Vitamin D levels in patients attending a tertiary care hospital in Mogadishu, Somalia: a retrospective review of 28,125 cases.

OBJECTIVE: The objective of this study was to identify the prevalence and risk factors for vitamin D deficiency among patients attending a tertiary hospital in Mogadishu, Somalia. METHODS: This retrospective study examined the results of serum 25-hydroxy-vitamin D tests of 28,125 patients admitted to Somalia Mogadishu-Turkey Training and Research Hospital between January 2017 and December 2021. Vitamin D insufficiency is defined as 20-30 ng/mL, deficiency as 10-19 ng/mL, and severe deficiency as <10 ng/mL. RESULTS: A total of 28,125 patients with a mean age of 44.27±20.4 years were included in the study. The majority of patients were in the age group of 19-40 years. The mean serum level of 25-hydroxy-vitamin D was 28.42±15.34 ng/mL. Of the patients included in the study, 5.8% (1,618/28,125) had vitamin D sufficiency, 6.5% (1,826/28,125) had vitamin D insufficiency, 41.8% (11,761/28,125) had vitamin D deficiency, and 45.9% (12,920/28,125) had severe vitamin D deficiency. The mean serum 25-hydroxy-vitamin D levels were lower in females than in males (p<0.001). CONCLUSION: The study indicated a high prevalence of vitamin deficiency among patients attending the largest tertiary care hospital, particularly female patients and older people. It is recommended to develop educational and awareness programs, and campaigns to reduce vitamin D deficiency in the population, especially those at high risk.

Postpartum depressive symptoms in women with female genital mutilation in Somalia.

OBJECTIVES: This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia. METHODS: This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale. RESULTS: Out of 446 postpartum mothers, 267 (59.9%) had increased depressive symptoms in the early postpartum period. PPD scale scores of mothers who were very poor were significantly higher depression scores than their counterparts (p = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups. CONCLUSIONS: Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.

Do Attitude, Awareness and Intention to Perform Female Genital Mutilation or Cutting for Their Daughters of Women Healthcare Providers Differ from Mothers in Somalia?

Aim: This study aimed to determine whether there were differences in attitude, awareness, and intention to perform female genital mutilation or cutting for their daughters in the future between female healthcare providers and mothers. Methods: A comparative cross-sectional study design was used. Results: A total of 508 women were included in the study. Of the participants, 68.7% (n = 349) were mothers (Group I) who visited the hospital and 31.3% (n = 159) were women healthcare professionals (Group II) [27% (n = 137) nurses and 4.3% (n = 22) doctors]. It was found that 8 (1.6%) of the participants did not have FGM/C and the FGM/C ratio was lower in group II (95%) than in group I (100%) (p < 0.001). In group I, 99.7% (n = 299) of the participants and 30.6% (n = 19) of those in group II reported intending to perform FGM for their daughters in the future (p < 0.001). The reasons for FGM/C most cited by participants were a traditional rite of passage into womanhood (78%), religious requirement (69.3%), and preservation of their virginity until marriage (59.3%). "Stop FGM" was given as a message on FGM/C by 60% of the participants (n = 79) who answered (n = 127, 100%) to open-ended questions. Conclusion: The results of this study show that female health professionals with higher education and monthly income had less positive perception of their FGM/C and less intention to allow their daughters to undergo FGM/C.

Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation.

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14-55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia.Impact statementWhat is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data.What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia.What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

Clinical Characteristics of Patients with Hepatocellular Carcinoma: A Single-Center 3-Year Experience from Somalia.

Background: To evaluate the relationship between prognosticators representing tumor aggressiveness and socio-demographic, laboratory, and imaging findings in patients with hepatocellular carcinoma (HCC). Methods: We retrospectively searched patients with HCC between January 2017 and December 2019 in our tertiary referral hospital. The tumor-related factors and liver damage indicators and their relationship to indicate the value of prognosis were analyzed. Results: A total of 268 HCC patients, with a male-to-female ratio of 2.8 : 1. The mean age was 52.6 years. The patient with portal vein thrombosis (PVT) was older, had higher liver laboratory parameters (AST, ALT, total bilirubin, and direct bilirubin), and had larger tumor size. Patients with the larger tumor size had a higher AFP level, had more tumor multifocality. The majority of patients were in Child's A (73.6%) and B (17.2%) classes. The laboratory parameters of HCC patients were increased in Child's C compared to other groups of Child-Pugh classification. Conclusions: The presence of PVT and large-sized tumor in patients with HCC indicated a poorer prognosis than non-PVT group and small tumor sizes.

