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Pregnancy in patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) is uncommon but clinically challenging. Essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF) are clonal hematopoietic stem cell disorders characterized by myeloid proliferation, JAK-STAT pathway activation, and an increased risk of thrombotic and hemorrhagic complications. Pregnancy itself is a hypercoagulable state, and when it occurs in patients with MPNs, maternal and fetal complications are more frequent than in the general population. The most common fetal complications are first trimester pregnancy loss, placental insufficiency, fetal growth restriction, preeclampsia, preterm delivery, and stillbirth. Maternal complications include venous and arterial thrombosis, bleeding, acquired von Willebrand syndrome, and postpartum thromboembolism. ET is the most frequently encountered MPN in pregnancy and generally carries the most favorable prognosis. PV is associated with higher thrombotic and placental risk, largely related to erythrocytosis and hyperviscosity. Pregnancy in PMF is rare, and available data are limited to small series and case reports, making management particularly dependent on expert opinion. The mainstay of treatment is risk-adapted therapy with low-dose aspirin, low-molecular-weight heparin, phlebotomy for PV, and interferon-based cytoreduction when needed. Hydroxyurea, anagrelide, and JAK inhibitors are generally avoided due to limited fetal safety data. Given the paucity of prospective evidence, management should be individualized and coordinated by hematology and maternal-fetal medicine specialists. This review summarizes current data on MPN pregnancy outcomes and provides a practical approach to preconception counseling, antepartum management, delivery planning, postpartum care, and future research priorities.

All communication involves the expression and the reception of information, both of which are considered by speech and language therapists (SLTs) when assessing and planning intervention for language difficulties. Comprehension, or understanding, has to be inferred, whereas expressive behaviours are directly observable. Possibly because of the level of inference, views and assessments of a person's understanding often vary: between different practitioners, professionals, family members and carers. The aim of the research was to examine how and why such different perspectives occur and how they are managed. There were three research questions: (1) How is understanding conceptualised and addressed from the perspectives of: (a) SLT practitioners and (b) SLT educators? (2) Are discrepant views on a person's understanding recognised and encountered in SLT practice? and (3) if so, how are such differences explained and navigated in practice? The research design used a survey methodology involving two bespoke online questionnaires aimed at: (i) SLT practitioners; and (ii) SLT educators. Purposive convenience samples were recruited via UK-based pre-registration programmes in Speech and Language Therapy and the Clinical Excellence Networks (CENs) of the Royal College of Speech and Language Therapists (RCSLT). The online questionnaires included demographic information followed by a mixture of closed and free-field questions exploring conceptualisation and assessment of understanding. Descriptive statistics were applied to closed question responses, and summative content analysis to the free-field responses. A total of 80 completed questionnaires were returned: (i) SLT practitioners = 77; (ii) SLT educators = 3. Understanding was defined in different ways. Approaches to assessment focused on vocabulary and semantics, language processing, and responses to different communicative modalities. Differing views on a person's understanding were recognised to be a common issue encountered by SLTs, which were mainly associated with parents, partners and family members rather than fellow professionals. SLTs seem to vary in the ways they conceptualise and address the question of understanding in their practice, and the findings confirm anecdotal suggestions that differences of opinion with other professionals, family members and carers are relatively common. Receptive communication, therefore, emerges as a contested field, which has implications for how successfully and thoroughly SLTs are able to plan and deliver effective interventions. Further clarification is needed regarding the relevant information and guidance provided in pre-registration training. Implementation science may provide some useful guidance as to the marrying of theory and research evidence. What is already known on the subject Language involves both expression and comprehension, the one process being observable whereas the other is inferred. Various models of understanding are proposed, which speech and language therapists can apply in their therapeutic practice, but we know little about which they choose and why. Furthermore, there is anecdotal report of disagreements occurring between assessments made by the speech and language therapist and those of other professionals, family members and caregivers.What this paper adds to the existing knowledge The current study is the first reported survey into how understanding is conceptualised and operationalised in the practice of speech and language therapists in the UK. The findings revealed the different ways that understanding was defined with assessment approaches generally focusing on components within the architecture of language and communication. It appears that differing views on a person's understanding are often encountered by speech and language therapists.What are the potential or clinical implications of this work? This survey suggests that more work needs to be done to establish a unified theory of understanding to underpin speech and language therapy practice: one that combines social cognitive processes and psycholinguistic processes.

