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The ambition of this study was to identify the factors that influence the financial situations of small and medium enterprises (SMEs) in Somalia. The research objectives of this study were to determine how capital building affected the financial situations of SMEs in Somalia, how human resource capacity affected the financial situations of SMEs, and what the impact of access to financing was according to the business conditions of SMEs. This study uses both descriptive and quantitative research approaches. The study’s main demographics consisted of 90 SMEs in Somalia; the shortage of female personnel may also be a disadvantage, considering that most paying customers were female. The study’s first research question was to investigate whether the use of committees improves the quality and efficiency of the board’s tasks and mandates. The study’s second research question was to determine the impact of human resources. The study’s findings about market adoption of technological trends also revealed a strong positive relationship between human resource performance and financial performance. The Somali government should implement SME policies based on development and new growth industries, such as migration. Investment and credit firms, such as private sector banks and donor organizations, should lower the requirements for their investments. SME owners and managers should hire educated staff and increase the number of female employees. SME owners and managers should develop training schedules focusing on financial management, innovation, communication, and promotional abilities.

Background Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications. Methods We will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study. Discussion This is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean. Trial registration ClinicalTrials.gov, NCT04060667. Registered on 08/01/2019.

Additional file 1.