Determinants of Disagreement with Female Genital Mutilation Among Mothers.

Aim: Female genital mutilation (FGM) is widely practiced in Somalia. Limited data are available on the attitude of the Somalia community regarding FGM. The present study aimed to explore the attitude of mothers toward the practice of FGM. Methods: A cross-sectional study was conducted from March to July 2021 among mothers attending outpatient clinics at a tertiary referral hospital in Mogadishu, Somalia. Results: A total of 247 participants were included, 65.2% of whom believed this practice should be continued. The most cited reason reported regarding FGM was a requirement for religion (90.7%). About 73.9% of mothers stated that the most cited reason reported regarding the abandonment of FGM was health complications. About 59.8% of the study participants thought that FGM could be stopped through education. The results revealed that women who graduated from primary school (OR: 2.21; 95% CI: 1.090-4.51), who had no social media account (OR: 2.305; 95% CI: 1.147-4.633), and women who were circumcised by a traditional birth attendant (OR: 4.55; 95% CI: 1.57-13.22) were more likely to think that FGM should be continued compare with their counterparts. Conclusions: We found that mothers who were less educated, had no social account and those circumcised by a traditional birth attendant had more positive attitudes toward FGM.

Clinical characteristics of acute liver failure associated with hepatitis A infection in children in Mogadishu, Somalia: a hospital-based retrospective study.

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.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases.

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.

Obesity in adolescents and the risk factors.

OBJECTIVES: This study aims to investigate the frequency of obesity and to identify possible risk factors affecting obesity in adolescents. MATERIALS AND METHODS: This cross-sectional study included a total of 1,357 adolescents between March 2011 and May 2012 in Beyoglu district of Istanbul province of Turkey. The questionnaire including 38 questions which was developed based on the Youth Risk Behavior Survey, which is used by the Center for Disease Control and Prevention (CDC), was used for the data collection. The weight and height of the participants were measured and their body mass index (BMI) values were calculated. RESULTS: Of all participants, 54.8% were females, 5% of them were underweight, 12.6% were overweight, and 2.6% were obese. Among the male participants, the BMI values were higher (21.06±3.32 kg/m2) than females (20.26±2.88 kg/m2) (p<0.0001). The obesity ratio was higher in males (p<0.0001) and in children of highly educated parents (p<0.05). Of the participants, 23.5% were physically active. Physical activity level was higher in males, compared to females (p<0.0001). The rate of breakfast habit was higher in males than females (p=0.002). Healthy diets and losing weight in a healthy way were more commonly accepted by the students in the public schools, compared to those in private schools (p<0.0001). CONCLUSION: Obesity is an important public health problem and proper eating habits and regular physical activity should be encouraged. High-income families should also encourage their children to become more aware of the importance of physical activity. The right time for this is childhood and adolescence, in which permanent habits can be easily acquired.

The prevalence of excessive daytime sleepiness among academic physicians and its impact on the quality of life and occupational performance.

OBJECTIVES: Sleep disorders can affect health and occupational performance of physicians as well as outcomes in patients. The purpose of this study was to assess the prevalence of excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS) among academic physicians at a tertiary academic medical center in an urban area in the northwest region of Turkey, and to establish a relationship between the self-perceived sleepiness and the quality of life using the EuroQol-5 dimensions (EQ-5D). MATERIAL AND METHODS: A questionnaire prepared by the researchers after scanning the literature on the subject was e-mailed to the academic physicians of a tertiary academic medical center in Istanbul. The ESS and the EQ-5D were also included in the survey. The e-mail database of the institution directory was used to compile a list of active academic physicians who practiced clinical medicine. Paired and independent t tests were used for the data analysis at a significance level of p < 0.05. RESULTS: Three hundred and ninety six academic physicians were e-mailed and a total of 252 subjects replied resulting in a 63.6% response rate. There were 84 (33.3%) female and 168 (66.7%) male academic physicians participating in the study. One hundred and eight out of 252 (42.8%) academic physicians were taking night calls (p < 0.001). Ninety study subjects (35.7%) felt they had enough sleep and 84 (33.3%) reported napping daily (p < 0.001). In our sample, 28.6% (N = 72) of the physicians felt sleepy during the day (ESS score > 10) (p < 0.001). In the case of the EQ-5D index and visual analogue scale of the EQ-5D questionnaire (EQ-5D VAS), the status of sleepiness of academic physicians was associated with a poorer quality of life (p < 0.001). CONCLUSIONS: More than a 1/4 of the academic physicians suffered from sleepiness. There was an association between the poor quality of life and daytime sleepiness. There was also a positive relationship between habitual napping and being sleepy during the day.

