The magnitude and factors associated with chronic liver disease in Ethiopia: a cross- sectional study

doi:10.21203/rs.3.rs-4852735/v1

Download PDF

Research Article

The magnitude and factors associated with chronic liver disease in Ethiopia: a cross- sectional study

https://doi.org/10.21203/rs.3.rs-4852735/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: Chronic liver disease (CLD) is a severe public health problem that affects 1.5 billion people globally. It was Ethiopia's seventh leading cause of death in 2019, with 24 fatalities per 100,000 people.

Objective: This study aimed to determine the magnitude and factors associated with medically confirmed chronic liver diseases among the adult population at selected public health hospitals in the West Arsi zone in 2022.

Methodology: An institution-based descriptive cross-sectional study design with a combination of structured interviews was employed from February 20, 2022, to July 6, 2022, G.C. There were 384 respondents selected using a systematic random sampling method. Multivariate logistic regression analysis was used to determine the factors associated with CLD.

Results: A total of 384 adult participants took part, and 100% of them responded. The magnitude of medically confirmed chronic liver disease among adults in the west Arsi zone is 60.2%, which is higher in males (37.26%). Having a family history of chronic liver disease (AOR = 5.23; 95% CI: 2.59–12.13), drinking more than 20 ml of alcohol per day (AOR = 13.53; 95% CI: 5.50–33.29), smoking cigarettes (AOR = 4.15; 95% CI: 1.70–10.14), chewing khat (AOR = 2.33; 95% CI: 1.13–4.77), eating a high-fat diet (AOR = 3.97; 95% CI: 1.67–9.42), being infected with the viral hepatitis B and C virus (AOR = 18.15; 95% CI: 7.47–44.09), having comorbidities (AOR = 3.58; 95% CI: 1.65–7.77), using herbal medication (AOR = 9.84; 95% CI: 4.58–21.13), and being overweight (AOR = 2.68; 95% CI: 1.05–6.11) all remained statistically significant.

Conclusions: The magnitude of medically confirmed chronic liver diseases in the western Arsi zone is 60.2%, which needs much more attention from the Ministry of Health and local authorities for prevention and interventions focused on behavioral changes, lifestyle modifications, and strengthening viral hepatitis screening activities to tackle these modifiable associated factors with consideration regarding family history of chronic liver diseases.

Chronic Liver Disease

Factors Associated

West Arsi

Ethiopia

The liver, the largest internal organ, is crucial for bodily function, removing poisons, producing immune agents, controlling infection, and regulating blood clotting. Chronic liver disease is a persistent decrease in the physiological activities of the liver that lasts for six months or more. Cirrhosis is a final stage of chronic liver diseasethat results in disruption of liver architecture, the formation of widespread nodules, vascular reorganization, neo-angiogenesis, and deposition of an extracellular matrix and characterized by scar tissue replacing healthy tissue, is the twelfth leading cause of death by disease, causing significant suffering and hospital costs [1].

Cirrhosis, a medical illness, has negative effects on the musculoskeletal system, including sarcopenia, loss of muscle mass, and decreased exercise tolerance [2]. It comes in two varieties: compensated and decompensated. Compensation has lower mortality rates, while decompensated cirrhosis is more common in cases caused by alcohol. Hospitalizations increase as the illness worsens, and liver transplants can be expensive [3].The prevalence of chronic liver diseasesvaries according to age, sex, and race [4]. There are different factors associated with chronic liver diseasesin different populations, particularly among those with different lifestyles and cultures [5].

Chronic liver disease caused by various factors, including chronic alcoholism and hepatitis C. Alcoholic cirrhosis usually develops after over a decade of heavy drinking, with the amount of alcohol affecting the liver varying greatly [6]. Chronic hepatitis C, a virus that causes inflammation and low-grade damage, is a major cause of chronic liver disease in the US. Hepatitis B and D are the most common causes worldwide, causing liver inflammation and injury over several decades. Autoimmune hepatitis attacks the liver, causing inflammation, damage, and scarring. Inherited diseases interfere with the liver's function, while nonalcoholic steatohepatitis (NASH) builds up in the liver and causes scar tissue. Blocked bile ducts, caused by biliary atresia or primary biliary cirrhosis, can also cause cirrhosis. Drugs, toxins, and infections can also contribute to chronic liver disease and leads to cirrhosis[7].

Chronic liver disease is a significant global health concern, accounting for 2.2% of fatalities and 1.5% of disability-adjusted life years [8]. In 2017, 1.32 million individuals died from chronic liver disorders, with higher mortality rates among males [9]. The World Health Organization claims that preventive measures have reduced the incidence of cirrhosis from hepatitis B and C [10]. The etiology of chronic liver disease varies across countries, with factors like alcohol consumption, comorbidities, and access to HBV immunization playing a role [11]. In Africa, the incidence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is estimated at 13% [12]. The Sub-Saharan African region has a high frequency of chronic liver disease due to economic insufficiency, skepticism towards Western medicine, and limited access to healthcare facilities [11, 12]. In Ethiopia, chronic liver disease ranks as the seventh leading cause of mortality, with 24 deaths per 100,000 individuals [13].

