Prevalence and Associated Factors of Liver Disease among Adults: A cross–sectional study at a Health facility in North-Eastern Part of Ghana

Introduction

Liver disease is the leading cause of liver-related deaths worldwide [1]. Despite significant interventions such as hepatitis B vaccination and advances in antiretroviral therapy in the treatment of liver disease [2], the incidence of liver disease such as non-fatty liver and alcoholic liver disease following end-stage liver-related morbidity is increasing [3]. Recent estimates suggest that approximately 1.5 billion people living with chronic liver disease are experiencing an epidemiological shift to liver complications which is attributed to concomitant increases in drug use, inappropriate alcohol use, and metabolic syndrome, despite ongoing containment measures on the incidence of liver disease [2]. Available statistics show that the world population is experiencing a dramatic increase in non-alcoholic liver disease from 8.2% to 10% within two decades [3]. Compared to obesity and type II diabetes, non-alcoholic liver disease is increasing, with prevalence increasing from 75% in 2016 to 30% in 2019 [4].

This has contributed to 4% of global deaths being attributed to liver disease, and this proportion is expected to increase due to unhealthy diets and increasing alcohol consumption [3]. Among liver diseases, alcoholic liver disease is the most common chronic liver disease and its prevalence is expected to increase due to current global alcohol consumption [5]. Recent evidence has shown that approximately 38.7% of hepatitis B virus infections and 68.4% of hepatic encephalopathy associated with liver cirrhosis in healthcare settings account for 41.3% of liver disease [2] For example, in Ghana, viral hepatitis B infection contributes to the incidence of most liver diseases and accounts for 10–12.3% of the total Ghanaian population, contributing to 3.4% of all deaths in Ghana [6, 7]. Although there are interventions to prevent and treat these diseases, they are still the leading cause of liver complications such as cirrhosis [8]. Although the liver is an important organ with multiple functions for the human body [9].

However, its disease condition impairs its functions which are attributed to causes such as viral infections, alcohol consumption, fatty foods, autoimmune diseases and drug abuse [10, 11, 12, 13, 14]. Most people with liver disease are generally asymptomatic [15]. However, when diagnosed clinically, patients with acute and chronic liver disease present with clinical signs and symptoms such as yellowish eyes and skin, dark urine, pale stools, itchy skin, and elevated liver enzymes [15]. Most patients with liver disease have liver cysts and cancer [16, 17]. In addition, patients with liver disease suffer from primary biliary cholestasis and sclerosing cholangitis, which eventually attacks the immune system and leads to decreased immunity [13]. In addition, chronic liver disease results in end-stage liver complications [18], leading to increased liver-related mortality [19]. As of 2020, a significant proportion of all hospital outpatients are diagnosed with various types of liver diseases, such as alcoholic and viral hepatitis. Of those clinically diagnosed with liver disease, a significant proportion were unaware of the liver disease and therefore were diagnosed at an advanced stage of the disease. Recent evidence has shown that there are studies on liver disease in Ghana that focus on the epidemiological characteristics and behavioral factors associated with liver disease [7, 8, 15]. However, there is paucity of data about the prevalence and associated factors of liver disease in North-Eastern part of Ghana. Therefore, this study aimed to determine the prevalence and associated factors of liver disease in adult patients seeking medical care at Zebilla Government Hospital.

Results

The study recruited 374 participants yielding a 97% response rate. The mean age of participants was 40±16 years. About 98/374(26.2%) of participants were between 18-27 years, 83/374(22.2%) between 28-37 years, 67/374(17.9%). About 201/374(53.7%) of the participants were females whilst 173/374(46.3%) were males. Most 209/374(55.9%) of the participants were married, 160/374(42.8%) were single. About 155374/ (41.4%) of participants had basic education, 94/374 (25.1%) secondary education, 94/374(25.1%) diploma and 29/374(7.8%) with degree qualification. Most 217/374(58.0%) were Christians whilst 144/374(38.5%) were Moslems. With regard to alcoholic intake, 111/374(29.68%) of the participants take alcohol whilst 263/374(70.32%) do not take alcohol. With the type of alcoholic intake, about 57/111(51.4%) of participants take Gin, 21/111(18.9%) drink alcoholic bitters, 13/111(11.7%) take Pito, 19/111(17.1%) drink Beer, Concerning the frequency of alcoholic intake, about 23/111(20.7%) daily take alcohol, 72/111(64.9%) sometimes drink alcohol and 16/111(14.4%) most of the times take alcohol (Table 1).