Investigation of mean platelet volume in patients with type 2 diabetes mellitus and in subjects with impaired fasting glucose: a cost-effective tool in primary health care?

The aim of this study was to compare mean platelet volume (MPV) in patients with type 2 diabetes mellitus (T2DM), in subjects with impaired fasting glucose (IFG), and in non-diabetic controls. A total of 201 adults with T2DM and 201 subjects with IFG from the Family Medicine out-patient clinic as well as 201 healthy controls were included in the study. We measured blood fasting glucose, complete blood count and LDL-cholesterol and compared the results between the groups enrolled. In the patients with diabetes and subjects with IFG, MPV was significantly higher (10.66 ± 0.94 fL and 10.49 ± 0.96 fL, respectively ) as compared to the non-diabetic group (10.04 ± 1.01 fL) (p = 0.000). Among the diabetic subjects, a positive statistical Pearson correlation was seen between MPV and HbA1c levels (r = 0.357; p = 0.000) and fasting blood glucose (FBG) levels (r = 0.306; p = 0.000). The mean MPV in patients having HbA1C < 7.5% was 10.17 ± 0.83 fL and significantly lower than that of patients with HbA1c ≥ 7.5% (10.80 ± 0.92 fL) (p = 0.001). MPV could be used as a simple and cost-effective tool to monitor the progression and control of T2DM and thereby in preventing vascular events in primary health care.

Anxiety levels among Turkish public transportation drivers: a relation to restless legs syndrome?

The aim of this study was to estimate the prevalence of individuals who are at high risk for state and trait anxiety as well as to investigate the relationship of anxiety levels of urban transportation drivers from Istanbul, Turkey with restless legs syndrome (RLS). The data was gathered between April 2013 and June 2013 by the use of a questionnaire prepared for the purpose of this study, completed anonymously. Restless leg syndrome and anxiety level were evaluated in the group; data obtained was analyzed using the SPSS version 16. Chi-square, correlation and student-t tests were used. Restless leg syndrome symptoms were determined by a self-assessment questionnaire, including the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria, to determine RLS symptoms and Spielberger State-Trait Anxiety Inventory (STAI) to determine anxiety levels of the participants. In the present study, the four RLS criteria were reported in 31.2%. STAI-state and STAI-trait scores were 40.82 ± 9.55 and 42.99 ± 8.54 respectively. The state and trait anxiety mean scores were different among participants with RLS in this study (p < 0.05). It was found a significant difference between tobacco usage and state anxiety (p < 0.05). There were a significant difference between RLS and age, number of cigarettes daily consumed and employment time (p < 0.05). The state and trait anxiety scores were found high among bus drivers with RLS in this study.

Quality of life and satisfaction with treatment in subjects with type 2 diabetes: results from primary health care in Turkey.

The aim of this study was to assess the quality of life and degree of satisfaction with the treatment of patients with type 2 diabetes mellitus (T2DM) in primary health care in Turkey. A total of 180 adults with type 2 diabetes mellitus from the Family Medicine out-patient clinic were included in the study. Participants were asked to fill out a self-report survey to collect data via two well validated scales, including the Turkish version of the Audit of Diabetes Dependent Quality of Life (ADDQoL) instrument and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Overall average weighted impact score for the study group was -2.73 ± 2.56. Diabetes mellitus has the largest impact on enjoyment of food (mean ± SD impact rating: -1.63 ± 1.50). The mean score of the DTSQ was 21.02 ± 8.07 (range from better to worse: 36 to 0) for the entire group. Presence of diabetes-related complication was significantly related with lower treatment satisfaction scores (mean ± SD = 23.08 ± 7.32 without complications; mean ± SD = 18.48 ± 8.36 with complications, P = 0.003). Physicians working in primary care should be equipped with more recent knowledge of diabetes treatment in order to tailor more appropriate treatment strategies from current guidelines.