Effective management of Whiplash-Associated Disorders (WAD) requires adherence to evidence-based guidelines. While educational interventions and e-resources improved guideline knowledge among healthcare professionals, their implementation in physiotherapy education remains unexplored. To evaluate the feasibility and acceptability of a multifaceted implementation strategy, including an integrated e-resource, within physiotherapy education. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this single-group pre-post pilot implementation study evaluated a blended learning strategy that included: (i) interactive education, with integration of an e-resource into existing curricula, (ii) opinion leaders, and (iii) student champions. Feasibility outcomes included participation in educational intervention, access to e-resources, research recruitment and retention rates. Acceptability of e-resource and exploratory knowledge change outcomes were assessed using baseline and six-week follow-up questionnaires. Of 229 students, 171 attended the educational tutorial (75% participation rate). E-resource access was reported by 55% of enrolled students and 74% of tutorial attendees. Recruitment and retention rates were 59% and 32%, respectively. E-resource acceptability was high (>80%). Exploratory pre-post analyses suggested higher levels of knowledge at follow-up for WAD classification (42%), prognostic factors (44%), and when to refer (48%). No differences were observed in knowledge of the Canadian C-Spine Rule or risk-stratified matched-care principles. The multifaceted implementation strategy was feasible to integrate within an existing physiotherapy curriculum and demonstrated high acceptability of e-resources. Exploratory findings suggested a change in knowledge of WAD classification, prognosis, and referral pathways; however, these should be interpreted with caution given the single-group design and the modest follow-up retention rate.

Coagulopathy is a common complication in patients with sepsis, ranging from subclinical coagulation activation only seen in laboratory values to disseminated intravascular coagulation (DIC). Over the past 25 years, several scoring systems have been developed to diagnose coagulopathy and DIC in critically ill patients. However, the presence of multiple overlapping definitions, diagnostic criteria and numerous scoring systems adds complexity and poses challenges for clinical decision-making. This scoping review aims to systematically map how coagulopathy and DIC in adult patients with sepsis are defined, diagnosed and managed, and to summarise risk factors and reported clinical outcomes. Knowledge gaps will be identified to inform future research and clinical practice. Eligible studies will include original clinical research of any design published from 1 January 1996 onwards reporting on coagulopathy or DIC in adult patients (≥ 18 years) with sepsis. Non-original articles (reviews, opinion pieces, editorials, guidelines, case reports, consensus statements) and conference abstracts will be excluded. We will only include studies published in English. Searches will be conducted in PubMed, EMBASE, Web of Science and CENTRAL, and supplemented by reference list screening. Two reviewers will independently screen abstracts and full texts, and extract data in duplicate using a piloted extraction form. In case of disagreement, a third senior reviewer will adjudicate and make the final decision on study inclusion. Extracted information will include study characteristics, population details, diagnostic approaches, frequency of coagulopathy, management strategies and clinical outcomes, as well as contextual factors such as hospital settings and geographical origin. Results will be presented using descriptive statistics, tables and narrative summaries. A critical appraisal of the quality of the included studies will be conducted. This scoping review will provide a comprehensive overview of definitions, diagnostic methods, management patterns and reported outcomes of coagulopathy and DIC in adult patients with sepsis. The findings will clarify the current practice variation, highlight knowledge gaps and areas of uncertainty, and guide priorities for future research and clinical decision-making.

