Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01–1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79–6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21–2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137–3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19–0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population’s acceptance of booster vaccination.

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe consequences worldwide. Our study aims to assess the quality of life (QoL) domains and its determinants among the general population in Arab countries after two years of the COVID-19 pandemic. Methods: An anonymous online cross-sectional survey using the short version of World Health Organization QoL (WHOQOL-BREF) instrument was distributed among Arab adults in 15 Arab Countries. Results: A total of 2008 individuals completed the survey. Amongst them, 63.2% were 18–40 years and 63.2% were females, 26.4% had chronic disease, 39.7% confirmed having contracted COVID-19, and 31.5% had experienced the unfortunate loss of relatives due to COVID-19. The survey revealed that 42.7% reported good physical QoL, 28.6% were satisfied with psychological QoL, 32.9% had a sense of well-being in the social domain, and 14.3% had good QoL in the environmental domain. The predictors of physical domains were as follows: being a male (β = 4.23 [95%CI 2.71, 5.82]), being from low-middle income country (β = -3.79 [95%CI -5.92, -1.73]) or being from high-middle-income country (β = -2.95 [95%CI -4.93, -0.92]), having a a chronic disease (β = -9.02 [95%CI -10.62,-7.44]) having a primary/secondary education (β = -2.38 [95%CI -4.41, -0.054]), number of years of work experience ≥ 15 years (β = 3.25 [95%CI 0.83, 5.73]), income-per-capita [ranged from (β = 4.16 [95%CI -5.91, -2.40]) to (β = -11.10 [95CI%, -14.22, -8.11])], a previous COVID-19 infection (β = -2.98 [95%CI -4.41, -1.60]), and having relative died from COVID-19 (β = -1.56 [95%CI -3.01, -0.12]). The predictors of psychological domain were having a chronic disease (β = -3.15 [95%CI -4.52, -1.82]), a postgraduate education (β = 2.57 [95% CI 0.41, 4.82]), number of years of work experience ≥ 15 years (β = 3.19 [95%CI 1.14, 5.33]), income-per-capita [ranged from (β = -3.52 [95%CI -4.91, -1.92]) to (β = -10.31 [95%CI -13.22, -7.44])], and a previous COVID-19 infection (β = -1.65 [95%CI -2.83, -0.41]). The predictors of social domain were being a male (β = 2.78 [95%CI 0.93, 4.73]), being single, (β =-26.21 [-28.21, -24.32]), being from a low-income country (β = 5.85 [95%CI 2.62, 9.13]), or from a high-middle-income country (β = -3.57 [95%CI -6.10, -2.12]), having a chronic disease (β = -4.11 [95%CI -6.13, -1.11]), and income-per-capita [ranged from (β = -3.62 [95%CI -5.80, -1.41]) to (β = -11.17 [95%CI -15.41, -6.92])]. The predictors of environmental domain were being from a low-middle-income country (β = -4.14 [95%CI -6.90, -1.31), from a high-middle-income country (β = -12.46 [95%CI -14.61, -10.30]), or from a low-income-country (β = -4.14 [95%CI, -6.90, -1.32]), having a chronic disease (β = -3.66 [95%CI -5.30, -1.91]), having a primary/secondary education (β = -3.43 [95%CI -5.71, -1.13]), being not working (β = -2.88 [95%CI -5.61, -0.22]), income-per-capita [ranged from (β = -9.11 [95%CI -11.03, -7.21] to (β = -27.39 [95%CI -31.00, -23.84])], a previous COVID-19 infection (β = -1.67 [95%CI -3.22, -0.21]), and having a relative who died from COVID-19 (β = -1.60 [95%CI -3.12, -0.06]. Conclusion: The study highlights the need for public health interventions to support the general population in the Arab countries and mitigate its impact on their QoL.

The novel coronavirus disease (COVID-19) pandemic has affected several countries worldwide, resulting in a considerable strain on healthcare systems and increased trend of self-medication practices. This study aims to evaluate the awareness of COVID-19 and the prevalence of self-medication during the pandemic among residents in Mogadishu, Somalia. A cross-sectional study was conducted using a structured and pretested questionnaire between May 2020 and January 2021. Participants from various disciplines were randomly recruited within the study location and interviewed about their self-medication practices during the pandemic. Descriptive statistics were used to summarise the respondents’ information and responses to the questionnaire items. Associations between participants’ demographic characteristics and specific items relating to self-medication practices were analysed using the Chi-square test. A total of 350 residents participated in the study. Approximately 63% of the participants reported having practised COVID-19 related self-medication with the main reasons being pharmacists’ advice (21.4%) and having an old prescription (13.1%), whereas 37.1% did not report their reasons for self-medication. Most participants (60.4%) engaged in self-medication despite not having any symptoms and 62.9% had taken antibiotics in the last three months. Most participants were aware that no medication has been approved for COVID-19 (81.1%), the negative effects of self-medication (66.6%), and the transmission routes of the virus. Meanwhile, more than 40% of the participants have not worn a mask while outside their homes, and do not follow the international COVID-19 guidelines. The most prevalent drug used by participants for self-medication against COVID-19 was paracetamol (81.1%) and antibiotics (78%). The factors associated with awareness of COVID-19 and self-medication practices included age, gender, educational qualification, and occupation. This study revealed considerable high self-medication practices among Mogadishu residents, thus highlighting the need to promote awareness regarding the adverse effects of self-medication and sanitisation guidelines in addressing COVID-19 at the community level.

