Background: Hepatitis B is a potentially fatal liver infection caused by the hepatitis B virus (HBV). It is a serious issue for global health. It considerably raises the risk of cirrhosis and liver cancer-related death and can result in chronic infection. The risk of infection is high among health sciences students due to the risk of occupational contact with fluids of infected patients and the risk of needle stick injury. The most effective way of preventing HBV infection is the vaccination of students prior to their posting to healthcare settings. There is no data available about HBV vaccination uptake among Health Sciences students in Somalia. Therefore, this study aimed to determine HBV vaccination uptake and associated factors toward HBV among health science students in Somalia.Methods: A cross-sectional study was undertaken among health sciences students from August to October 2022. Data were gathered using Kobo Toolbox using a standardized questionnaire with questions on characteristics, knowledge attitude, and HBV prevention practices. A total of 569 students were involved in the study. Stata version 15 was utilized for the analysis. Bivariate and multivariate logistic regression analysis, as well as descriptive statistics, were performed. In order to assess the existence and significance of the relationship between the outcome and risk factors, an adjusted odds ratio with a 95% confidence interval (CI) was used. Statistical significance was considered as a p-value ≤0.05.Results: Of the 569 study participants, 33.4% (95%CI: 29.6–37.4) received a full dose of the HBV vaccine in this study. Participants had good HBV prevention knowledge, attitudes, and practices at 69.6, 37.96, and 50.6%, respectively. The lack of access and the high cost of the vaccine were the reasons for not taking the vaccine. Second-year [AOR: 0.22 (0.12–0.43)]. Positive attitude [AOR: 0.54 (0.31–0.93)], and good practice [AOR: 6.99 (3.62–13.5)].Discussion: The study indicated that 33.4% of health sciences students had received the required HBV vaccination doses, academic year, attitude, and practice were significantly associated with full-dose vaccination status. The unavailability of the vaccine and the high cost of vaccination were the most common reasons for not taking the vaccine. It is recommended that students receive vaccinations before beginning clinical rotations, and give instruction on infection prevention strategies and general precautions, particularly regarding HBV infection.

Somalia faces one of the world's highest maternal mortality ratios, and fewer than one in sixteen pregnant women obtain the previously recommended minimum of four antenatal care (ANC) visits. Understanding the drivers of low ANC use is essential for responsive policy. We investigated the prevalence and determinants of optimal ANC use (≥4 visits) among women in South and Central Somalia using nationally representative survey data. We conducted a cross-sectional analysis of the 2020 Somali Health and Demographic Survey. The weighted analytic sample comprised 4124 women aged 15–49 years with complete data. Survey-adjusted descriptive statistics characterized ANC use. Bivariate associations and multivariable survey logistic regression identified independent predictors; adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) are reported. Only 5.7 % of women (95 % CI 4.3–7.6) had four or more ANC visits. After adjustment, secondary education (aOR 2.33, 95 % CI 1.01–5.40) and higher education (aOR 5.36, 95 % CI 1.58–18.15) were associated with optimal ANC. Household wealth showed a graded increase, with the richest quintile having nearly 30 times the odds compared with the poorest (aOR 29.66, 95 % CI 8.51–101.27). Home delivery was associated with lower odds of optimal ANC (aOR 0.29, 95 % CI 0.18–0.47). Regional disparities persisted: women in Bay (aOR 4.07, 95 % CI 1.22–13.60) and Galgaduud (aOR 2.74, 95 % CI 1.13–6.64) had higher odds than those in Mudug. Optimal ANC coverage in South and Central Somalia remains critically low. Priorities include reducing financial and geographic barriers to care, strengthening facility-based services, and promoting female education to improve maternal and neonatal outcomes.

Introduction: Spontaneous rupture of renal masses, known as Wunderlich's syndrome, is a rare but potentially life-threatening condition characterized by acute perirenal hemorrhage. Renal cell carcinoma (RCC) is a less common cause of these ruptures, which may serve as the initial manifestation of the disease. This case report highlights the diagnostic and management challenges of spontaneous RCC rupture. Case presentation: A 40-year-old female presented with acute right-sided abdominal pain for 4 h. She exhibited tachycardia (120 bpm). Bedside ultrasonography suggested a renal mass, confirmed by contrast-enhanced computed tomography (CECT), which revealed a right renal mass with a large retroperitoneal hematoma. Rapid hemoglobin decline and severe pain raised suspicion of renal rupture. Emergency laparotomy with nephrectomy was performed, and histopathology confirmed clear cell renal cell carcinoma. The patient recovered uneventfully. Clinical discussion: Spontaneous rupture of renal cell carcinoma (RCC) is rare and presents diagnostic and therapeutic challenges. Contrast-enhanced computed tomography (CEST) is the most reliable imaging modality for confirming diagnoses. Differential diagnoses include vascular anomalies, coagulopathies, and angiomyolipomas. Surgical resection is the primary treatment, and prompt intervention is vital to reduce complications and improve prognosis. Postoperative surveillance ensures complete tumor removal and monitors for recurrence. Conclusion: This case highlights the rarity of spontaneous RCC rupture and its diagnostic challenges. CEST is crucial for diagnosis, with the differential diagnoses including vascular disorders, coagulopathies, and renal tumor. Surgical resection remains the mainstay of treatment, with timely intervention essential for improving patient outcomes. Highlights:

