Abstract / Summary
Prehospital emergency medical services (EMS) are an essential component of emergency care systems, yet remain underdeveloped in many low-income and conflict-affected settings. Evidence on ambulance utilization and access barriers in Somalia is limited. To estimate the proportion of emergency patients arriving by ambulance, describe barriers to ambulance non-use, and identify factors associated with ambulance arrival among emergency patients presenting to a tertiary referral centre in Mogadishu, Somalia. A prospective hospital-based cross-sectional study was conducted at Mogadishu Somali Turkiye Training and Research Hospital between 28 September 2025 and 30 April 2026. Data were collected using a structured interviewer-administered questionnaire supported by emergency department records. The primary outcome was arrival by ambulance. Descriptive statistics and multivariable logistic regression were performed, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported. Among 339 analysed patients, median age was 38 years (IQR 28–56), 216 (63.7%) were male, and 116 (34.2%) arrived by ambulance. Among ambulance arrivals, 108 had valid reported request-to-arrival time data; the median reported interval was 27.5 min (IQR 20.0–45.0), and 37/108 (34.3%) exceeded 30 min. Seventy ambulance users (60.3%) received at least one recorded intervention during transport. Among 223 non-ambulance arrivals, the most frequent reported barriers were not knowing how to call an ambulance (33.2%), ambulance unavailability (26.5%), preference for other transport (26.5%), cost (26.0%), and traffic/poor roads (10.8%). Knowledge of the ambulance call number, previous ambulance use, male sex, altered mental status, facility referral, and night-time arrival were positively associated with ambulance arrival, while household vehicle ownership was inversely associated. Ambulance arrival was limited in this tertiary referral cohort. The findings identify information access, service availability, affordability, referral pathways, and transport alternatives as potentially important domains for EMS development. The observed associations should not be interpreted as causal, and proposed system changes require prospective evaluation. Not applicable.