Strengthening Blood Transfusion Safety in Somalia: Challenges, Opportunities, and the Need for a Sustainable National Blood System

Blood transfusion is essential for obstetric, trauma, surgical, and chronic care, yet the organization of transfusion services in Somalia is poorly documented. This narrative commentary summarizes published hospital-based studies of blood donors in Somalia and Somaliland and discusses implications for a coordinated national blood service. Targeted searches identified four donor studies (three in Mogadishu and one in Hargeisa; 165,196 donor records in total) and one blood group study, which were read together with World Health Organization and United Nations documents. The studies were hospital-based, differed in design, period, assays, and donor definitions, and are not nationally representative. Donors were almost entirely male (93.9% to 99.8%). Donor type differed by site: 80.8% of donors at one hospital were family donors, donors at another were described as mostly paid, and 61.9% of donors in a smaller study were voluntary. Hepatitis B positivity ranged from 0.6% to 9.7% across these study populations, with different case definitions; these are study-specific figures, not national prevalence estimates. At one hospital, overall transfusion-transmitted infection (TTI) positivity declined from 4.27% in 2016 to 1.98% in 2022, a temporal association whose cause was not established. We describe challenges in donor recruitment, screening quality, regulation, hemovigilance, and financing, and propose recommendations ordered by dependency, feasibility, and supporting evidence, with indicators for monitoring. A coordinated national blood service is presented as an implication of this evidence that requires nationally representative surveillance to evaluate.