Epidemiology, factors associated with in-hospital survival, and outcomes of fall-related injuries in Mogadishu, Somalia: a retrospective cohort study

Abstract

Fall-related injuries are an important but underrecognized public health problem in Somalia, where epidemiological evidence remains scarce. This study investigated the epidemiology, clinical characteristics, factors associated with in-hospital survival, and outcomes of patients presenting with fall-related injuries in Mogadishu. A retrospective cohort study was conducted using electronic health records from the Mogadishu Somali-Türkiye Recep Tayyip Erdoğan Training and Research Hospital between February 2024 and February 2026. Consecutive patients presenting with fall-related injuries were included. Demographic characteristics, injury mechanisms, anatomical injury patterns, clinical outcomes, and in-hospital complications were summarized using descriptive statistics. Because of sparse mortality events, exploratory analyses of baseline factors associated with in-hospital survival were performed using Firth’s penalized logistic regression. Results are presented as odds ratios (OR), adjusted odds ratios (aOR), 95% confidence intervals (CI), and p-values. A total of 514 patients were included. The median age was 24 years (IQR: 18–35), and 56.2% were male. Children and adolescents (1–17 years) accounted for 42.0% of cases. Ground-level slips/trips (49.8%) and falls from height (33.7%) were the most common injury mechanisms. Fractures or dislocations occurred in 50.0% of patients, while head/neck (31.7%) and lower-extremity (31.5%) injuries predominated. Chronic pain (31.5%), psychological trauma (7.8%), and severe systemic complications (4.7%) were common sequelae. Overall in-hospital mortality was 4.3%. Exploratory multivariable analysis demonstrated that workplace falls (aOR = 0.20, 95% CI: 0.04–0.88; P = 0.033) and multiple/polytrauma injuries (aOR = 0.089, 95% CI: 0.013–0.619; P = 0.014) were associated with lower odds of survival. Fall-related injuries impose a considerable public health burden in Mogadishu, disproportionately affecting children, adolescents, and working-age adults. Occupational falls and polytrauma were associated with poorer in-hospital survival. These findings support strengthening occupational safety regulations, injury prevention strategies, emergency trauma systems, rehabilitation services, and national trauma surveillance in Somalia.