Background: Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Right ventricular dysfunction (RVD) reflects the hemodynamic consequences of acute pulmonary arterial obstruction and is an important prognostic marker in patients with PE. However, data regarding the prevalence, clinical correlates, and prognostic significance of RVD remain limited in sub-Saharan Africa, particularly in Somalia, where diagnostic and critical care resources are constrained. Objective: To determine the prevalence and clinical correlates of RVD among adults with acute PE and to assess its association with in-hospital mortality at a tertiary referral hospital in Mogadishu, Somalia. Methods: This retrospective cohort study included adults aged ≥18 years with acute PE confirmed by computed tomography pulmonary angiography (CTPA) who were admitted to Mogadishu Somali–Türkiye Recep Tayyip Erdoğan Training and Research Hospital between January 2020 and December 2023. RVD was defined as structural or functional right ventricular impairment documented on transthoracic echocardiography or CTPA. Demographic, clinical, comorbidity, imaging, treatment, and outcome data were extracted from medical records. Associations were assessed using chi-square or Fisher’s exact tests, as appropriate. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results: Among 293 patients, the mean age was 59.2 years, and 201 patients (68.6%) were female. RVD was identified in 110 patients (37.5%). Compared with patients without RVD, those with RVD had higher prevalences of hypertension (46.4% vs. 34.4%; p=0.042) and pre-existing heart failure (19.1% vs. 9.8%; p=0.024). Patients with RVD were more likely to require intensive care admission (92.7% vs. 59.0%; p<0.001) and to present with hypoxemia (91.8% vs. 58.5%; p<0.001) and syncope (12.7% vs. 1.6%; p<0.001). Active malignancy was more frequent among patients with RVD, although the difference was not statistically significant (12.7% vs. 6.6%; p=0.081). Overall, 51 patients (17.4%) died during hospitalization. Mortality was significantly higher among patients with RVD than among those without RVD (29.1% vs. 10.4%; p<0.001). After adjustment for age, sex, hypertension, diabetes mellitus, hypoxemia, and intensive care admission, RVD remained independently associated with in-hospital mortality (adjusted odds ratio [aOR], 2.55; 95% confidence interval [CI], 1.30–5.04; p=0.007). Conclusions: RVD was present in more than one-third of Somali adults hospitalized with acute PE and was independently associated with a more than two-fold increase in the odds of in-hospital mortality. Routine assessment of right ventricular function may improve early risk stratification and support prioritization of intensive care resources in resource-limited settings.