The statistics represent the full picture of the situation in Ethiopia, but there is no information available on any specific subgroup of populations, such as the West Arsi Zone population. Despite existing knowledge concerning the magnitude of CLD in Ethiopia, its associated factors have not been exhaustively explored. Various investigations of chronic liver disease (CLD) have generated certain contentious postulation that necessitate further research, including but not limited to advanced age, gender, domicile, educational attainment, alcohol consumption, kchat use, and the presence of comorbidities. This study assumes critical significance insofar as it yields information pertinent to the effective management of chronic liver disease. To date, no scholarly inquiry has been conducted in the realm of inquiry that bears any resemblance to the subject matter under consideration.

This study investigates the magnitude and factors associated with medically confirmed chronic liver disease among adults on follow-up evaluation in selected public hospitals in the West Arsi Zone.

Theoretical framework

This study was informed by a literature review to establishthetheoretical foundationfor this study. This framework divides factors thatare associated with medically confirmed chronic liver disease (CLD)into three distinct categories:Socio-demographic and economic factors involve sex, age, income, education, residence, marital status, cultural pattern, and family support, while behavioral related factors involve alcohol intake, cigarette smoking, khat chewing, and physical activity, and clinical related factors involve viral hepatitis, comorbidities, and increased body mass index (BMI) [14–20].

This institutional-based descriptive cross-sectional study was conducted from February 20, 2022, - July 6, 2022, in three public hospitals located in the West Arsi zone: Shashamane Comprehensive and Specialized Hospital, Melka Oda General Hospital, and Negele Arsi Hospital.All adult (18 years or older) medically confirmed and/or probable chronic liver disease patients on follow-up care were included except those who were critically ill at the time of data collection. A formula for a single population percentage was used to calculate the right sample size, taking the population's infinity into account and the net sample of 384 was recruited using a systematic random sampling method to ensure representativeness between hospitals since they had greatly unequal chronic liver disease patient population. Accordingly, we have selected 130 patients from Negele Arsi Hospital, 127 from Shashamane Comprehensive and Specialized Hospital, and 127 fromMelka Oda General Hospital. The study participants were chosen using a systematic random sampling methodology every two patients. The data was collected in two local languages Afaan Oromo and Amharic languages using interviewer-administered questionnaire. Three nursesholding Bachelor of Science degree were involved in data collection under the supervision of a senior nurse professional. The principal investigator also made continues follow up in order to ensure the quality of the data collected[21]. The research project was reviewed by an Institutional Review Board of the College of Health Sciences at Addis Ababa University. Permission to conduct the research was obtained from the authorities in the study settings and written informed consents were secured from each participant.

Measurements

Before data collection, we took measures to ensure meaning equivalence between the original English version of the questionnaire and the versions in the two local languages. The questionnaire was translated from English to Afan Oromo and Amharic languages by a multilingual translator and then back translated to English by another multilingual translator. The sociodemographic and economic characteristics of the participants were recorded using 15 items that were used to measure age, gender, marital status, educational status, occupation, residence, monthly income, family history of chronic liver disease, and family support. The behavioral components were recorded using 15 items and were used to measure six areas or domains of behaviorally related factors of chronic liver diseases: drinking alcohol greater than 20 ml daily, smoking cigarettes, chewing khat, regular physical activity (exercise), eating fruits and vegetables, and consuming foods high in animal fats [22]. The clinical characteristics were recorded using 11 items used to measure comorbid diseases like DM, HIV/AIDS, NAFLD, viral hepatitis infection, use of herbal medicines, and body mass index (BMI) [23].

Patient assessment

Fit patients visiting Shashamane Comprehensive and Specialized Hospital, Negele Arsi Hospital, and Melka Oda General Hospital underwent semistructured interviews with neighborhood nurses who were native speakers of their mother tongues [24]. Chronic liver disease (CLD) is the progressive deterioration of liver functions that lasts over six months. CLD status is classified into two categories, which include medically confirmed CLD (yes): chronic liver diseases were medically diagnosed in addition to signs and symptoms by using biochemical tests and radiological studies. Probable CLD (no): clinically suspected chronic liver diseases but not medically confirmed Factorsare classified and presented into the following categories: socioeconomic factors, behavioral factors, and clinically related factors. Potential risk factors were investigated, and demographic information was gathered [25].

The amount of alcohol consumed in the past and present was measured in milliliters. Alcohol abuse was deemed to have occurred if the research subject consumed more than 20 grams or 20 ml of alcohol per day for more than six months, whether it was manufactured or produced locally [26]. When a patient reported chewing khat in any amount every day for more than six months, it was determined that the patient was chewing khat. Smoking cigarettes is defined as a daily cigarette habit that lasts longer than six months [27]. Physical inactivity was defined as if the patient was not engaged in any moderate-intensity aerobic physical activity (brisk walking, hand-sweeping, gardening, swimming, or recreational cycling) for three days per week not less than 30 minutes and if the patient was not allowed to engage in any vigorous-intensity aerobic physical activity (jogging or running, playing soccer, digging with a shovel, playing basketball or tennis, or engaging in martial arts or equivalents) for two days per week not less than 15 minutes [28]. Family support was defined as any assistance from loved ones in the treatment of chronic liver disease. Each patient's weight was calculated using precalibrated weighing equipment, ensuring that they were all wearing loose clothes and had no shoes on. Between each measurement, the weighing scales were examined and reset to zero, and the equipment was regularly calibrated using a known object. The prescribed methods were used to measure height [29]. Kg/m2 was used to compute body mass index, which was then divided into four categories: underweight (< 18.5 kg/m2), overweight (25–29.9 kg/m2), and obese (30–34.9 kg/m2).