Shared decision-making (SDM) has emerged as a cornerstone of patient-centered care in the surgical setting. Surgeons can provide their opinion based on evidence and expertise, while patients provide their unique values and preferences-culminating in a unified plan. This is especially important at the end-of-life. This chapter will explore the unique role and benefit that SDM has in end-of-life situations and provide a context in which to navigate these difficult times.

Keratoconus is a common blinding corneal disease among young adults. A large number of atypical or early-stage patients are highly susceptible to missed diagnosis or misdiagnosis due to unremarkable clinical manifestations, leading to the loss of opportunities for early effective intervention and management, and ultimately resulting in irreversible blindness. In recent years, with the expansion of the population undergoing corneal refractive surgery, establishing an accurate screening and diagnostic system for keratoconus has important clinical significance for preventing postoperative complications. In view of this, the Refractive Surgery Group of the Ophthalmology Branch of the Chinese Medical Doctor Association, in collaboration with the Corneal Disease Group of the Ophthalmology Branch of the Chinese Medical Association, has developed consensus opinions on confusing concepts and terms related to early keratoconus, as well as the strategies, criteria, methods and systems for the early screening and diagnosis of keratoconus, based on relevant domestic and international consensus, evidence-based medicine evidence and expert clinical experience, using scientific and standardized methods. This consensus aims to continuously establish and improve the early screening and diagnostic pathway for keratoconus, which not only provides a scientific basis for the preoperative evaluation of corneal refractive surgery and enhances the safety of corneal refractive surgery, but also offers a reference for the early clinical diagnosis and treatment of keratoconus. 圆锥角膜为青年人常见的致盲性角膜疾病，大量非典型或早期患者因临床表现不明显，极易被漏诊或误诊，丧失早期有效干预和处理时机，导致不可逆盲。近年随着角膜屈光手术人群扩大，建立精准的圆锥角膜筛查诊断体系，对于预防术后并发症具有重要临床意义。鉴于此，中国医师协会眼科医师分会屈光手术学组联合中华医学会眼科学分会角膜病学组，基于国内外相关共识、循证医学证据及专家临床经验，采用规范的指南和共识制订方法，针对与早期圆锥角膜相关的易混淆概念和词语，以及圆锥角膜早期筛查诊断的策略、标准、方法、体系等，形成共识性意见，以期建立并不断完善圆锥角膜早期筛查诊断路径，不仅为角膜屈光手术的术前评估提供科学依据，提升角膜屈光手术的安全性，也为临床圆锥角膜的早期诊疗提供指导意见。.

Inflammatory Bowel Diseases (IBD) are challenging conditions to manage due to the heterogeneity of the disease, diverse treatment options, and nuances of care over a range of ages. Clinical care pathways (CCPs) developed by experts enable health care providers (HCPs) to deliver standardized, high-quality, evidence-based care. In order to remain useful and valuable, these pathways need to evolve alongside changing treatment recommendations. Standardizing IBD care is a priority of Crohn's Colitis Canada's Promoting Access and Care through Centres of Excellence (PACE) network. To describe the process of nationalizing IBD CCP's, including development, standardization, maintenance, and dissemination. This project was based on a previously developed structured framework for review and maintenance. The CCP team consisted of a leadership group, advisory council and a working group with diverse representation from the country and areas of expertise. The work was tracked with a database with coordination completed by staff of the national organization. The nationalization process lasted 14 months, with input from 23 HCPs from 14 academic and community institutions across Canada. Sixteen CCPs for IBD care were developed and approved by the CCP team. Challenges encountered included outdated guidelines, differing clinical opinions, and busy clinical schedules of the team members. Translation into French is complete. Support of Crohn's and Colitis Canada was invaluable. Despite anticipated challenges, 16 CCPs received approval from the advisory council and are publicly available to HCPs across Canada. Our approach to this undertaking and the lessons learned may be valuable for experts undertaking similar projects for patients with chronic diseases.

