Neonatal Hypothermia in Mogadishu, Somalia: Strengthening Thermal Care Beyond NICU Equipment.

Neonatal hypothermia remains an important and preventable threat to newborn survival in low-resource settings. Somalia has a high neonatal mortality burden, while published evidence on admission hypothermia in Somali neonatal intensive care units (NICUs) remains limited. Regional evidence provides an important basis for understanding the problem. A systematic review of East African studies reported a pooled neonatal hypothermia prevalence of 57.2%, and a Kenyan tertiary hospital study found hypothermia in 73.7% of neonatal admissions. In Mogadishu, the challenge is shaped by home birth, gaps in thermal care during the period before referral, limited transport capacity, inconsistent temperature monitoring, workforce constraints, and unreliable infrastructure. This commentary examines how these factors interact and considers interventions that have shown benefit in comparable low-resource settings. The evidence supports a layered approach that combines immediate drying and skin-to-skin care, delayed bathing, early breastfeeding, reliable temperature measurement, kangaroo mother care for preterm and low-birth-weight newborns, thermal protection during referral, staff training, and sustainable maintenance of warming equipment. These measures should complement rather than replace incubators and radiant warmers. Somalia-specific prospective data are needed to quantify admission hypothermia, assess adherence to thermal-care practices, and evaluate implementation outcomes.