Objectives To identify the individual and community-level factors associated with barriers to accessing healthcare services among currently married women in Somalia. Design A cross-sectional analysis using data from the 2020 Somalia Demographic and Health Survey. Setting Somalia. Participants A nationally representative sample of 30 311 currently married women aged 15–49 years with complete data on outcome and explanatory variables. Primary outcome measures The primary outcome was ‘reporting at least one barrier to accessing healthcare’, a composite binary variable based on four specific problems: obtaining permission to go for treatment, getting money for treatment, distance to the health facility and not wanting to go alone. Results A substantial majority (77.06%) of married women reported experiencing at least one barrier to accessing healthcare. Financial cost was the most common barrier (69.91%), followed by distance to health facilities (65.95%), reluctance to go alone (49.64%) and the requirement for permission (46.03%). Multilevel analysis confirmed that higher household wealth was strongly protective (richest vs poorest: adjusted OR (aOR)=0.27, 95% CI 0.24 to 0.32). Paradoxically, factors typically considered protective were associated with increased barriers: women with secondary education (aOR=1.19, 95% CI 1.00 to 1.41) and those with educated husbands (aOR=1.23, 95% CI 1.14 to 1.33) reported more obstacles. Similarly, urban residents faced higher odds of barriers than their nomadic counterparts (aOR=1.40, 95% CI 1.27 to 1.55). Significant regional disparities were evident, with community-level context explaining 26.30% of the total variance in reporting barriers. Conclusion Access to healthcare for married women in Somalia is predominantly hindered by economic, educational and community-level constraints. Targeted interventions addressing socioeconomic disparities, infrastructural deficits and specific community contexts are essential to alleviate these barriers.

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a potentially severe complication of ovulation induction. Although less common than with gonadotropin treatment, OHSS can occur secondary to an excessive dose of clomiphene citrate, a first-line ovulation induction agent. A serious complication of OHSS is ovarian torsion, which demands prompt diagnosis and intervention to prevent permanent damage. This case report highlights a rare case of severe ovarian hyperstimulation syndrome (OHSS) with subsequent ovarian torsion following clomiphene citrate treatment. Case presentation: A 24-year-old woman with primary infertility developed severe OHSS after receiving clomiphene citrate (100 mg twice daily, D2-D16). Her initial symptoms included vomiting and severe abdominal pain. Ultrasound examination revealed an enlarged left ovary (100x65x60mm) with multiple follicles and pelvic effusion. Despite initial conservative management, the patient returned four days post-discharge with worsening symptoms. Emergency laparoscopy revealed vascular congestion of the left ovary and successful detorsion restored normal blood flow. Case discussion: this case illustrates severe OHSS complicated by ovarian torsion secondary to an excessive dose of clomiphene citrate. The patient's initial presentation and ultrasound findings were indicative of OHSS, and despite conservative management, progression to ovarian torsion required surgical intervention. The successful detorsion and restoration of blood flow underscore the importance of timely surgical management to prevent irreversible damage, regardless of the ovulation induction agent used. Conclusion: Although clomiphene citrate is generally considered safer than gonadotropins for ovulation induction, it can still induce severe OHSS leading to complications such as ovarian torsion particularly if given in overdosage. This case emphasizes the critical need for vigilant monitoring and prompt surgical intervention in OHSS cases to preserve ovarian function, regardless of the ovulation induction agent used. Highlights:

Introduction: Preterm birth, delivery before 37 weeks of gestation, affects 15 million births globally and causes 1.1 million under-five deaths annually. In Somalia, decades of civil war have severely weakened the healthcare infrastructure, posing significant challenges to maternal and neonatal healthcare. However, data on preterm birth and its determinants in Somalia remain limited. Objective: This study examines the prevalence and determinants of preterm birth among women delivered at the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital. Design: Retrospective cross-sectional study. Methods: A retrospective review of 1900 medical records from January to December 2022 was conducted. Data were analyzed using Stata 17, with logistic regression employed to identify significant determinants of preterm birth. The Hosmer–Lemeshow test (p = 0.64) was used to assess model fit, and statistical significance was determined at p < 0.05. Results: The prevalence of preterm birth was 17.5% (95% confidence interval: 15.8%–19.3%), which aligns with similar studies in Ethiopia (16.1%–16.3%) and Malawi (16.3%), but is lower than in Uganda (24.6%) and Kenya (20.2%). Maternal age below 20 years (adjusted odds ratio = 2.4; 95% confidence interval: 1.34–4.17; p = 0.003), absence of antenatal care visits (adjusted odds ratio = 16.4; 95% confidence interval: 10.96–24.48; p < 0.001), and fewer than four antenatal care visits (adjusted odds ratio = 4.1; 95% confidence interval: 2.66–6.47; p < 0.001) were significant predictors of preterm birth. Obstetric complications such as antepartum haemorrhage (adjusted odds ratio = 12.3; 95% confidence interval: 5.75–26.36; p < 0.001), pregnancy-induced hypertension (adjusted odds ratio = 6.0; 95% confidence interval: 3.77–9.56; p < 0.001), and premature rupture of membranes (adjusted odds ratio = 23.2; 95% confidence interval: 12.60–42.71; p < 0.001) were also significant determinants. Additionally, severe anaemia (adjusted odds ratio = 1.8; 95% confidence interval: 1.06–2.97; p = 0.030) and multiple gestations (adjusted odds ratio = 9.7; 95% confidence interval: 4.27–21.97; p < 0.001) were associated with preterm birth. Conclusion: The study highlights the high prevalence of preterm birth and identifies significant factors, including inadequate antenatal care visits, pregnancy complications, and multiple gestations. Strengthening antenatal care services, early risk detection, and targeted interventions are critical for reducing preterm birth rates in Somalia.