing a coordinated One Health approach to control and eliminate the disease. This would ensure improved public health and increased livestock productivity.

Prevalence of Depression Among Women Using Hormonal Contraceptives in Mogadishu, Somalia: A Cross-Sectional Study.

Background: Depression is a global health concern with significant consequences, especially for women. Hormonal changes and gender disparities contribute to its prevalence. Hormonal contraceptives are widely used among women of reproductive age, but some users report mood-related side effects. Purpose: This study aims to investigate the relationship between hormonal contraceptive use and depression among women in Mogadishu, Somalia. Methods: An analytical cross-sectional study was conducted at two hospitals in Mogadishu, targeting married women aged 15-49 using hormonal contraceptives. A sample size of 227 participants was determined, and data was collected using semi-structured questionnaires, including the Patient Health Questionnaire-9 (PHQ-9) to assess depression. The data were analyzed using SPSS version 25, including multivariate logistic regression. Results: The prevalence of depression among participants was 33.5%, with significant associations observed between depression and occupation, income level, type of hormonal contraceptive used, and duration of contraceptive use. Housewives, individuals with lower income, users of oral pills and implant methods, as well as those with shorter durations of contraceptive use, constituted the high-risk groups for depression. Conclusion: Depression poses a concern among women using hormonal contraceptives in Mogadishu, Somalia. Healthcare providers should educate women about potential side effects and consider individualized contraceptive recommendations. Mental health support initiatives and awareness campaigns should be introduced. Future research is recommended to further understand and address depression in this context.

Open defecation practice among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia.

Background: Open defecation contributes to the spread of different feco-oral diseases. Therefore, access to a latrine is strongly recommended, as it considerably reduces the risks. Even though provision of latrine facilities alone does not guarantee the desired health benefits, they should be integrated with behavior change. In Ethiopia, efforts have been made to increase the coverage of latrine facilities. However, evidence on how consistently households use it is limited. Most prior studies focused on latrine utilization among households, and limited evidence is available about open defecation practices among households with latrines and associated factors. Thus, this study is critical for developing effective intervention approaches to prevent open defecation among households with latrines. Objective: The aim of this study was to assess the open defecation practice and associated factors among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia, 2023. Method: A community-based, cross-sectional study design was employed among households with latrines in the district. A total of 632 households latrines were selected using a systematic sampling technique. Data were collected using a structured questionnaire and an observational checklist. The questionnaire was designed in KoboTool box, Humanitarian Response software, and the data were collected using the Kobo Collect version 2023.2.4 mobile application. The data were downloaded from the server in the Microsoft Excel format for data cleaning before being exported to STATA version 14 for analysis. Bivariate and multivariable analyses were employed to investigate the relationship between outcome and independent variables. Odd ratios with 95% confidence intervals were utilized to assess the association between the outcome and the predictor variables. A P-value of <0.05 was used as the threshold point for statistical significance. Result: In this study, the prevalence of open defecation practice among households with latrines was 32.4% (95% CI: 28.1, 35.9). Sex of the household (AOR = 1.60, 95% CI: 1.06, 2.4), educational status (AOR = 2.40, 95% CI: 1.08, 5.53), family size (AOR = 1.62, 95% CI: 1.22, 2.78), the presence of under-5-year-old children in the house (AOR = 1.84, 95% CI: 1.19, 2.75), the need for latrine maintenance (AOR = 2.37.95% CI: 1.62, 3.48), current status of the latrine (AOR = 2.37, 95% CI: 1.62, 3.48), and latrine cleanness status (being unclean) (AOR = 1.91, 95% CI: 1.29, 2.81) were significantly associated with open defecation practice among households with latrine. Conclusion: The study concluded that open defecation was significantly practiced by households with latrines. This revealed that the presence of a latrine alone was insufficient to considerably reduce open defecation. To alleviate this problem, the government and health workers, in collaboration with the health bureau, should promote frequent sanitation and hygiene education in the communities.

Exploring health disparities in congenital CMV (cCMV): a study in a Somali-American community to assess awareness of cCMV and facilitate understanding of universal cCMV screening.

