Preventing Avoidable Amputations in Somalia: Building a Diabetic Foot Care Pathway for Somali Hospitals [Commentary]

Diabetes-related foot disease requires coordinated prevention, timely assessment, and access to treatment. Two hospital-based studies in Mogadishu reported foot ulcer prevalence of 15.0% and 17.9% among adults with diabetes; neither provides a national estimate or establishes the effectiveness of a care pathway. This commentary proposes a six-function pathway for Somali hospitals: screening, risk stratification, triage, initial treatment, coordination, and recurrence prevention. The proposal draws on International Working Group on the Diabetic Foot guidance, the World Health Organization Package of Essential Noncommunicable Disease Interventions, Somali hospital studies, and implementation experience elsewhere. Established clinical recommendations are distinguished from author-proposed responsibilities, pilot arrangements, and operational targets. The pathway has not undergone formal stakeholder review, feasibility testing, or validation in Somali hospitals. A proposed 12-month pilot would begin with assessment of staffing, competencies, supplies, referral access, patient costs, and data governance. It would then test a clinical algorithm, supervised training, referral coordination, and a small set of defined process and clinical measures. Emergency care must not wait for routine review or completion of a treatment bundle. Expansion should depend on demonstrated readiness, affordable recurrent financing, and evaluation across different hospital settings. The intended contribution is a locally testable organization of established care, with explicit responsibilities and measurable transitions, rather than new clinical guidance or a proven amputation-reduction intervention.