Data processing and analysis

Epidata version 4.6 was used to code, input, and export the obtained data before being verified as complete and sent to SPSS version 25 for analysis. Frequency and SD descriptive statistics were computed. Bivariate and multivariate analyses were conducted using the statistical approach of binary logistic regression to examine the relationship between the dependent and independent variables. The variables from the bivariate logistic regression analysis with p values of 0.25 at the 95% CI were also considered in the multivariate analysis. Finally, predictors for chronic liver disorders were judged statistically significant if they had a p-value of less than 0.05 and a 95% confidence interval [30].

Sociodemographic characteristics

A total of 384 adult participants with a 100% response rate were included in the research. A total of 224 people, or 58.3% of the total, were male participants. The majority of respondents (191, 49.7%) were married. As depicted in Table 1 below, the mean age of the respondents was 42.77 ± 13.110 years; 102 (26.6%) had secondary education; 84 (21.9%) worked for the government; and 209 (54.4%) lived in urban areas. The respondents' average monthly income was 2613.50 ± 1495.94 ETB.

Table 1

Distribution of sociodemographic characteristics of study participants at selected public hospitals, West Arsi Zone, Oromia, Ethiopia 2022 (n = 384)
Variables	Response	n (%)
Sex	Male	224 (58.3%)
	Female	160 (41.7%)
Marital Status	Married	191 (49.7%)
	Single	130 (33.9%)
	Divorced	40 (10.4%)
	Windowed	23 (6.0%)
Age in years(42.77 ± 13.110)*	Above mean age	69(17.9%)
	Below mean age	65(16.9%)
Educational status	Cannot read and write	36 (9.4%)
	Able to write and read	79 (20.6%)
	Primary	70 (18.2%)
	Secondary	102 (26.6%)
	Diploma and above	97 (25.3%)
Occupational status	Government employee	84 (21.9%)
	Merchant	83 (21.6%)
	Farmer	83 (21.6%)
	Student	44 (11.5%)
	Other	90 (23.5%)
Residence	Urban	209 (54.4%)
	Rural	175 (45.6%)
Average monthly incomeETB (2613.50 ± 1495.942)*	Above mean	186 (48.4%)
Average monthly incomeETB (2613.50 ± 1495.942)*	Below mean	68 (17.73)
Note: *mean ± standard deviation, ETB: Ethiopian birr, km: kilometer ^a: other occupational status includes; housewife, daily laborer, and Retired.

The behavioral and sociocultural characteristics of the study participants

Of the total respondents, 280 (72.9%) drank more than 20 milliliters of alcohol per day, 110 (28.6%) smoked cigarettes, 222 (57.5%) chewed khat, 280 (72.9%) consumed foods high in animal fat, 284 (74.0%) consumed produce, 216 (56.2%) used herbal remedies, 226 (58.9%) engaged in sustained physical activity as shown in Table 2 below, 274 (71.4%) received support from their families in sticking with treatment, and231(60.2%) had medically confirmed chronic liver diseases.

Table 2

Behavioral and sociocultural characteristics of study participants at selected public hospitals in the West Arsi Zone, Oromia, Ethiopia, 2022 (n = 384)
Variables	Response	n (%)
Alcohol consumption > 20 ml per day	Yes	280(72.9%)
	No	104(27%)
Smoking cigarettes	Yes	110(28.6%)
	No	274(71.3%)
Chewing khat	Yes	222(57.8%)
	No	162(44%)
Consuming high animal fatty diets	Yes	280(72.9%)
	No	104(27%)
Consuming Fruit and vegetable	Yes	284(74.0%)
	No	100(26.0%)
Herbal medicine use	Yes	216(56.2%)
	No	168(43.7%)
Regular physical activity	Yes	226(58.9%)
	No	158(41.1%)
Family support	Yes	274(71.4%)
	No	110(28.6%)
CLD status	Yes	231(60.2%)
	No	153(39.84%)
Note: ml: milliliter

The clinical characteristics of the study participants

The study's findings showed that 240 (62.5%) of participants had no family history of chronic liver disease, 88 (22.9%) reported no familial death attributed to CLD, 225 (58.6%) of them had health insurance, 196 (51%) said it had not caused them to contract viral hepatitis, 214 (55.7%) reported no comorbidities as depicted in Table 3, and the average body mass index (BMI) of the participants was 22.8 +/-SD.