Discussion

This study determined the prevalence and associated factors of liver disease in adult patients at a healthcare facility in north-eastern Ghana. A prevalence of 38.8% of liver diseases was established and factors such as age, sex, marital status and alcohol consumption were associated with the disease prevalence. Comparing the current prevalence of 38.8% with other results, [20] reported a higher prevalence of 72.2% of liver disease which differed from the current study outcome. In China, a 38.7% prevalence of liver disease in patients seeking medical assistance was reported, and this was consistent with recent study outcome [21]. In Japan, the outcome of a cross-sectional study of patients assessing health care was reported and it was documented that 28.7% had liver disease, which did not collaborate well with the current study prevalence [22].

The report of a prospective study conducted to determine the predictors of in-hospital mortality from hepatic encephalopathy in patients found that 31.7% of patients had liver disease, which did not agree well with the results of this recent study [2]. The possible reasons for the differences in the study results could be attributed to the differences in the study methods and the behavioral patterns of the participants with regard to alcohol consumption and poor eating habits. There is evidence that the high burden of liver disease is the cause of metabolic disorders such as abnormal lipid metabolism leading to lipidemia, a factor that contributes to insulin resistance after the early onset of diabetes mellitus [23, 24] and thus contributes to the risk of diabetes mellitus and hypertension, secondary to chronic kidney disease [25, 26, 27]. There is evidence that alcoholics are significantly associated with liver disease, and this was consistent with the results of the present study [28]. Similarly, patients who consume alcohol were found to develop liver disease [29] and this was consistent with the current study report. A significant association between alcoholism and the incidence of liver disease has been reported in Ethiopia, which also agrees well with recent survey results [3, 30]. Additionally, [31] documented an association between alcohol consumption and the manifestation of liver disease, which supported the current study result. A similar finding has been reported that alcohol consumption is associated with the incidence of liver disease [32].

In Ghana, there is evidence that alcohol consumption correlates well with the occurrence of liver disease which supported the findings of the present study [33]. Similarly there was a strong association between alcohol consumption and the occurrence of liver disease which also was consistent with this present study [34]. The age of the participants was found to be related to liver disease. A cross-sectional study found that age is associated with liver disease which supported current survey results. Similarly found a strong association between age and liver disease, which also correlated well with the results of the present study [35]. In Ghana, a prospective study reported that there was no association between liver disease and age, and the results did not agree with this current study. In contrast, showed that age is associated with risk of liver disease and the results were therefore consistent with the results of the present study [34]. This recent study showed an association between gender and the incidence of liver disease. Gender was well associated with risk of liver disease [35]. In conclusion, it should be recognized that increases in alcohol consumption with respect to aging increases the risk of liver disease and progression to chronic liver disease, leading to higher healthcare and administrative cost, a burden on family members to provide supportive care, and lost work time, resulting in financial losses and decreased productivity in a nation.

Conclusion and Recommendations

Participants’ self-assessment of liver disease was high; therefore prompt intervention to decrease prevalence is desirable. In addition, factors such as alcohol consumption, gender, age, and marital status of the participants showed a significant association to liver disease. There should be an effective alliance between health policy makers and stakeholders of health to expand policies and protocols for mandatory screening of patients presenting for treatment in health care facilities. In addition, health promotion programs on liver disease, risk factors and complications should be intensified by local health authorities through local radio stations. Non-governmental organisations and community health officials should work together to organize screening for liver disease for residents of the community while helping those infected with liver disease to secure better healthcare. The study is also recommended for additional qualitative investigations into the burden of patients with diagnosed liver disease.

Acknowledgements

The authors wish to appreciate the support and approval of management and staff of the facility. We are also most grateful to participants who fully consented to partake in the study and to anyone who in diverse ways contributed to the success of this study.

Conflict of interest

The authors declare that no competing interest existed among them

Funding

The authors self-financed this paper

Data and material availability

Data and materials for the study are available upon request from the corresponding author

Approval and consent to participate

The study was approved by the management of the municipal health directorate and the local leaders of the selected communities before its commencement. Eligible participants voluntarily agreed to participate without coercion.

Authors Contributions

PA and MOP: conceived the topic and drafted the introduction. MOP, EDK and MD: Developed the methodology. MOP, PA and EDK: analysed the study data. DS, EK and II wrote the discussion. MOP, II and BKIA: drafted the manuscript and reviewed it. All authors proof read the paper and accepted it for submission.