Preventive Strategies for Otitis Media in Low-Income Urban Contexts: A Case Study from Somalia

Background: Otitis media (OM) is a leading cause of preventable hearing loss in children globally, with a particularly high burden in low- and middle-income countries (LMICs). In urban areas of Somalia, OM prevalence is exacerbated by overcrowded living conditions, inadequate sanitation, low immunisation coverage, and limited access to healthcare. Despite this burden, little is known about context-specific strategies for OM prevention in fragile and low-resource urban environments. This study aimed to explore community-informed, feasible interventions for the prevention and early management of OM in Somali urban schoolchildren. Methods: A qualitative case study approach was employed, nested within a larger cross-sectional epidemiological study. Data were collected in three major Somali cities—Mogadishu, Hargeisa, and Bosaso—between March and June 2024. Fifteen key informants were purposively selected, including healthcare providers (n=6), school staff (n=5), and caregivers (n=4). Semi-structured interviews explored awareness of OM, barriers to prevention, and recommendations for school, clinic, and community-based interventions. Field observations in schools and clinics complemented interview data. Transcripts were coded and thematically analysed using NVivo software. Triangulation and member checking enhanced credibility. Results: Three key domains of intervention emerged: healthcare, school, and community. In the healthcare setting, barriers included irregular vaccine supply, lack of otoscopic equipment, and limited training among frontline staff. Participants stressed the need for integrated OM screening in routine child health services and capacity-building for community health workers. Schools were identified as underutilised platforms for early detection, with strong support among teachers for basic training in ear health and classroom-based awareness campaigns. Community-level challenges included poor sanitation, high exposure to indoor smoke, and early cessation of breastfeeding. Participants recommended culturally tailored education campaigns using trusted platforms such as mosques, women’s associations, and radio broadcasts. Conclusions: Preventing OM in Somali urban contexts requires a multi-level, community-engaged approach. Strengthening vaccine delivery, training frontline workers, integrating OM education into school health programmes, and leveraging community networks are essential strategies. The findings offer a practical framework for policymakers and health planners seeking to reduce OM burden and improve child health outcomes in similarly constrained LMIC settings.