Cross-sectional review of diabetic retinopathy prevalence and risk factors in 384 Somaliland patients

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medRxiv Published April 18, 2026 Medically reviewed April 30, 2026 Study authors: Woredekal, A. T. DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note that longer diabetes duration and cardiac illness are associated with higher DR risk in this Somaliland cohort.

This observational, descriptive cross-sectional review assesses the prevalence of diabetic retinopathy (DR) and its associations with various risk factors in a cohort of 384 patients with diabetes mellitus attending a tertiary-care hospital in Hargeisa, Somaliland. The study population included individuals with comorbidities such as hypertension, and the analysis focused on the presence of DR as the primary outcome, with secondary outcomes detailing the type of DR, specifically non-proliferative diabetic retinopathy (NPDR) and macular oedema.

The review reports a DR prevalence of 51% (197 out of 384 patients). Among those with DR, the distribution was 17% NPDR (67 cases) and 26% macular oedema (98 cases). The authors identify several significant associations: age above 40 years was associated with DR, with a 37% lesser risk for patients aged below 40 compared to those above 40 (p=0.020). Additionally, marital status (P=0.010), employment status (P=0.002), and literacy status (P=0.020) were all significantly associated with DR presence.

Further analysis indicated that a longer duration of diabetes was strongly associated with DR, showing approximately 2 times higher chance for duration >10 years versus <10 years (p=0.001). The presence of concomitant cardiac illness was also strongly associated with DR (p=0.001). The study did not report adverse events, discontinuations, or tolerability data. The authors acknowledge that because this is an observational study, causal relationships cannot be definitively established, and effect sizes should be interpreted with caution.

Practice relevance centers on the priority of effective regular eye screening and treatment for all diabetes patients. Clinicians should recognize these associations as potential markers for risk stratification but must avoid inferring causation from these observational associations. The findings highlight the high burden of DR in this specific setting and the importance of managing comorbidities like cardiac illness and monitoring disease duration.

Study Details

Sample sizen = 293

EvidenceLevel 5

PublishedMar 2026

View Original Abstract ↓

PurposeDiabetic retinopathy (DR) is one of the most important complications of diabetes mellitus (DM), representing the leading cause of blindness among working age adults in developed countries. This study was aimed to investigate the epidemiology and risk factors of DR in patients with diabetes mellitus in a hospital setting in Somalia. MethodsThe study was an observational, descriptive cross-sectional and hospital-based study and data were collected from January 2023 to May 2023. A structured questionnaire was used to collect relevant demographic and clinical data. Both univariate and bivariate tables were used for analysis. Data analysis included frequency distribution, cross-tabulation, co-relation and association, and statistically significant tests between variables (X2, p-value, and CI). ResultsA total of 384 DM patients were studied and 76% (n=293) of them had type 2 DM. The average duration of diabetes mellitus was 9.7{+/-} 6.9 years and the mean age was 47.24 {+/-} 19.36 years (range 18 -100 years old). A majority 66% (n=253) were female, about a third of them had normal body mass index (BMI) (n=172, 44.8%) and 170 (44.3%) had concomitant hypertension. About 51% of the patients (n=197) had DR out of which 17% had non-proliferative diabetic retinopathy (NPDR) (n=67) and 26% had Macular oedema (n=98). Age above 40 years (p=0.020), marital status (P=0.010), employment status (P=0.002) and literacy status (P=0.020) were significantly associated with the presence of DR. Patients aged below 40 had 37% lesser risk of having diabetic retinopathy than patients aged above 40 years. Longer duration of diabetes (p=0.001) and the presence of concomitant cardiac illness (p=0.001) were strongly associated with the presence of diabetic retinopathy. Patients with duration of diabetes more than 10 years had approximately 2 times higher chance of developing DR than those with duration less than 10 years. ConclusionThe very high prevalence of DR (51%) among our patients implies the needs for a good health policy to manage DM and DR patients in Somalia. Effective regular eye screening and treatment for all diabetes patients should get priority.