Pleural fluid cytology is an essential component in diagnosing malignant pleural effusions. It is therefore vital to identify the optimal timing for cytologic evaluation to maximize diagnostic yield. This study assesses the yield of pleural fluid cytology based on the length of time between collection of pleural fluid and the start of cytologic processing. This retrospective analysis included patients who underwent thoracentesis with pleural fluid samples sent for cytology. A Diff-Quik®, ThinPrep®, and cell block for histologic examination were created using standard institutional protocols. Logistic regression and log-risk models were used to assess the association between time to sample processing and malignant diagnosis. 327 pleural fluid samples were included, of which 81 were positive for malignancy. Thoracenteses occurred most often on Tuesdays and Fridays and in the afternoons. There was no relationship between time of day of sample collection and yield, nor between day of the week collected and yield for malignant cells. Furthermore, there was no statistically significant difference in yield based on absolute time between sample collection and processing. This remained true even after adjustment for sample volume. Despite historical beliefs, our study failed to show a statistically significant association between cytology yield for malignant cells and increasing time from sample collection to laboratory processing. Given these findings, clinicians may be reassured that timing of diagnostic thoracentesis likely does not affect the probability of malignant diagnosis. Other components of sample processing and storage warrant further study in efforts to maximize diagnostic yield.

This study aimed to investigate the predictive roles of xenophobia and social contact in shaping nursing students' attitudes toward refugees. Refugees are a highly vulnerable population who often face barriers to equitable healthcare access. Nursing students' attitudes toward refugees are important because they may influence future care quality, communication, and culturally safe practice. However, evidence on how xenophobia and social contact jointly shape these attitudes remains limited, particularly in university settings where a high proportion of international students creates frequent multicultural interaction. This study employed a descriptive, cross-sectional, correlational design. The study was conducted with 421 nursing students at a public university in T&#xfc;rkiye where the number of international students, particularly Syrian students, is relatively high. Data were collected using a Descriptive Information Form, the Attitudes Toward Refugees Scale, the Xenophobia Scale, and the Social Contact Scale. Descriptive statistics and multiple linear regression analyses were performed. The mean scores were 92.36&#xa0;&#xb1;&#xa0;16.48 for attitudes toward refugees, 47.20&#xa0;&#xb1;&#xa0;9.96 for xenophobia, and 25.97&#xa0;&#xb1;&#xa0;6.74 for social contact. Xenophobia was the strongest predictor of more negative attitudes toward refugees (&#x3b2;&#xa0;=&#xa0;0.526, p&#xa0;<&#xa0;.001). Both contact frequency (&#x3b2;&#xa0;=&#xa0;-0.149, p&#xa0;<&#xa0;.001) and contact quality (&#x3b2;&#xa0;=&#xa0;-0.161, p&#xa0;<&#xa0;.001) were significant negative predictors of attitude scores, indicating that more frequent and more positive contact was associated with less negative attitudes. Female sex predicted more negative attitudes (&#x3b2;&#xa0;=&#xa0;0.125, p&#xa0;=&#xa0;.001), whereas being a fourth-year student predicted more positive attitudes (&#x3b2;&#xa0;=&#xa0;-0.091, p&#xa0;=&#xa0;.019). Social contact frequency (&#x3b2;&#xa0;=&#xa0;-0.122, p&#xa0;=&#xa0;.013) and contact quality (&#x3b2;&#xa0;=&#xa0;-0.291, p&#xa0;<&#xa0;.001) were also significant negative predictors of xenophobia. Xenophobia appears to be a key barrier to positive attitudes toward refugees, whereas both the frequency and quality of social contact may play a protective role. Nursing curricula should therefore strengthen intercultural education and create opportunities for meaningful, positive contact with culturally diverse groups to support inclusive and equitable care.

