Comprehensive analysis of neurological disease patterns in a fragile health system in Somalia

Neurological disorders are increasingly prevalent in developing countries, particularly in sub-Saharan Africa. However, data regarding the epidemiology of these conditions in Somalia remain limited. This study aims to analyze the patterns of neurological diagnoses among patients admitted to the neurology department of a tertiary referral hospital in Mogadishu, Somalia. We conducted a retrospective cross-sectional study at Somalia's largest referral hospital in Mogadishu between July 2019 and July 2024. Data were extracted from electronic medical records of adult patients admitted with neurological conditions to the neurology ward, emergency department, and general intensive care units. Pediatric and trauma-related admissions were excluded. Descriptive statistics, Pearson chi-square tests, binary logistic regression, and Kaplan-Meier survival analysis were employed to assess the distribution of neurological diagnoses and factors associated with in-hospital mortality. A total of 2,126 patients were included in the study. The mean age was 56.03 ± 19.07 years (range: 18-98 years), and the majority were male (n = 1,274; 60%). Most admissions originated from the emergency department (n = 1,741; 82%). Over half of the patients had at least one comorbidity (n = 1,329; 62.5%), with hypertension being the most common (n = 654; 31%), followed by diabetes mellitus (n = 175; 8.2%), epilepsy (n = 138; 6.5%), heart disease (n = 118; 5.6%), and previous stroke or transient ischemic attack (TIA) (n = 67; 3.2%). The leading neurological diagnoses were ischemic stroke (n = 905; 42.6%), hemorrhagic stroke (n = 552; 26%), epileptic disorders (n = 166; 7.8%), cerebral venous thrombosis (n = 138; 6.5%), non-traumatic subarachnoid hemorrhage (n = 92; 4.2%), and Guillain-Barré syndrome (n = 47; 2.2%). Intrahospital mortality was recorded in 342 patients (23%). Poor survival outcomes were significantly associated with advanced age, comorbidities, multiple diagnoses, low Glasgow Coma Scale (GCS) scores, and ICU admission, underscoring the importance of early detection and targeted interventions to reduce mortality. This study represents the first comprehensive assessment of neurological admissions in Mogadishu, Somalia-a region with limited healthcare resources. Cerebrovascular diseases and epileptic disorders were the most common diagnoses. The high in-hospital mortality rate emphasizes the urgent need to strengthen preventative and therapeutic strategies targeting non-communicable neurological diseases in low-resource settings.