Abstract
OBJECTIVES: Internal displacement creates complex health challenges, particularly regarding the spread of antimicrobial resistance (AMR). In Somalia, internally displaced persons (IDPs) reside in overcrowded settlements with limited sanitation, creating conditions that favor the transmission of methicillin-resistant Staphylococcus aureus (MRSA). While clinical infections are reported, community-based data on asymptomatic carriage is scarce. This study investigated the prevalence and predictors of nasal MRSA carriage among IDPs in Mogadishu. METHODS: A community-based cross-sectional study was conducted in the Daynile and Kahda districts of Mogadishu. A total of 428 IDPs were enrolled using systematic random sampling. Data on sociodemographics, housing, and medical history were collected via structured questionnaires. Anterior nasal swabs were cultured on Mannitol Salt Agar, and MRSA was confirmed using cefoxitin disk diffusion per Clinical & Laboratory Standards Institute (CLSI) guidelines. Multivariable logistic regression was used to identify independent predictors of carriage. RESULTS: A total of 428 participants were enrolled (mean age 24.5 years). The overall prevalence of MRSA nasal carriage was 51.87% (222/428). In the multivariable analysis, the duration of displacement and household size were significant predictors of carriage. Recent arrival in the camp (1-15 months) was a strong risk factor (adjusted odds ratio = 2.92; 95% confidence interval: 1.64-5.19) compared to long-term residents. Additionally, smaller household sizes (1-4 members) showed higher odds of carriage (adjusted odds ratio = 2.08; 95% confidence interval: 1.23-3.51) compared to larger households, potentially reflecting specific housing vulnerabilities among newer, smaller family units. CONCLUSIONS: The burden of MRSA carriage is exceptionally high among displaced populations in Mogadishu. The findings suggest that recent displacement and living conditions associated with newer arrivals are critical drivers of transmission. Public health interventions should target recent arrivals with improved shelter and hygiene promotion to mitigate the spread of resistant pathogens.