In recent years, there has been increased public concern surrounding the mental health of young people in Barbados. A significant challenge for young people experiencing mental health conditions is stigma, which is a key barrier to help-seeking. This study aimed to explore how young Barbadians with mental health conditions experience and respond to mental health stigma and help-seeking. Qualitative semi-structured interviews were conducted in 2022 with 28 Barbadians aged 18-24&#xa0;years who reported being diagnosed with a mental health condition, or self-identifying as having experienced mental health challenges. The data were analysed through reflexive thematic analysis. The findings highlighted the importance of culture in how mental health is perceived, and the role of anticipated and experienced stigma deterring help-seeking. Social networks acted as both facilitators and barriers to stigma and help-seeking, and mixed experiences and opinions of formal services raised concerns regarding the quality of care and accessibility. These findings highlight the need for locally informed, culturally relevant strategies and interventions to address and reduce stigma, facilitate help-seeking and improve care outcomes within the community in Barbados.

Up to 30% of in-utero selective serotonin reuptake inhibitor (SSRI)-exposed newborns experience withdrawal and up to 60% experience behavioural impacts. Breastfeeding may offer benefits from skin-to-skin contact and transfer of SSRIs through breastmilk. Limited data are available on healthcare utilisation of these newborns beyond neonatal intensive care unit admission. We aimed to identify whether newborn feeding method affected healthcare utilisation in the first 30 days of postnatal life among Neonates With In-utero SSRI Exposure (NeoWISE). This retrospective cohort study included newborns born in Ontario hospitals between 1 April 2012 and 31 March 2020 to beneficiaries of the Ontario Drug Benefit Program who filled at least one SSRI prenatal prescription. Administrative health and birth registry data were used. Newborn feeding methods were available from birth to hospital discharge. Outcomes were postnatal length of stay (LOS), emergency department visit(s) and hospital readmission within the first 30 days of life. Adjusted linear regression models using inverse probability of treatment weights for feeding method were conducted. The cohort included a total of 5079 NeoWISE participants, with 3321 (65.4%) exclusively breastfed. Formula-fed infants were more likely to have older mothers with an urban residence, lower income quintile, prior live birth, who smoked at delivery and to be born via caesarean delivery; these imbalances were balanced after propensity score weighting. Exclusively breastfed newborns were significantly less likely to have postnatal LOS &#x2265;3&#x2009;days (11.6% vs 16.3%) (adjusted relative risk (adjRR) 0.84, 95% CI 0.72 to 0.97), but more likely to have emergency department visit (adjRR 1.42, 95% CI 1.03 to 1.97) and hospital readmission (adjRR 1.78, 95% CI 1.21 to 2.62) compared with formula-fed newborns, primarily due to jaundice. Women taking SSRI medication during pregnancy should receive anticipatory guidance about newborn feeding effectiveness, signs of jaundice and when to seek healthcare after birth. In-hospital feeding method was associated with emergency department visits and hospital readmission among NeoWISE. Breastfeeding cessation was not measured and could have affected estimated associations.

Despite increasing e-cigarette use among young adults, data on medical students' knowledge, attitudes, and practices (KAP) remain limited. This study assessed KAP regarding e-cigarettes and examined the influence of sociodemographic factors on their use. A cross-sectional study was conducted among 311 MBBS students at RUHS College of Medical Sciences, Jaipur. A validated 37-item questionnaire assessed sociodemographic details and KAP. Responses were recorded on a 5-point Likert scale. Data were analyzed using SPSS version 26 with descriptive statistics, independent t-tests, ANOVA, and chi-square tests. Subgroup analysis compared ever-users and never-users. Among ever-users, the majority were male (74%) and aged 19-23 years (78%). Knowledge gaps were evident, with 23% unaware of e-cigarette types and 63% perceiving them as less harmful than conventional cigarettes. While most participants recognized nicotine-related harms (91%), awareness of regulatory measures was lower, including the national ban (61.6%) and prior taxation (57.5%). Over half (58.9%) considered e-cigarettes not cost-effective. Ever-users demonstrated relatively more favorable attitudes (43.8%); however, most rejected perceived social benefits (75.3%) and supported regulatory bans (56.2%). Overall use was low, with 76.5% reporting no lifetime use; among ever-users, occasional use predominated (43%). Medical students displayed partial awareness and permissive attitudes, but ever-users showed inconsistent cessation behaviors. These findings underscore the need for targeted education and structured cessation support to address rising e-cigarette use in this vulnerable group.