Table 3

Distribution of clinical-related characteristics of study participants at selected public hospitals, West Arsi Zone, Oromia, Ethiopia 2022 (n = 384)
Variables	Response	n (%)
Family history of CLD	Yes	143(37.2%)
	No	240(62.5%)
Family death due to CLD	Yes	58(15.1%)
	No	88(22.9%)
Medical Insurance	Yes	225(58.6%)
	No	130(33.9%)
Viral hepatitis infection	Yes*	159(41.4%)
	No	196(51%)
Comorbid disease	Yes**	170 (44.3%)
	No	214 (55.7%)
Body Mass Index		Health Weight (18.5–24.9 kg/m²)	207(53.9%)
		Under Weight (< 18.5 kg/m²)	21 (5.4%)
		Over Weight (25-29.9 kg/m²)	102 (26.5%)
		Obese (30-34.9 kg/m²)	54 (14%)
Note: CLD: chronic liver disease, NAFLD: nonalcoholic fatty liver disease, kg/m²: kilograms per meter square ^a: : were embraces viral hepatitis Band C. ^b: *: were embraces diabetes mellitus, HIV/AIDS, heart disease, nonalcoholic fatty liver disease (NAFLD), and hypertension.

Factors associated with chronic liver diseases

Men, aging, living in urban areas, having a family history of chronic liver disease (CLD), drinking alcohol, smoking cigarettes, chewing khat, engaging in regular physical activity, eating an animal-fat-rich diet, having viral hepatitis that has been medically confirmed, having comorbid conditions, using herbal remedies, and being overweight were the factors that had an association with medically confirmed CLD in the bivariate analysis. P values of less than 0.25 were found to be substantially linked with these variables. Nine factors were found to be linked to medically confirmed CLD in the multivariate model: having a family history of CLD, drinking more than 20 ml of alcohol per day, smoking, chewing khat, eating a high animal fat diet, having viral hepatitis, having comorbid conditions, using herbal medications, and being overweight. A family history of CLD increased the risk of developing medically confirmed CLD by 5.23 times compared to not having one (AOR = 5.23, 95% CI = 2.59–12.13). They were 13.53 times more likely to acquire medically diagnosed CLD if they consumed more than 20 cc of alcohol per day compared to those who did not (AOR = 13.53, 95% CI: 5.50-33.29). Smokers had a 4.15 times greater chance than nonsmokers of developing medically proven CLD (AOR = 4.15 (95% CI: 1.70–10.14)). They were 2.33 times more likely to acquire medically verified CLD if they chewed khat than if they did not chew (AOR = 2.33; 95% CI: 1.13–4.77). They were 3.97 times more likely to acquire medically diagnosed CLD if they ate a diet heavy in animal fat than if they did not (AOR = 3.97; 95% CI: 1.67–9.42). As depicted in Table 4 below, they were 18.15 times more likely to have medically proven CLD if they had viral hepatitis B and Chad than if they did not (AOR = 18.15; 95% CI: 7.47–44.09). Comorbidities increased the risk of developing medically verified CLD by 3.58 times compared to those without them (AOR = 3.58; 95% CI: 1.65–7.77). The risk of developing medically proven CLD was 9.84 times higher in those who took herbal medications than in people who did not (AOR = 9.84, 95% CI: 4.58–21.13). They were 2.68 times more likely to have medically diagnosed CLD if they were overweight compared to those who were normal weight (AOR = 2.68; 95% CI: 1.05–6.71). At a p-value of 0.05 or below, these connections were declared statistically significant.

Table 4

Significant variables only using backward variable selection to identify factors associated with medically confirmed CLD at selected public hospitals, West Arsi Zone, Oromia, Ethiopia, 2022 (n = 384)
Variables	Response	CLD		COR (95%CI)	AOR (95%CI)	P value
Variables	Response	Yes	No	COR (95%CI)	AOR (95%CI)	P value
Family history of CLD	Yes	109	34	3.10 (1.95–4.91)	5.23(2.25–12.13)	< .001***
Family history of CLD	No	122	118	1	1
Alcohol intake > 20 ml daily	Yes	208	72	10.17 (5.95–17.37)	13.535(5.50-33.29)	< .001***
Alcohol intake > 20 ml daily	No	23	81	1	1
Smoking cigarettes	Yes	97	13	7.79(4.17–14.57)	4.15(1.70-10.14)	.002**
Smoking cigarettes	No	134	140	1	1
Chewing khat	Yes	158	64	3.01 (1.96–4.35)	2.33 (1.13–4.77)	.021**
Chewing khat	No	73	89	1	1
Consuming high animal fatty diet	Yes	187	93	2.74 (1.72–4.35)	3.97(1.67–9.42)	.002**
Consuming high animal fatty diet	No	44	60	1	1
Viral hepatitis	Yes	157	31	8.35 (5.15–13.51)	18.15(7.47–44.09)	< .001***
Viral hepatitis	No	74	122	1	1
Comorbid disease	Yes	130	44	3.18 (2.06–4.93)	3.58(1.65–7.77)	.001**
Comorbid disease	No	101	109	1	1
Using herbal medicines	Yes	184	32	14.80(8.93–24.51)	9.84(4.58–21.13)	< .001***
Using herbal medicines	No	47	121	1	1
Body Mass Index (BMI = kg/m²)	18.5–24.9	114	93	1	1	0.108
	< 18.5	14	7	1.26(.55-2.87)	1.488(.253- 8.745)	0.66
	25-29.9	71	31	1.84(.55-6.12)	2.681(1.054–6.817)	.038*
	30-34.9	32	22	1.84(.75-4.49)	.65(.22 − 1.90)	0.44
Note: COR: crude odds ratio, AOR: adjusted odds ratio, CI: confidence interval, CLD: Chronic Liver Disease, NAFLD: Non-Alcoholic Fatty Liver disease, ml = Mil litter, ^a:1 = Reference ^b: BMI:<18.5 = Under Weight, 18.5–24.9 = Health Weight, 25-29.9 = Over Weight, 30-34.9 = Obese ^c: p < .05 p < .01 **p < .001

