Late antenatal care and preeclampsia prevention in hargeisa, somaliland

To Editor, Somaliland, a self-declared state in the Horn of Africa, has an estimated population of 3.5 million, most of whom live in rural, hard-to-reach areas[1]. Access to maternal health services remains limited, contributing to poor maternal health outcomes. The maternal mortality ratio in Somaliland is among the highest globally, estimated at 1044 deaths per 100,000 live births, reflecting gaps in healthcare delivery and surveillance systems[2]. Antenatal care (ANC) is a critical platform for delivering essential maternal health services. It includes health education, nutritional counseling, early detection and prevention of pregnancy-related complications, family planning counseling, and support for women experiencing intimate partner violence[3]. Preeclampsia and eclampsia are common and severe complications of pregnancy worldwide, with particularly high prevalence in sub-Saharan Africa[4]. In developing countries, the prevalence of preeclampsia ranges from 1.8% to 16.7%, contributing substantially to maternal and perinatal morbidity and mortality[5]. In Somaliland, health system capacity to manage hypertensive disorders of pregnancy is limited. Monitoring and evaluation systems are weak, with no dedicated national framework for maternal and child health indicators specific to preeclampsia. Supervision and reporting activities are irregular and largely dependent on implementing partners rather than standardized national oversight mechanisms[2]. These limitations hinder timely detection, prevention, and management of preeclampsia, particularly when women initiate ANC late in pregnancy. Mandating first-trimester antenatal care attendance with universal blood pressure measurement and proteinuria screening at the first visit should be established as a national standard of care in Somaliland to address the high burden of undetected hypertensive disorders of pregnancy.