Hospital acquired infections in Mogadishu: A review of infection prevention and control practices, and implications for antimicrobial resistance

Vollständiger Abstract

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Healthcare associated infections (HAIs) remain a major but under documented threat to patient safety in low resource and conflict affected settings. Somalia’s prolonged health system fragility increases vulnerability to HAIs and the concurrent escalation of antimicrobial resistance (AMR). This minireview synthesises available evidence on infection prevention and control (IPC) practices in Mogadishu hospitals and examines implications for AMR. A narrative review was undertaken using empirical studies and grey literature from Mogadishu hospitals (including Benadir, Macaani and De Martino), complemented by international guidance and surveillance reports. Sources describing IPC practices, compliance indicators, HAI patterns, or AMR related outcomes were included and synthesised thematically. Globally, HAI prevalence is reported at approximately 7% in high income settings and 10%-15% in low and middle-income settings. In Mogadishu, formal HAI surveillance remains limited; available studies indicate low IPC compliance, including hand hygiene after wound care (46%) and routine glove use (23%) in a tertiary facility. During the coronavirus disease 2019 period, satisfactory IPC compliance was reported in 58.3% of healthcare workers at De Martino Hospital, with poorer adherence among ancillary staff. Basic water, sanitation, and hygiene and IPC supplies (including water, soap, alcohol-based hand rubs and appropriate waste segregation materials) were inconsistently available across facilities. These gaps coincide with a high national AMR burden; a global burden analysis estimated 8400 deaths attributable to bacterial AMR in Somalia in 2019. HAIs in Mogadishu hospitals constitute a substantial yet largely preventable public health problem. Strengthening IPC governance, supplies, training and surveillance is essential to reduce HAIs and mitigate AMR.