This study showed that the magnitude of medically confirmed chronic liver diseases among adults was 231 (60.2%), which was in line with a study conducted in sub-Saharan Africa, where there is a high burden of cirrhosis and more than 50% of patients are admitted to hospitals with end-stage chronic liver disease [31]. Of 231 (60.2%) males, 143 (37.26%) were male, while 88 (22.93%) were medically confirmed to be female adults, which is in line with a study conducted in Europe and Mexico [32, 34]. Even if it is difficult to conclude that males are more at risk of developing CLD than females, studies have described that, due to the protective effect of estrogen hormone, females are less likely to develop medically confirmed chronic liver disease than males [35, 36].

This study shows that those who have a family history of chronic liver disease are more likely to develop medically confirmed CLD than those who do not. From a scientific perspective, numerous hereditary disorders may cause liver damage and contribute to the development of chronic liver disease, rather than chronic liver disease invariably being a hereditary disease [37].

According to this study, those who drink more than 20 ml of alcohol per day have a noticeably higher chance of acquiring chronic liver disease (CLD), which has a medically verified prognosis, than those who abstain from alcohol. This outcome is in line with those of other research conducted in areas such as sub-Saharan Africa and central India [13, 23, 25, 26]. Drinking alcohol for a long time can increase the risk of alcoholic liver disease, which damages the liver cells and causes scar tissue. According to numerous studies [38–40], this might therefore result in the development of chronic liver disease and hepatocellular carcinoma (HCC). The observed discrepancy may be in the classification parameters used to separate alcohol consumers from nonconsumers. Regardless of the actual amount of alcohol consumed, the threshold for daily alcohol intake in this study and previous scientific investigations was at least 20 milliliters. In contrast, some studies have utilized the length of alcohol usage and the amount drank as criteria for classifying people as drinkers or abstainers [41]. The conventional Cut Down, Annoyed, Guilty, and Eye-Opener (CAGE) instrument was utilized in the prior research, which might not have taken into consideration the precise amount of alcohol drunk. According to research, the main factor influencing the development of chronic liver disease (CLD) is the quantity of alcohol taken, regardless of the kind of alcohol consumed. Intake of more than 60 to 80 grams per day for males and more than 20 grams per day for women for a decade enhanced the chance of acquiring this condition [42]. Therefore, it is conceivable that this underlying element is what causes the observed fluctuation.

The findings of this study showed that, compared to nonsmokers, those with a history of smoking were more likely to have medically proven chronic liver disease. This result is in line with research conducted in several regions, including Sub-Saharan Africa, Central India, Copenhagen, and China [13, 26, 28, 29]. The occurrence of liver damage due to nicotine ingestion is due to the physiological process in which nicotine is absorbed through inhalation and rapidly metabolized in the liver. The observed discrepancy may result from variations in the classification standards used to separate smokers from nonsmokers [43]. The baseline for smokers in this study was when the patient smoked cigarettes of any dosage every day, regardless of how many cigarettes they smoked. In contrast, several studies have utilized consumption volume as a criterion for classifying people as smokers or nonsmokers. For smokers, previous studies have indicated that intakes of more than 10 grams per day increase the chance of developing chronic liver disease. Therefore, it is plausible to believe that this underlying element is what causes the observed variability [44].

According to this study, there is a statistically significant link between a patient's history of khat use and their propensity to develop chronic liver disease. This discovery lends more support to the causal link between khat use and the onset of chronic liver disease since it is similar to results previously reported in a study carried out in Ethiopia [14, 36].

According to this study, people who frequently consume a diet high in animal fat have a higher risk of developing chronic liver disease than people who do not. This finding is consistent with research conducted in the US [44]. A notable association was found about cholesterol consumption, which may lead to the unrestricted accumulation of cholesterol in liver parenchyma cells and affect the cell physiology of hepatocytes [13, 44].

According to this study, individuals who tested positive for the hepatitis B and C viruses had a much higher risk of developing medically recognized chronic liver disease than those who did not. This study supports the findings of other studies that were carried out in places such as India, sub-Saharan Africa, Togo, and Ethiopia, as reported in the literature [31, 33, 34, and 36]. The rationale provided by science for why viral hepatitis, especially hepatitis B and hepatitis C, can cause cellular necrosis, an inflammatory response, cytokine production, and hepatic fibrosis As a result, chronic hepatitis can result in life-threatening conditions such as cirrhosis, liver failure, and hepatocellular cancer [16]. Nevertheless, this study is not exempt from its inherent limitations, despite the findings' important importance to the field of chronic liver disease. The lack of access to reviewable medical records significantly hindered the collection of a history of chronic viral hepatitis for most individuals. Consequently, the influence of this important variable was not evaluated in this study.