Background: Congenital cytomegalovirus (cCMV) disproportionately impacts black and multiracial infants. While there have been strides made to address this health disparity, strategies to increase awareness and knowledge of cCMV have not been investigated in a Somali community. Methods: Two survey study strategies (in-person and online), consisting of a pre-survey test, educational intervention, and a post-survey, were designed to gauge knowledge and perceptions about cCMV among Somali women aged 18 to 40 years old. Results: 96 respondents partook in the online module, and 15 in the in-person event. On recruitment, < 45% of women were aware of cCMV. Following the pre-intervention survey, educational modules were conducted, and the survey repeated. For statistical comparisons, a point was assigned for each correct survey query, and the mean of correct responses tabulated for pre- and post-surveys. In the online intervention, mean scores changed from 55 to 87% (paired t-test, p = 0.001), whereas in the in-person intervention, mean scores changed from 65 to 87% (paired t-test, p = 0.007), demonstrating enhanced cCMV awareness upon completion of both interventions. Using multiple linear regression, the expected post-test score was 2% (95% CI [- 8%, 12%]) higher for the online module compared to the in-person module, adjusting for pre-test score. Conclusion: Both interventions were successful in enhancing knowledge about cCMV in this population, although there was no evidence either intervention was substantially better than the other. Educational efforts will be critical in enhancing the trust required to facilitate diagnostic evaluation and treatment of newborns identified with cCMV in this high-risk population.

Treatment Outcomes of Tuberculosis and Associated Factors Among Tuberculosis and Human Immunodeficiency Virus Co-infected Patients in Public Health Facilities in Jigjiga, Somali Region, Ethiopia.

BACKGROUND: Worldwide, tuberculosis (TB) is a serious public health issue, especially in low-income countries, including Ethiopia. For those who are HIV-positive, TB poses a major risk to their health. The development of chemotherapy and the effectiveness of treatment have resulted in notable increases in patient survival. The evaluation of TB treatment outcomes is an essential metric for determining the success of TB and HIV co-morbidity control strategies. PURPOSE: This study aims to identify TB treatment outcomes and associated factors among TB/HIV co-infected patients in public health facilities in Jigjiga, Somali Region, Ethiopia, in 2021. PATIENTS AND METHODS: A hospital-based cross-sectional study design was done on three facilities (Karamara, Hasan Yabare Referral Hospital, and Jigjiga Health Center) with a total of 194 study participants. Data were extracted using a checklist, entered into EpiData version 3 (The EpiData Association, Odense, Denmark), and analyzed using SPSS Statistics version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) for descriptive and inferential analysis of the study objectives. Variables in the bivariate logistic regression analysis with p-values less than 0.25 were entered into a multivariate logistic regression to identify the independent factors of TB treatment outcome. Associations were computed using an adjusted odds ratio with a 95% CI. P-values less than 0.05 were finally considered statistically significant. RESULTS: The following TB treatment outcomes were observed among all TB/HIV co-infected patients enrolled in this study: 126 (67.4%) completed treatment, three (1.8%) died, 42 (22.5%) were cured, and 16 (8.6%) were transferred out; 168 (89.8%) had a successful treatment outcome. Category of the patient (AOR = 0.194, 95% CI: 0.041, 0.923), sex of the patient (AOR = 1.490, 95% CI: 1.449, 4.951), and cotrimoxazole preventive therapy (CPT) initiation (AOR = 0.073, 95% CI: 0.021, 0.254) were found to be significant predictors for successful TB treatment outcome at a p-value less than 0.05 with a 95% CI. CONCLUSION: Overall, 89.8% of TB treatments were successful among TB/HIV co-infected patients. This study has found sex, socioeconomic status, and CPT initiation were significant factors for a successful TB treatment outcome. Based on these findings, governmental and non-governmental organizations should facilitate the implementation and enforce the availability of all TB/HIV co-infected patients.

The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis.

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

Brucellosis in camel, small ruminants, and Somali pastoralists in Eastern Ethiopia: a One Health approach.

Brucellosis is a neglected bacterial zoonotic disease with economic and public health importance in pastoral communities of sub-Saharan Africa. A cross-sectional study was conducted from December 2021 to April 2022, to estimate the prevalence and identify the associated risk factors causing brucellosis in animals and associated with occupational diseases in humans from three selected districts of "the Somali Pastoral region," Eastern Ethiopia. In this study, 1,000 serum samples were screened for anti-Brucella spp. antibodies using Rose Bengal Plate Test (RBPT) and further confirmed using a competitive enzyme-linked immunosorbent assay (cELISA). A structured questionnaire was used to collect the biodata of tested animals and animal attendants to test the association between explanatory and outcome variables. The overall animal level prevalence was 5% (95% CI, 6.1-7.2.0) in small ruminants, 2.9% (95% CI, 1.5-4.9) in camels, and 2.0% (95% CI, 0.2-3.7) in occupationally linked humans. Herd size and herd history of retained fetal membranes were risk factors associated with Brucella spp. seropositivity in animals (p < 0.05). Disposing of retained fetal membranes was significantly associated (p < 0.05) with Brucella spp. seropositivity in humans. Evidence of brucellosis in various livestock species and associated seropositivity in humans indicates the need for a coordinated One Health approach, considering sociocultural dynamics of pastoral communities in controlling brucellosis to safe guard public health and increase livestock productivity.

