Cholera remains a major public health problem that threatens human health worldwide and its severity is continuing. In this paper, an edge-based model for cholera transmission on random networks is proposed and investigated. The model assumes that two communities share a common water source and includes three transmission routes, namely intra- and inter-community human-to-human transmission as well as water-to-human transmission. Intra-community human-to-human contacts are modeled through a random contact network, while both inter-community and water-to-human transmission are modeled through external nodes that reach each individual in the network to the same extent. The basic reproduction number and the equations of the final epidemic size are obtained. In addition, our study considers the cholera situation in Banadir, which is one of the most severely infected regions in Somalia, during the period (2019-2021). According to the geographical location, two adjacent districts are selected and our model fits well with the real data on the monthly cumulative cholera cases of these two districts during the above-mentioned period. From the perspective of network topology, cutting off high-risk contacts by supervising, isolating, quarantining and closing places with high-degree cholera-infected individuals to reduce degree heterogeneity is an effective measure to control cholera transmission. Our findings might offer some useful insights on cholera control.

This study examines the choice of conflict resolution mechanisms between Yocaale and Harshin pastoral communities in the Somali regional state of Ethiopia. Between 1984 and 2014, the area experienced several land use changes, leading to a decrease in the vegetation cover of grass, shrubs, and woodlands. Furthermore, from 2000 to 2005, ten new urban areas have been established. This changed the area\'s rangeland caring capacity, which, in turn, triggered competition over dwindling resources. Evidence also indicates that climate change has exacerbated the competition for scarce resources in this area. In response, the pastoralist communities began practicing crop cultivation, petty trading, land enclosure, and charcoal production, particularly in the Harshin woreda (district). The 2011 regional administrative restructuring decision created new administrative units and sandwiched the Yocaale pastoralist community between the Harshin and Aware woredas. The decision to establish a new woreda, coupled with the area enclosure and land privatization, impeded the opportunistic movement of the Harshin and Yocaale\'s pastoralists and became a source of competition for communal land resources. This study used a mixed methods approach of qualitative and quantitative analyses and deployed a binary logit model to identify the two woredas\' conflict resolution preferences. The findings indicate that the land disputes between the two woredas, which are mainly on administrative borders conflict, is less likely to be taken to customary institutions to resolve. Instead, they opt to formal court system. In conclusion, even though the findings of this work highlight the customary institution\'s vital role in preventing and resolving inter-ethnic conflicts, administrative border-related land conflicts are less likely to be taken to customary institutions, as they require political decision-making in multiple contested clan areas, such as Yocaale and Harshin. Therefore, in addition to particular corrective political measures, the results of this study point to the need for enhancing the level of integration and cooperation between the two communities and finding a middle way to enhance community dialogue.

OBJECTIVE: This study evaluated the underlying factors associated with poor tuberculosis (TB) treatment outcomes among patients attending health care facilities in Galkayo, Puntland, Somalia.
METHODS: An institution-based cross-sectional study was conducted between 2016 and 2017 in three selected TB clinics. Data were collected from 400 TB patients, through medical record review and structured questionnaire. Multivariate logistic regression analyses were performed.
RESULTS: Of the 400 TB respondents, 57.3% were new cases, 12.3% had smear-negative TB and 12.5% had extrapulmonary TB. The median age was (35.66 ± 13.16) with majority being male (65.5%). Overall, 85% of patients were successfully treated, 9.7% failed and 5.3% defaulted. Multivariate analysis revealed that patient\'s body weight (odds ratio [OR]: 1.078); diabetes (OR: 8.022); family size (OR: 3.851); patients\' delay in diagnosis (OR: 11.946); frequency of receiving anti-TB medication (OR: 9.068); smoker (OR: 5.723); category of patients (retreatment versus new, OR: 5.504; retreatment versus transfer in, OR: 4.957); health facilities (OR: 6.716) and treatment duration (OR: 132.091) were independent factors associated with poor TB outcomes.
CONCLUSIONS: Our findings highlight the need to improve TB services for vulnerable groups. They also emphasize the need for health system strengthening, public awareness and risk of treatment interruption. This may reduce both patients\' delay in seeking care and TB treatment failure in Galkayo district.

To study the frequency of obstructive sleep apnea (OSA) in individuals of Somali ancestry referred to a clinical sleep laboratory.
This was a retrospective study using a large registry of patients who underwent diagnostic polysomnography between 17 November 2009 and 15 April 2017. Adult patients self-reporting as being of Somali origin were confirmed using the electronic medical record.
Somali-American patients comprised approximately 0.2% of all patients undergoing polysomnography at the Mayo Clinic Center for Sleep Medicine. The median (interquartile range) age was 52.6 (35, 64) years with 66% males and a median (interquartile range) body mass index of 31.2 (27, 34) kg/m². OSA was diagnosed in 77% of patients, with approximately 50% having moderate to severe OSA. OSA was more frequent in older patients and similar between men and women, and only age predicted an OSA diagnosis while sex and body mass index did not. All patients with diabetes mellitus type 2 (n = 7) and all but one of the hypertensive patients (n = 11) had significant OSA.
Less than 0.2% of all patients undergoing polysomnography at Mayo Clinic were of Somali origin. Moderate-to-severe OSA was frequent in this select sample of individuals who underwent polysomnography. Hypertension and diabetes were present in most Somali-Americans with OSA. Given the rising prevalence of diabetes and hypertension in Somali-Americans, and the likely high prevalence of undiagnosed OSA, screening Somali-Americans for sleep disorders may contribute importantly to prevention, early detection, and reduction of cardiovascular and metabolic diseases in this population.

BACKGROUND: The recurrent civil conflict in Somalia has impeded progress toward improving health and health care, with lack of data and poor performance of health indicators. This study aimed at making inference about Banadir region by exploring morbidity and mortality trends at Banadir Hospital. This is one of the few functional hospitals during war.
METHODS: A retrospective analysis was conducted with data collected at Banadir Hospital for the period of January 2008-December 2012. The data were aggregated from patient records and summarized on a morbidity and mortality surveillance form with respect to age groups and stratified by sex. The main outcome was the number of patients that died in the hospital. Chi-square tests were used to evaluate the association between sex and hospital mortality.
RESULTS: Conditions of infectious origin were the major presentations at the hospital. The year 2011 recorded the highest number of cases of diarrhea and mortality due to diarrhea. The stillbirth rate declined during the study period from 272 to 48 stillbirths per 1,000 live births by 2012. The sum of total cases that were attended to at the hospital by the end of 2012 was four times the number at the baseline year of the study in 2008; however, the overall mortality rate among those admitted declined between 2008 and 2012.
CONCLUSIONS: There was reduction in patient mortality at the hospital over the study period. Data from Banadir Hospital are consistent with findings from Banadir region and could give credible public health reflections for the region given the lack of data on a population level.