Self-compassion is a core professional value in nursing and is positively associated with nursing students' psychological well-being, academic performance, and caring behaviors. However, heterogeneity and influencing factors in self-compassion among nursing undergraduates remain underexplored. This cross-sectional study investigated latent profiles of self-compassion and their associated factors among Chinese undergraduate nursing students. A total of 2004 participants completed a sociodemographic questionnaire and the self-compassion scale-short form. Latent profile analysis identified three distinct self-compassion profiles: medium self-compassion (42.71%), high self-compassion (30.59%), and an imbalanced profile characterized by higher positive self-compassion but lower reverse-scored negative self-compassion (26.70%). Multinomial logistic regression showed that gender, academic grade, professional attitude, and whether nursing was the first-choice major were significant predictors of profile membership. These findings highlight substantial heterogeneity in self-compassion among nursing undergraduates, with most students demonstrating moderate levels and potential for improvement. Tailored educational and psychological interventions based on self-compassion profiles may help enhance nursing students' self-compassion, professional identity, and mental well-being.

Purpose Feedback literacy is a pivotal concept in education. Students with well-developed feedback literacy are able to understand, interpret, and implement feedback effectively to improve learning and performance. The purpose of the study was to evaluate the effectiveness of a feedback literacy course for dental hygiene students.Methods This study utilized a quantitative randomized control trial comprising a convenience sample of 42 dental hygiene students over two consecutive semesters. The control group received no formal feedback education, while the experimental group completed a feedback literacy module with an in-person feedback workshop, a follow-up in-person reflection activity, and online feedback literacy resources. Feedback Literacy was measured using the Feedback Literacy Scale, where participants self-rated their abilities on a Likert scale. A pre/posttest design was used, paired with supplemental open-ended questions for the experimental group to determine perceived program impact. Descriptive statistics were used to analyze the data.Results Overall Feedback Literacy posttest mean scores of the experimental group (n = 21) were significantly higher (p < 0.001) when compared to controls (n = 21). The experimental group demonstrated statistically significant improvements in Appreciation of Feedback (p < .001), Positive Attitude toward Feedback (p = .001), and Openness to Feedback (p < .001). Four key concepts emerged from open-ended questions posed to experimental group, namely: valuing feedback, seeking feedback, managing emotions, and enhancing self-assessment.Conclusion Students may benefit from feedback literacy training delivered early in their education. The feedback literacy module helped students value feedback, use self-assessment to identify learning gaps, actively seek feedback, and regulate emotions during feedback.

Adolescent girls and young women (AGYW) are among the high-risk groups for new HIV infection, particularly in Sub-Saharan Africa (SSA). HIV testing is an entry path to HIV care and treatment and is crucial in ending the HIV epidemic by 2023. Despite the availability of HIV Testing Services (HTS) in most SSA countries, including Tanzania, most AGYW are undiagnosed HIV or have ongoing HIV exposure. This study explored the enablers for and barriers to the uptake of HTS among AGYW aged 15-24 in northern Tanzania. This qualitative study was conducted between 4th October and 30th November 2024 in the Kilimanjaro Region, northern Tanzania. We included AGYW attending four purposively selected Care and Treatment (CTC) sites. Four Focused Group Discussions (FGDs) (two for 15-19 years and 20-24 years, respectively) were conducted using a semi-structured interview guide to explore perceived enablers for and barriers to the uptake of HTS among AGYW. Data were analyzed using thematic content analysis, and findings were presented narratively, using verbatim quotes. A total of 32 AGYW participated in the FGDs, more than half (53%) were aged 20- 24 years old and had primary education, and 63% (n = 20/32) were still in school. Perceived enablers that may facilitate the uptake of HTS include small blood samples collected, trust of a sexual partner, confidentiality of HIV test results, and existing social support. Other perceived enablers were the provider-centred HIV approach, comprehensive HIV education, health benefits of ARV use, and antenatal care as an entry point to HTS. Perceived barriers to HTS uptake include lack of HTS knowledge, being asymptomatic, fear of HIV test results, spiritual healing beliefs, being visible at the health facility, and anticipated stigma. Other perceived barriers were the provider's negative attitudes, long waiting times, lack of confidentiality of HIV test results, and transport costs. This calls for a multifaceted, client-centred intervention that strengthens the perceived enablers and simultaneously addresses the perceived barriers to create an enabling environment for uptake of HTS among AGYW.