Neonatal pain management practices in Somali region of Ethiopia: insights from neonatal intensive care unit providers.

Background: Neonates admitted to neonatal intensive care units experience an average of 8-17 moderate to severe painful procedures per day. Because neonates lack the cognitive capacity to express their pain's location or severity, they are very dependent on healthcare providers to recognize, assess, and manage their pain. The health and development of newborns are negatively impacted by persistent or untreated pain experienced early in life. Therefore, studying neonatal pain management practices and associated factors in healthcare is critical to tackling workforce problems, enhancing neonatal care, and lowering the long-term health impacts of neonates. Method: From January 1 to 30, 2023, a facility-based cross-sectional study design was used at six public hospitals in the Somali region of Ethiopia. A total of 336 healthcare providers enrolled using a simple random sample technique. A self-administered, structured questionnaire was utilized to collect the data. The analyses used bivariate and multivariate logistic regression. To find the association between the outcome and predictor factors, the odd ratio and the 95% CI were computed. Result: The study revealed that 35.4% [95% CI 30.4%-40.5%] of respondents reported that they had good neonatal pain management practices. Ever having undergone training in neonatal pain assessment and management [AOR = 2.26 (95% CI 1.259, 4.07)], availability of pain assessment tools [AOR = 3.05 (95% CI 1.249, 7.469)], and having a favorable attitude toward neonatal pain management practice [AOR = 3.71 (95% CI 1.525, 9.035)] were found to be factors with a significant association with neonatal pain management practice. Conclusion: Based on the study's findings, there is a low level of neonatal pain management practice among healthcare providers in the Somali region. The study emphasizes the significance of having access to pain assessment tools and the requirement for healthcare professionals to get training on neonatal pain assessment and management.

Somali women's perceptions and experiences of pain and pain relief during childbirth in Norway: A qualitative study.

INTRODUCTION: Research shows that Somali women are less likely to receive epidural analgesia for labor pain compared to non-immigrant women in Norway. It is unclear why. This study aimed to explore the perceptions and experiences of Somali women regarding pain relief during childbirth. METHODS: In January 2023, semi-structured interviews were conducted with 10 Somali women who had lived in Norway for at least ten years and given birth within the past 12 months. Data were analyzed using thematic content analysis as described by Graneheim and Lundman. RESULTS: Three themes emerged from the data: a cultural understanding of epidural analgesia, religious and cultural coping strategies, and the midwife's role during labor. The participants expressed that there is a prevalent understanding in the Somali community that epidural analgesia in childbirth subsequently causes physical problems. Participants felt the influence of friends and family, expressed the need for culturally adapted information prior to labor, and concluded that, ultimately, what they decided upon was their own choice. They emphasized the belief that women were designed by God for childbirth. Prayer and placing oneself in God's hands were mentioned as pain management strategies. Nevertheless, the Somali women highlighted the importance of having a culturally competent midwife who is present when needed, creates trust, and provides information and access to different methods of pain relief, including epidural analgesia. CONCLUSIONS: Understanding Somali women's cultural and religious background while listening to individual needs for information and pain relief is essential to ensure a positive birth experience for women from a Somali background.

Exploring knowledge of autism, its causes and treatment among immigrant and nonimmigrant parents in Somalia\Somaliland.

