Health in a fragile state: a five-year review of mortality patterns and trends at Somalia's Banadir Hospital.
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.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Asli
A
Kulane
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Douglas
D
Sematimba
Women and Child Care Section, Banadir Maternity & Children Hospital, Mogadishu, Somalia.
Lul M
LM
Mohamed
Women and Child Care Section, Banadir Maternity & Children Hospital, Mogadishu, Somalia.
Abdirashid H
AH
Ali
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; College of Information System and Management, National University of Defense Technology, Changsha, People's Republic of China; Flowminder Foundation, Stockholm, Sweden.
Xin
X
Lu
Banadir Hospital; Somalia; health indicators; hospital mortality; sex