Clinical features risk factors and outcomes of adult cellulitis among patients presenting to an emergency department in Somalia

Abstract

Cellulitis is an acute bacterial infection of the skin and subcutaneous tissues that represents a frequent cause of emergency department visits and hospital admissions worldwide, particularly in low-resource settings. Data from Somalia remain limited. A prospective observational study was conducted in the Emergency Department of Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia, from August 1, 2021, to July 30, 2022. Adult patients (≥ 18 years) with a clinical diagnosis of cellulitis were consecutively enrolled. Data on demographics, comorbidities, risk factors, clinical presentation, management, and outcomes were collected using structured forms and hospital records. Patients with necrotizing fasciitis or confirmed deep abscess requiring surgical drainage were excluded. Descriptive statistics were used to summarize data. A total of 100 patients were included; 74% were male and 26% female, with a mean age of 56.7 ± 19.9 years. The most affected age group was ≥ 70 years (27%). Diabetes mellitus was the most common comorbidity (51%). Mechanical trauma (20%) and previous cellulitis (20%) were the leading predisposing factors. The lower extremity was the predominant site of infection (90%). Hospitalization was required in 47% of patients, while 45% were managed as outpatients. Intensive care admission was necessary in 8%. Eleven patients (11%) underwent limited incision and drainage for superficial localized collections in addition to antibiotic therapy. Overall, 96% of patients recovered, while 4% died during hospitalization. Cellulitis remains a major cause of emergency presentation and hospitalization in Somalia, particularly among older adults and patients with diabetes. The disease is associated with high healthcare utilization, but most patients recover with appropriate treatment. Early recognition and improved outpatient management strategies may reduce hospitalization burden in resource-limited settings.