BACKGROUND: The prevalence of autism spectrum disorders (ASDs) has increased over the recent years; however, little is known about the experience of parents of children with autism in Africa such as Somalia. The aim of this study is to understand the knowledge on autism of Somali parents of children with autism and their perceptions of causes and treatment of ASD. METHODS: We conducted a qualitative study involving 22 parents of children with autism who lived in Mogadishu and Hargeisa; the two largest cities in Somalia. In-depth interviews were used to collect the data. Of the 22 participants, 9 were returned immigrants and 13 were local people (non-immigrants). Data were analysed using thematic analysis. RESULTS: The data revealed that most of the parents hold the belief that their children's autism were caused by the measles vaccine. The findings demonstrated that parents sought diagnosis and treatment care from outside Somalia due to the lack of experience of health providers in the diagnosis and treatment of autism. The data also revealed a lack of knowledge about autism among the public with resultant stigma and discrimination against children with autism and their families. CONCLUSIONS: Efforts to increase public knowledge on autism, its causes and treatments are of paramount importance, while a public health campaign designed to eliminate the stigma subjected to children with autism is necessary to improve the quality of life of children with autism and their caregivers. Finally, to counteract vaccine hesitancy, particularly in response to the measles vaccine, health policy makers should take steps to separate the cooccurrence of the onset of autism symptoms and the provision of the measles vaccine.

Prevalence and risk factors of bovine tuberculosis in cattle in selected districts of Fafan pastoral settings, Eastern Ethiopia.

Cross-sectional study was conducted from October 2021 to August 2022 to investigate the prevalence and associated risk factors of bovine tuberculosis in cattle in selected districts of the pastoral settings of Fafan zone, Somali region, eastern Ethiopia. A comparative intradermal tuberculin test was performed using purified protein derivatives. Animal-related characteristics, and the owner's knowledge on the importance of BTB were collected using a structured questionnaire. The prevalence was 11.24 % (95 % CI, 8.61-14.35) and 43.3 % (95 % CI, 33.27-53.75) at the individual and herd levels, respectively. There were statistically significant differences in the proportions of positive reactor animals according to body condition score (P = 0.000), age (P = 0.048), seasonal migration (P = 0.038), parity number (P = 0.005), and reproductive status (P = 0.037). Animals with poor body condition scores had a significantly higher likelihood of testing positive, with their odds being 11.4 times greater (COR = 11.408, CI = 3.43-37.94, P < 0.001). In multivariate logistic regression, poor body condition score remained significantly associated with the odds of a positive reaction to tuberculosis (AOR = 0.137, CI = 0.053-0.356, P < 0.001). Similarly, the analysis showed that seasonal migration (AOR = 2.882, CI = 1.155-7.191, P = 0.023) and parity number (AOR = 11.64, CI = 1.818-74.464, P = 0.010) were significant predictors of bovine tuberculosis infection in cattle. According to the questionnaire, 14.2 % (17 of 120) and 13.3 % (16 of 120) of the respondents were knowledgeable about bovine tuberculosis and its transmission from animals to humans, and vice versa, respectively. The general judgment of herders' understanding of bovine tuberculosis transmission methods to humans was very low. The study findings showed a high prevalence of bovine tuberculosis in the study area, emphasizing the need for an effective control and prevention strategy.

Modern contraceptive prevalence and its predictors among non-refugee and refugee Somali women in Nairobi city, Kenya; a comparative view.

Introduction and methods: This study sought to determine the prevalence and predictors of modern contraceptive use among non-refugee and refugee Somali women in Nairobi City, Kenya. The analysis was based on 976 currently married Somali women aged 15-39 years (non-refugees; 523, refugees; 415) who were interviewed in a 2021 household survey conducted in Kamukunji, Embakasi, and Ruaraka sub-counties of Nairobi City. The analysis was stratified by refugee status and multivariable logistic regression were run to determine predictors of modern contraceptive use in each group. Results: The prevalence of modern contraceptives was 34% for the total sample and 43% and 24% for non-refugees and refugees, respectively. The main methods of contraception among non-refugees were injectables, implants, and daily pills, while refugees mainly used male condoms, implants, and injectables. Stratified multivariable analysis showed that residence in formal vs. informal settlements was associated with significantly higher odds of modern contraceptive use among non-refugees but significantly lower odds among refugees, after controlling for other factors. Interaction terms confirmed that the strength of the associations of these variables with the odds of modern contraceptive use varied significantly by refugee status. Conclusion: Use of modern methods of contraception was lower among non-refugee and refugee Somali women compared to the national average and refugee status moderated the association of some predictor variables with the odds of modern contraceptive use. To increase use of modern contraceptives in urban areas, it is recommended that the Ministry of Health, refugee agencies, and county governments engage with the Somali community and implement appropriate interventions to empower refugee women economically and promote their access to and use of voluntary contraception services as soon as they settle in urban areas.