Background. Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago. Purpose. In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu. Methods. We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021. Results. The majority (39.7) of the patients were adults (aged between 20 and 39years), and 67.8 were male patients. The median ICU length of stay was three days (IQR=5days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1. The demand for critical care services in low-income countries is high. Conclusion. The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.

Background: Early initiation of breastfeeding (EIBF) within one hour of birth is essential for neonatal survival, yet evidence from Somalia is limited. This study examined determinants of EIBF using nationally representative data. Methods: A secondary analysis of the 2020 Somali Demographic and Health Survey (SDHS) was conducted among 2,020 women with children aged 0–23 months. Sampling weights were applied. EIBF was analyzed as a binary outcome using bivariate and multivariate logistic regression. Statistical significance was set at p ≤ 0.05. Analyses were performed using SPSS version 27. Results: Overall, 75% of newborns were breastfed within the first hour after birth. In the multivariate analysis, mothers aged 30–39 years were more likely to initiate breastfeeding early compared with those aged 15–19 years (AOR = 1.65; 95% CI: 1.01–2.70). Urban residence was positively associated with EIBF (AOR = 1.31; 95% CI: 1.02–1.68), while nomadic residence was negatively associated (AOR = 0.52; 95% CI: 0.40–0.68). Mothers without radio exposure (AOR = 0.68; 95% CI: 0.47–1.00), unemployed mothers (AOR = 0.17; 95% CI: 0.04–0.85), and those whose husbands were unemployed (AOR = 0.75; 95% CI: 0.63–0.91) had lower odds of EIBF. Facility delivery significantly increased the likelihood of EIBF (AOR = 1.44; 95% CI: 1.03–2.00). Conclusion: EIBF in Somalia is influenced by maternal, socioeconomic, and health service related factors. Strengthening facility-based deliveries and expanding health education through mass media may improve EIBF practices.

Introduction and Importance: Bilateral thalamic infarction is an uncommon manifestation of cerebral venous thrombosis (CVT), particularly when caused by thrombosis of the internal cerebral veins. Venous infarctions affecting the bilateral thalami are exceptionally rare and often present with nonspecific clinical features, making early diagnosis challenging. Case presentation: Here we present a-28-year-old postpartum female who presented to the emergency room with severe headache, convulsions, and altered mental status, following 1-week of progressive headache and blurred vision. She had recently undergone uncomplicated spontaneous vaginal delivery. Neurological examination revealed a stuporous mental state and bilateral grade II papilledema. Initial noncontrast CT showed bilateral thalamic hypodensities, while magnetic resonance imaging (MRI) confirming acute infarction in the bilateral thalami. Cerebral magnetic resonance angiography (MRA) showed no arterial abnormality, where as MR venogram revealed thrombosis of internal cerebral vein, confirming CVT as the underlying etiology. The patient was managed in the ICU with therapeutic anticoagulation using low-molecular-weight heparin (LMWH), levetiracetam for seizure prophylaxis, and transitioned to warfarin for long-term anticoagulation treatment. Her clinical condition significantly improved, and she was discharged after 2 weeks of hospitalization. At 6-month follow-up, she remained asymptomatic and functionally independent. Clinical discussion: Bilateral thalamic infarction resulting from internal cerebral vein thrombosis is exceptionally rare. The internal cerebral veins drain deep brain structures, including the thalami, and their occlusion can lead to symmetrical infarction in these regions. Because bilateral thalamic infarcts are more commonly associated with arterial causes; diagnosis in venous infarction can be challenging and requires a high index of suspicion. Conclusion: This case highlights the importance of early diagnosis and management of cerebral venous thrombosis to prevent complications. A high index of suspicion is needed for CVT in cases of bilateral thalamic infarction specially in patient with risk factors for venous thromboembolism like postpartum state.