According to this study, those who had comorbidities such as diabetes mellitus, HIV/AIDS, heart disease, nonalcoholic fatty liver disease (NAFLD), and hypertension had a higher risk of developing medically diagnosed chronic liver diseases than those who did not have these conditions. This result is in line with other research from Ethiopia and central India as well as the overall prevalence of NAFLD and NASH [14, 15, 16, 17, 18]. The typical spectrum of NAFLD, which includes hepatic steatosis without any obvious secondary sources of liver fat accumulation, may be the reason for this connection. The medication used to treat the illness and its comorbidities may harm liver cells by impairing their ability to operate [44, 45].

According to this study, those who had ever taken herbal drugs had a greater likelihood of developing medically verified chronic liver disease than people who had not. This result is in line with research conducted in China [35]. The liver is a key organ for filtering toxins, which explains why there is a link between the two. By engendering deleterious compounds during the metabolic process, certain herbs can harm liver cells.

In line with a study performed in Ethiopia and central India, it has also been discovered that people with a body mass index (BMI) in the range of 18.5 to 24.9 kg/m2 (classified as a healthy weight) are less likely to develop medically confirmed chronic liver disease (CLD) than those with a BMI in the range of 25 to 29.9 kg/m2 (classified as overweight) [29, 32]. Body mass index (BMI) and the chance of acquiring chronic illnesses linked to the buildup of adipose tissue are positively correlated, which is the fundamental reason for this phenomenon [45]. The fundamental reason for this phenomenon is linked to the buildup of adipose tissue, which increases the chance of acquiring chronic illnesses [45].

The magnitude of medically confirmed CLD was 60.26%. Being infected with viral hepatitis (hepatitis B and C viruses), indulging in the consumption of alcohol, using herbal medications, having a familial background of ailment, being a habitual smoker of cigarettes, regularly consuming a diet rich in animal fats, exhibiting symptoms of comorbid conditions such as diabetes mellitus, HIV/AIDS, heart disease, nonalcoholic fatty liver disease (NAFLD), and hypertension, engaging in the practice of khat chewing, and exhibiting the condition of being overweight were factors significantly associated with confirmed chronic liver disease.

anti-HCV

HCV antibody

BMI

body mass index

confidence interval

CLD

chronic liver disease

DALYs

disability-adjusted life years

GBD

Global Burden of Disease

ETB

Ethiopian Birr

HBV

hepatitis B virus

HBsAg

hepatitis B surface antigen

HCV

hepatitis C virus

HIV

human immunodeficiency virus

H.P.S.

hepatopulmonary syndrome

milliliter

NASH

nonalcoholic steatohepatitis

PWYLL

potential working years of life

Competing interests

All authors reported no conflicts of interest for this work. The authors followed all ethical principles of scholarship in the preparation, data collection, analysis, interpretation, and completion of this thesis. All scholarly matters addressed in the thesis have been given recognition through citations, and all sources used to prepare the document are included in the list of references. This thesis is a partial fulfillment of the requirement for graduation with a master's degree from the School of Nursing and Midwifery postgraduate studies at Addis Ababa University. A hard copy of the thesis is in the library of Addis Ababa University and available to the user under the rules of the library. We have included acknowledgments and conflicts of interest. We did not receive any financial support from our organization, and we confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication by any journal.

Author Contributions Statement

The paper is the result of joint research, and the contribution of every author is comparable to the others. LB. searched the literature, trained field researchers for data collection, and wrote draft results and reviews of the manuscript. GD. has participated in the data analysis, interpretation, and review of the manuscript for publication. HT has participated in the data analysis, the conceptualization of the paper (report), manuscript preparation, and other necessary document preparation for publication. All the authors have read and approved the final manuscript.

Ethics approval and concept to participate

The Addis Ababa University Health Sciences College Institutional Review Board authorized the study (protocol number: 18/22/SNM, meeting number: 10/2014EC). A letter from the School of Nursing was obtained, and the chief clinical director, matron officer, and coordinators of the gastrointestinal units of the chosen hospitals all provided their authorization for the study to be carried out. The Declaration of Helsinki was followed when conducting the study. Before any data were collected, the study's goal and purpose were explained to the participants, and both verbal and written informed consent was obtained. Additionally, it was made clear to respondents that they could end the interview at any moment. Instead of utilizing any personal identifiers, a code was used to ensure the confidentiality of the information throughout the study procedure, and it was only used for the study.

Consent for publication

Not applicable

Competing interest

No competing interests

Funding

The study was funded by the grant office of Addis Ababa University's College of Health Sciences, postgraduate office.

