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Peer-reviewedCC BY 4.0Frontiers in Public Health

High burden of extrapulmonary tuberculosis and its clinical determinants: a 6-year retrospective analysis of patients at Hargeisa TB Hospital, Somaliland

  • Abdirashid Muhumed Guled1
  • Abdulkadir Mohamed Nuh1
  • Mohamed Abdilahi Mohamed2
  • Abdisalam Hassan Muse1
  • Hamse Arab Ali1
  • Hamse Adam Abdi3
  • Mustafe Abdilahi Abdiqadir4
  • Amani Yusuf Yonis1
  • Omran Salih1
4 affiliations
  1. 1School of Postgraduate Studies and Research, Amoud University
  2. 2School of Graduate Studies and Research, Gollis University
  3. 3Faculty of Medicine and Health Sciences, University of Hargeisa
  4. 4Faculty of Statistics and Data Science, College of Business, Economics and Statistics, University of Hargeisa
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Abstract

Background: Extrapulmonary tuberculosis (EPTB) remains a major diagnostic challenge, particularly in resource-limited settings where tuberculosis services are often centred on pulmonary disease. This study assessed the burden, anatomical distribution, and clinical determinants of EPTB among patients treated at Hargeisa TB Hospital, Somaliland.

Methods: A retrospective facility-based cross-sectional study was conducted using tuberculosis registry data from 2019–2024. All 7,211 registered TB patients were included. Missing data were handled using complete-case analysis, whereby participants with missing values for variables were excluded. Descriptive statistics summarized patient characteristics and EPTB sites, while logistic regression identified factors independently associated with EPTB. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.

Results: Of 7,211 patients, 3,123 (43.3%) had EPTB and 4,088 (56.7%) had pulmonary TB. Lymphatic TB was the most common specific anatomical form (25.5%), followed by pleural (17.9%), abdominal (15.8%), bone/spinal (14.1%), and meningeal TB (1.3%). Female sex was independently associated with EPTB (aOR = 1.77; 95% CI: 1.60–1.95). Compared with patients aged 0–14 years, higher odds were observed among those aged 15–34 years (aOR = 1.40; 95% CI: 1.23–1.59), 35–54 years (aOR = 2.11; 95% CI: 1.82–2.44), and ≥55 years (aOR = 1.84; 95% CI: 1.57–2.15). New TB cases were also associated with EPTB (aOR = 1.48; 95% CI: 1.21–1.82), whereas HIV-positive and on ART status was inversely associated (aOR = 0.37; 95% CI: 0.27–0.52). Reporting year was not significant.

Conclusion: EPTB constituted a substantial proportion of the TB burden at Hargeisa TB Hospital. Female sex, older ages, and HIV status were independent predictors. Strengthening EPTB-specific diagnostic pathways, referral systems, imaging, molecular testing, and histopathology is essential for improving case detection and TB control in Somaliland.

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Cite

BibTeXRIS
BibTeX
@article{guled2026high,
  title = {{High burden of extrapulmonary tuberculosis and its clinical determinants: a 6-year retrospective analysis of patients at Hargeisa TB Hospital, Somaliland}},
  author = {Abdirashid Muhumed Guled and Abdulkadir Mohamed Nuh and Mohamed Abdilahi Mohamed and Abdisalam Hassan Muse and Hamse Arab Ali and Hamse Adam Abdi and Mustafe Abdilahi Abdiqadir and Amani Yusuf Yonis and Omran Salih},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1982502},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1982502/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - High burden of extrapulmonary tuberculosis and its clinical determinants: a 6-year retrospective analysis of patients at Hargeisa TB Hospital, Somaliland
AU  - Abdirashid Muhumed Guled
AU  - Abdulkadir Mohamed Nuh
AU  - Mohamed Abdilahi Mohamed
AU  - Abdisalam Hassan Muse
AU  - Hamse Arab Ali
AU  - Hamse Adam Abdi
AU  - Mustafe Abdilahi Abdiqadir
AU  - Amani Yusuf Yonis
AU  - Omran Salih
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1982502
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1982502/full
AB  - Background: Extrapulmonary tuberculosis (EPTB) remains a major diagnostic challenge, particularly in resource-limited settings where tuberculosis services are often centred on pulmonary disease. This study assessed the burden, anatomical distribution, and clinical determinants of EPTB among patients treated at Hargeisa TB Hospital, Somaliland.  Methods: A retrospective facility-based cross-sectional study was conducted using tuberculosis registry data from 2019–2024. All 7,211 registered TB patients were included. Missing data were handled using complete-case analysis, whereby participants with missing values for variables were excluded. Descriptive statistics summarized patient characteristics and EPTB sites, while logistic regression identified factors independently associated with EPTB. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.  Results: Of 7,211 patients, 3,123 (43.3%) had EPTB and 4,088 (56.7%) had pulmonary TB. Lymphatic TB was the most common specific anatomical form (25.5%), followed by pleural (17.9%), abdominal (15.8%), bone/spinal (14.1%), and meningeal TB (1.3%). Female sex was independently associated with EPTB (aOR = 1.77; 95% CI: 1.60–1.95). Compared with patients aged 0–14 years, higher odds were observed among those aged 15–34 years (aOR = 1.40; 95% CI: 1.23–1.59), 35–54 years (aOR = 2.11; 95% CI: 1.82–2.44), and ≥55 years (aOR = 1.84; 95% CI: 1.57–2.15). New TB cases were also associated with EPTB (aOR = 1.48; 95% CI: 1.21–1.82), whereas HIV-positive and on ART status was inversely associated (aOR = 0.37; 95% CI: 0.27–0.52). Reporting year was not significant.  Conclusion: EPTB constituted a substantial proportion of the TB burden at Hargeisa TB Hospital. Female sex, older ages, and HIV status were independent predictors. Strengthening EPTB-specific diagnostic pathways, referral systems, imaging, molecular testing, and histopathology is essential for improving case detection and TB control in Somaliland.
SN  - 2296-2565
ER  -