Infectious Diseases 2027

Background: Childhood tuberculosis remains an important public health challenge in fragile health systems. Community-based tuberculosis (TB) control strategies involving Community Health Workers (CHWs) may improve early identification, referral, and continuity of care. Evidence on their implementation in Mogadishu, Somalia, remains limited.
Objective: To evaluate the implementation of community-based TB control strategies for children under five years of age in Mogadishu, Somalia, using the RE-AIM framework.
Methods: The practicum report describes a mixed-methods implementation research study conducted in selected health facilities and surrounding communities in Mogadishu. Quantitative data were reported from 66 caregivers of children under five using structured questionnaires. Qualitative data were collected through key informant interviews and focus group discussions involving community health workers, healthcare workers, and community leaders. Findings were organized according to the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance.
Results: The report indicates that 65.2% of caregivers had been visited by CHWs, 59.1% had received TB education, and 50.0% were aware of childhood TB symptoms. TB screening coverage was reported as 47.0%, while referral completion among suspected cases was 84.2%. Treatment adherence was reported as 85.7%. CHW household visits were associated with higher TB detection (p = 0.01). Implementation barriers included limited supervision, shortages of supplies and diagnostic tools, insecurity, and inadequate transport for CHWs. Sustainability was constrained by limited government support and dependence on external funding.
Conclusion: Community-based TB control may support childhood TB detection and continuity of care in Mogadishu. Strengthening community awareness, referral systems, CHW supervision, logistical support, and sustainable government financing may improve implementation. The findings should be interpreted in light of the study's selected settings and reported methodological limitations. Keywords: Childhood tuberculosis; community health workers; implementation research; RE-AIM framework; Somalia.

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