Author Contribution

A. LB. searched the literature, trained field researchers for data collection, and wrote draft results and reviews of the manuscript. B. GD. has participated in the data analysis, interpretation, and review of the manuscript for publication. C. HT has participated in the data analysis, the conceptualization of the paper (report), manuscript preparation, and other necessary document preparation for publication. All the authors have read and approved the final manuscript.

Acknowledgments

The authors would like to acknowledge Addis Ababa University, the College of Health Sciences, the School of Nursing and Midwifery, Madda Walabu University, and the study participants for their unreserved support during data collection.

Availability of data and materials

All relevant data are included in the manuscript document. If necessary, it is possible to contact the corresponding author to obtain additional materials.

Flamm, S. L. (2018). Complications of cirrhosis in primary care: Recognition and management of Hepatic encephalopathy. The American Journal of the Medical Sciences, 356(3), 296–303.
Allen, S. L., Quinlan, J. I., Dhaliwal, A., Armstrong, M. J., Elsharkawy, A. M., Greig, C. A., Lord, J. M., Lavery, G. G., & Breen, L. (2021). Sarcopenia in chronic liver disease: mechanisms and countermeasures. American journal of physiology. Gastrointestinal and liver physiology, 320(3), G241–G257.
Tandon, P., Ismond, K.P., Rises K, Duarte-Rojo, A., Al-Jundiai, B., et al (2018). Exercise in cirrhosis: Translating evidence and experience to practice. Journal of hepatology, 69(5), 1164-1177.
Singh, S., Fuji, L. L., Murad, M.H., Wang, Z., Asrani, S.K., et al (2013). Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 11(12), 1573-1584.
Fleming, K. M., Aithal, G. P., Card, T. R., West, J. (2012) All‐cause mortality in people with cirrhosis compared with the general population: a population‐based cohort study. Liver International, 32(1), 79-84.
Fialla, A. D., de Muckadell, O. B. S., Touborg Lassen, A. (2012). Incidence, etiology and mortality of cirrhosis: a population-based cohort study. Scandinavian journal of gastroenterology, 47(6), 702-709.
World Health Organization.Global Health Estimates 2016: Death by Cause, Age, Sex, by Country and by Region, 2000-20016 Geneva: World Health Organization; 2018 [cited 2020 July 20].
Marcellin, P., Kutala, B. K. (2018). Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver International, 38, 2-6.
Shin, H. S., Jun, B. G., & Yi, S. W. (2022). Impact of diabetes, obesity, and dyslipidemia on the risk of hepatocellular carcinoma in patients with chronic liver diseases. Clinical and molecular hepatology, 28(4), 773.
Paik, J. M., Golabi, P., Younossi, Y., Mishra, A., & Younossi, Z. M. et al (2020). Changes in the global burden of chronic liver diseases from 2012 to 2017: the growing impact of NAFLD. Hepatology,72(5), 1605–1616.
World Health Organization. (‎2016)‎. Global health sector strategy on viral hepatitis 2016-2021. Toward ending viral hepatitis (No. WHO/HIV/2016.06). World Health Organization.
World Health Organization. (2018). The work of WHO in Ethiopia during 2017.
Chao, T. E., Sharma, K., Mandigo, M., Hagander, L., Resch, S. C., et al (2014). Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. The Lancet Global Health, 2(6), e334-e345.
Tesfaye, B. T., Feyissa, T. M. et al (2021).Chronic liver disease in Ethiopia with a particular focus on the etiological spectrums: a systematic review and meta-analysis of observational studies. Canadian Journal of Gastroenterology and Hepatology, 2021.
Sepanlou, S. G., Safiri, S., Bisignano, C., Ikuta, K.S., Merat, S., et al (2020). The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet gastroenterology & Hepatology, 5(3), 245-266.
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., et al (2018). Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature reviews Gastroenterology & Hepatology, 15(1), 11-20.
Samji, N. S., Verma, R., Satapathy, S. K. (2019). Magnitude of nonalcoholic fatty liver disease: Western perspective. Journal of Clinical and Experimental Hepatology, 9(4), 497-505.
Targher, G., Tilg, H., Byrne, C. D. (2021). Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach. The lancet. Gastroenterology & hepatology, 6(7),578–588.
Shreedfar, F., Biase, S. D., Koonen, D., Vinciguerra, M. (2013). Liver diseases and aging: friends or foes. Aging cell, 12(6), 950-954.
Maeso-Díaz, R., Gracia-Sancho, J. (2020, November). Aging and chronic liver disease. In seminars in liver disease (Vol. 40, No. 04, pp. 373–384).
Lee, C., Kim, J., Jung, Y. (2019). Potential therapeutic application of estrogen in gender disparity of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Cells,8(10), 1259.
Goncalves, P. L., da PenhaZago-Gomes, M., Marques, C. C., Mendonca, A. T., Gonçalves, C. S., et al (2013). Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espirito Santo. Clinics,68(3), 291-295.
Doycheva, I., Issa, D., Watt, K. D., Lopez, R., Rifai, G., et al (2018). Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in young adults in the United States. Journal of clinical gastroenterology, 52(4), 339-346.