Medical waste management training for healthcare managers - a necessity?

BACKGROUND: This is an interventional study, since a training has been given, performed in order to investigate whether training has significant impact on knowledge levels of healthcare managers (head-nurses, assistant head nurses, hospital managers and deputy managers) regarding bio-medical waste management. METHODS: The study was conducted on 240 volunteers during June - August 2010 in 12 hospitals serving in Istanbul (private, public, university, training-research hospitals and other healthcare institutions). A survey form prepared by the project guidance team was applied to the participants through the internet before and after the training courses. The training program was composed of 40 hours of theory and 16 hours of practice sessions taught by persons known to have expertise in their fields. Methods used in the analysis of the data chi-square and t-tests in dependent groups. RESULTS: 67.5% (162) of participants were female. 42.5% (102) are working in private, and 21.7% in state-owned hospitals. 50.4% are head-nurses, and 18.3% are hospital managers.A statistically significant difference was found among those who had received medical waste management training (preliminary test and final test) and others who had not (p<0.01). It was observed that information levels of all healthcare managers who had received training on waste management had risen at the completion of that training session. CONCLUSION: On the subject of waste management, to have trained healthcare employees who are responsible for the safe disposal of wastes in hospitals is both a necessity for the safety of patients and important for its contribution to the economy of the country.

Metabolic syndrome in collection and disposal of solid waste sector.

OBJECTIVES: This study aims to assess the frequency and factors relevant to metabolic syndrome in workers employed in the collection and disposal of solid waste sector. MATERIALS AND METHODS: This cross-sectional study was conducted in the major solid waste collecting and disposal company named ISTAÇ AS (Istanbul Environmental Protection and Waste Processing Corporation) in Istanbul, Turkey. All 715 male employees of the company were included in the study without sampling. The study was completed with 619 subjects. Since it was a small group, female workers were not taken into account in the study. Metabolic syndrome frequency was investigated according to the NCEP-ATP III criteria including the levels of systolic and diastolic blood pressure, waist perimeter, HDL, triglyceride, fasting blood glucose values. RESULTS: Metabolic syndrome was present in 40.9% of participating employees. Metabolic syndrome was more common in those working in the excavation field (54.0%), such as caterpillar operators (56.5%), and less common in employees working in administrative offices, such as office staff or managers, who were under 35 years old and who had been working for less than 10 years (p < 0.05). Employees working in work stations other than administrative offices had a 2.60 times higher risk compared to those working in administrative offices. CONCLUSIONS: Metabolic syndrome may be related to work station, job, age and period worked by the subjects.

Statistical analysis of waste generation in healthcare services: a case study.

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed(-1) day(-1) and this rate was 1.45 ± 9.84 kg outpatient(-1) day(-1) for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.

Evaluation of the regulation changes in medical waste management in Turkey.

In this study, a survey containing 28 questions concerning general information about the healthcare services, waste collection, training, waste quantities, storage and general evaluation was applied to 311 healthcare services. The response rate was 82%, which was considered acceptable for the evaluation of the results. The separate collection of medical waste and sharps was completely achieved in all of the healthcare services participating in the survey and 82.6% of the healthcare services used containers for separate collection of medical waste. Only 5% of the containers used for waste collection and temporary storage were inappropriate for collecting medical waste. Almost 33% of healthcare services organized courses monthly, 40% quarterly and 20% at least twice a year. A total of 88% of the hospitals have temporary storage depots for medical waste and all of these depots complied with the Medical Waste Control Regulation. The results of this study showed that the medical waste generation rate was 2.35 kg bed(-1) day(-1). The amount of liquid waste and sharps was determined for the first time in Turkey. The rate of separate collection for recyclables increased to 94%, having been 83% in 2006. The results indicate that in the period 2006-2009, the healthcare services conformed completely to the Medical Waste Control Regulation as it applied. Any deficiencies observed will be satisfied by precautionary actions that will be taken by hospital managers and local administrations.