Prevalence, Socioeconomic Determinants, and Health-System Factors Associated with Laboratory-Confirmed Renal Impairment Among Adults Attending Tertiary Referral Hospitals in Mogadishu, Somalia: A Cross-Sectional Study

The kidneys are the body's silent filtration system, working tirelessly to clean the blood, remove waste, and balance fluids. When these organs begin to fail, the damage often goes unnoticed for years because the early stages of the disease produce no obvious symptoms. This condition, known as chronic kidney disease, is a growing global health crisis, particularly in regions where access to medical testing is limited. In many parts of the world, people do not discover they have kidney trouble until the damage is severe and irreversible, often because the simple blood and urine tests needed to spot the problem are not part of routine care. Without early detection, the disease can progress to a point where the only options are expensive, life-sustaining treatments that are out of reach for most families.

In a recent study, researchers set out to understand the scale of this hidden problem in Somalia, a nation still rebuilding its health infrastructure after decades of conflict. They focused on adults visiting major hospitals in Mogadishu, the country's capital, to see how many were suffering from kidney impairment and what factors were driving it. The team looked for specific signs of trouble: high levels of waste products in the blood, the presence of protein in the urine which indicates the filters are leaking, and a measure of how well the kidneys are filtering blood. By examining these markers alongside patient histories, they aimed to uncover not just how widespread the issue was, but also the social and medical reasons behind it. Their work reveals a stark reality: kidney disease is far more common among those seeking hospital care than previously realized, and it is deeply tied to poverty, unregulated medication use, and the lack of routine health checks.

The study took place between April and July 2026 at two large referral hospitals in Mogadishu. Researchers screened hundreds of adult patients, eventually analyzing complete data from 200 individuals who agreed to participate. These were not random people from the street, but patients already seeking specialized medical help, meaning they likely had more serious health issues than the average person. Despite this, the results were startling. When the team tested the patients' blood and urine, they found that a vast majority showed signs of kidney damage. Specifically, 72.5 percent of the participants had a reduced ability to filter blood, a condition that signals the kidneys are struggling to do their job. Even more concerning, 84 percent had elevated levels of creatinine, a waste product that builds up when the kidneys cannot clear it effectively, and 79 percent had protein leaking into their urine.

Perhaps the most telling finding was the gap between what the patients knew and what the tests revealed. Only 64 percent of the participants had ever been told by a doctor that they had chronic kidney disease. This means that for a significant number of people, the disease was present and measurable in their bodies, yet they remained unaware of it. This disconnect suggests that many people are living with advanced kidney damage without knowing it, likely because they have never had the opportunity to get a simple screening test. The study also highlighted that the people most affected were often those facing the greatest hardships. More than half of the participants had no formal education, and 65 percent lived on less than 100 US dollars a month. These economic struggles were not just background noise; they were directly linked to behaviors that harmed kidney health.

The researchers dug deeper to find out what was driving this damage. They found that older age, high blood pressure, and diabetes were the strongest medical predictors of kidney trouble. However, two other factors stood out as critical and preventable causes. First, the frequent use of non-prescribed painkillers, specifically a class of drugs called non-steroidal anti-inflammatory drugs or NSAIDs, was strongly linked to kidney impairment. In Somalia, these medications are often sold without a prescription, and people with lower incomes were significantly more likely to use them frequently, perhaps because they are cheap and easily available. Second, the study found that patients who did not stick to their prescribed treatments for conditions like high blood pressure or diabetes were much more likely to have damaged kidneys. When people cannot afford their medication or do not have the support to take it regularly, their underlying conditions worsen, eventually destroying the kidneys.

The data painted a clear picture of how poverty and health systems intersect. People with lower incomes and less education were more likely to skip routine health check-ups, more likely to rely on non-prescribed painkillers, and more likely to miss their scheduled medical treatments. These behaviors created a perfect storm for kidney disease. The study showed that while poverty itself was a risk factor, its true danger lay in how it limited access to care and forced people into unsafe health practices. For instance, those earning less than 100 dollars a month were far more likely to use non-prescribed painkillers than those with higher incomes. Similarly, those without formal education were much less likely to attend regular health screenings. This cycle means that the most vulnerable populations are the ones most likely to develop severe kidney disease and the least likely to catch it early.

The researchers were careful to note that their findings apply specifically to the adults who came to these hospitals, not necessarily to every person in Somalia. Because these patients were already seeking specialized care, they likely had more advanced disease than someone living in a rural village who has never visited a doctor. However, the high rates of undiagnosed damage among these hospital visitors suggest that the problem is likely even larger in the general population. The study does not claim to have solved the mystery of kidney disease in Somalia, but it provides a crucial map of where the problem is most severe. It confirms that the disease is widespread, often hidden, and tightly connected to the daily struggles of poverty and the lack of a regulated health system.

Looking at the path forward, the study suggests that the solution lies in bringing simple kidney checks into the places where people already go for care. Instead of waiting for patients to arrive at a major hospital with severe symptoms, the researchers propose that basic tests for blood and urine should become a standard part of routine care for anyone with high blood pressure or diabetes. They also emphasize the need to regulate the sale of painkillers and educate communities about the dangers of taking them without a doctor's advice. By integrating these simple steps into the existing health framework, and by ensuring that the poorest citizens can afford the necessary treatments, the country could potentially stop the disease before it reaches a critical stage. The study concludes that while the burden of kidney disease is heavy, the tools to manage it are available; what is needed now is the will to make them accessible to everyone.