Harman, D. J., Ryder, S. D., James, M. W., Jelpke, M., Ottey, D. S., et al (2015). Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: a cross-sectional diagnostic study utilizing transient elastography. BMJ Open,5(4), e007516.
Banat, S., Bedloe, S.M., Jain, J., Thorat, A. (2021). Risk factors for chronic liver disease in population of Central India: a case‒control study from rural India. Egyptian Liver Journal, 11, 1-9.
Desai, A. P., Mohan, P., Roubal, A.M., Bettencourt, R., Loomba, R. et al (2018). Geographic variability in liver disease-related mortality rates in the United States. The American journal of medicine,131(7), 728-734.
Dam, M. K., Flensborg-Madsen, T., Eliasen, M., Becker, U., Tolstrup, J. S.et al (2013). Smoking and risk of liver cirrhosis: a population-based cohort study. Scandinavian journal of gastroenterology, 48(5), 585-591.
Ou, H., Fu, Y., Liao, W., Zheng, C., Wu, X.et al (2019).Association between Smoking and Liver Fibrosis among Patients with Nonalcoholic Fatty Liver Disease. Canadian Journal of Gastroenterology and Hepatology, 2019.
Byass, P. (2014). The global burden of liver disease: a challenge for methods and for public health. BMC Medicine, 12, 1-3.
Spearman, C. W.,Sonderup, M. W. (2015). Health disparities in liver disease in sub-Saharan Africa. Liver International, 35(9), 2063–2071.
EASL HEPAHEALTH Steering Committee. (2018). Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. Journal of Hepatology, 69(3), 718–735.
Mukherjee, P. S., Vishnubhatla, S., Amarapurkar, D. N., Das, K., Sood, A., et al (2017). Etiology and mode of presentation of chronic liver diseases in India: A multi centric study. PolS one, 12(10), e0187033.
Bagny, A., Bouglouga, O., Lawson-Ananissoh, L. M., Dusabe, A., Kaaga, Y. L., et al (2015). Quality of life of the patients suffering from chronic liver diseases at the university health center campus of Lomé. Open Journal of Gastroenterology, 5(07), 88.
Hong, M., Li, S., Tan, H. Y., Wang, N., Tsao, S. W., et al (2015). Current status of herbal medicines in chronic liver disease therapy: the biological effects, molecular targets and future prospects. International journal of molecular sciences, 16(12), 28705-28745.
Ashenafi, W., Eshetu, F., Assefa, N., Oljira, L., Dedefo, M., et al (2017). Trend and causes of adult mortality in Kersa health and demographic surveillance system (Kersa HDSS), eastern Ethiopia: verbal autopsy method. Population Health Metrics, 15, 1-10.
Setiawan, V.W., Stram, D.O., Porcel, J., Lu, S.C., Le Marchand, L., et al (2016). Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology, 64(6), 1969-1977.
Von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., Gotzsche, P.C., et al (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. The lancent, 370(9596), 1453-1457.
Hosmer Jr, D. W., Lemeshow, S., Sturdivant, R. X. (2013). Applied logistic regression. John Wiley & Sons.
Manne, V., Kowdley, K. V. (2020). Alpha1-antitrypsin deficiency: a cause of chronic liver disease. Clinics in liver disease, 24(3), 483–492.
Seitz, H. K., Bataller, R., Cortez-Pinto, H., GAO, B., Gual, A., et al (2018). Alcoholic liver disease. Nature reviews Disease primers, 4(1), 16.
Ganne-Carrié, N., Nahon, P. (2019). Hepatocellular carcinoma in the setting of alcohol-related liver disease. Journal of hepatology, 70(2), 284–293.
Doycheva, I., Issa, D., Watt, K. D., Lopez, R., Rifai, G., et al (2018). Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in young adults in the United States. Journal of clinical gastroenterology, 52(4), 339-346.
Jarvis, H., Craig, D., Barker, R., Spiers, G., Stow, D., et al (2020). Metabolic risk factors and incident advanced liver disease in nonalcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies. PLoS medicine, 17(4), e1003100.
Navarro, V. J., Khan, I., Björnsson, E., Seeff, L.B., Serrano, J., et al (2017). Liver injury from herbal and dietary supplements. Hepatology, 65(1):363-373.
Saitta, C., Pollicino, T., Raimondo, G. (2019). Obesity and liver cancer. Annals of hepatology, 18(6), 810–815.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
08 Aug, 2024
Editor assigned by journal
06 Aug, 2024
Submission checks completed at journal
06 Aug, 2024
First submitted to journal
03 Aug, 2024

You are reading this latest preprint version

The magnitude and factors associated with chronic liver disease in Ethiopia: a cross- sectional study

Status:

Version 1

Abstract

Introduction

Theoretical framework

Methodology

Measurements

Patient assessment

Data processing and analysis

RESULTS

Sociodemographic characteristics

The behavioral and sociocultural characteristics of the study participants

The clinical characteristics of the study participants

Factors associated with chronic liver diseases

DISCUSSION

Conclusion

Abbreviations

Declarations

Competing interests

Author Contributions Statement

Consent for publication

Funding

Author Contribution

Acknowledgments

Availability of data and materials

References

Additional Declarations

Status:

Version 1