In the past 3 years key recommendations for the management of systemic sclerosis (SSc) have been published, including updated EULAR recommendations and British Society for Rheumatology (BSR) guidelines. These recommendations are generally aligned but also reflect differences in the methodology and scope of the responsible organizations. For both EULAR and BSR, the methodology is robust and aligns with recommendations and guidelines developed for other rheumatic conditions and produced by other specialist societies. Advances in treatment and a growing evidence base for management of interstitial lung disease (ILD), a frequent complication of SSc, have informed additional relevant recommendations that include SSc-ILD. Some of these cover a broad range of ILDs that occur across systemic autoimmune rheumatic diseases, including those developed by the ACR-American College of Chest Physicians and the 2025 European Respiratory Society-EULAR clinical-practice guidelines. The American Thoracic Society has also developed recommendations for SSc-ILD. Taken together, a comparison of these published guidelines provides an overview of best practice evidence-based management that is supported by expert opinion and relevant stakeholders. By considering the overlap and similarity in recommendations and highlighting differences in approach and scope, this article helps readers to navigate an evolving treatment landscape of SSc.

Somalia has one of the highest maternal mortality ratios and low coverage of maternal health services. Evidence on socioeconomic and geographic inequalities across maternal care continuum remains limited. This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia. We analysed data from the 2020 Somali Health and Demographic Survey (SHDS), including 8,598 ever-married women aged 15-49&#x2009;years with a recent live birth. Outcomes were at least one antenatal care visit (ANC), health facility childbirth, and postnatal care (PNC) within 2 days of birth. Multilevel mixed-effects logistic regression examined associations with socioeconomic, geographic, and empowerment-related factors, while Erreygers Concentration Indices (ECIs) assessed wealth-related inequalities. Results are presented as adjusted odds ratios (aORs), ECIs, and 95% confidence intervals (CIs). Coverage was low: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received PNC. Nomadic women were less likely to deliver in a health facility (aOR&#x2009;=&#x2009;0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR&#x2009;=&#x2009;0.49; 95% CI: 0.32, 0.75). Rural residence, the Northeastern and Southcentral zones, and higher parity were associated with lower service utilisation, whereas higher education, mobile phone ownership, household wealth, and media exposure increased utilisation. Pro-rich inequalities were observed for ANC (ECI: 0.40), health facility childbirth (ECI: 0.38), and early PNC (ECI: 0.19). Maternal health service utilisation remains critically low with socioeconomic and geographic inequalities. Equity-focused strategies targeting rural, remote, and nomadic populations are needed to accelerate universal health coverage. Main findings: Coverage of antenatal care, facility childbirth, and early postnatal care in Somalia remains critically low, with substantial inequalities by wealth, geography, and community type.Added knowledge: Using nationally representative survey data, this study shows that women from nomadic, and poorer remote communities are consistently less likely to access essential maternal health services across the maternal care continuum.Global health impact for policy and action: Reducing maternal health inequalities in fragile settings will require targeted outreach, financial protection, stronger primary health care, and sustained investment in women&#x2019;s education and empowerment.