AETIOLOGY AND RISK FACTORS AMONGST PATIENTS WITH CHRONIC LIVER DISEASE IN CALABAR, NIGERIA

Abstract

Background: Chronic liver disease (CLD) is a major public health problem which accounts for significant morbidity and mortality figures worldwide most especially in developing countries where hepatitis B virus is also endemic. The aetiology of CLD is protean and also diverse depending on the region being studied. Current epidemiological data reveals that in Africa and other developing countries, hepatitis B viral (HBV) infection is the most common cause of chronic liver disease, while alcohol followed by hepatitis C virus (HCV) are significant causes of chronic liver disease in developed countries of Europe and U.S.A. Non-alcoholic fatty liver disease (NAFLD) in addition plays a major role in the aetiology of CLD particularly in areas where obesity and diabetes mellitus is a growing public health challenge . Aims and Objectives: The main aim of this study was to determine the prevalence of chronic liver disease and its common aetiologic agents (hepatitis B, hepatitis C,
alcoholic liver disease, non-alcoholic liver disease), in addition to its risk factors in
Calabar, Cross River, State.
Methods: This study was an observational cross-sectional case control study involving
patients with suspected chronic liver disease referred to the Gastroenterology clinic or
admitted into the medical wards and subsequently referred to the Gastroenterology unit
of the University of Calabar teaching hospital. Two hundred and thirteen individuals
were recruited ( over a nine month period from September 2012 to May 2013) for the
study comprising 106 patients with clinical, biochemical , ultrasonographic and
histologic features of chronic liver disease and 107 personnel of UCTH and non-liver
disease patients as controls. The controls were matched with the cases according to
age and sex.
Results: Chronic liver disease accounted for 5.7% of the total cases seen during the
study period. Seventy three (68.9%) of the chronic liver disease patients were males,
while 33 (31.1%) were females with a Male to Female ratio of 2.2: 1. Whereas there
were 71 (66.4%) Males to 36 (33.6%) Females among the Controls with M: F ratio of
1.9:1. The diagnosis of CLD was made in 91 (85.8%) of the cases based on a
combination of clinical, biochemical and liver ultrasound scan findings in addition
characteristic histological findings in the remaining 15 cases (14.25%). Chronic
hepatitis B infection was found in 62 (58.5%) of the cases, while chronic hepatitis C
infection occurred in 9 (8.5%) of the patients. Four (3.8%) CLD patients had both
hepatitis B and C co-infection, while 12 (11.3%) and 2 (1.9%) met the criteria for ALD
and NAFLD respectively. In seventeen (16%) of the cases the exact aetiology could not
be ascertained. The prevalence of HBsAg and Anti- HCV among the cases was 62.3%
and 12.3% respectively. The prevalence of HBV and HCV among the controls was 5.6%
and 10.3% respectively. HBV infection among the cases was found to be statistically
significant (p=0.001) compared to controls, contrary to HCV infection which was not.
Conclusion: It is concluded from this study that hepatitis B viral infection is the
leading cause of CLD in patients in Calabar. It was also found that there is a
relatively high prevalence of HBsAg and Anti -HCV in apparently healthy volunteer’s
(controls).In relatively high number of CLD patients no clear aetiologic agent could
be determined, hence there is need for further research regarding the role of factors
18 such as; occult HBV infection in CLD and rarer causes of CLD in this environment.
Recommendation: It is recommended that health advocacy strategies be
implemented to enlighten the general public about the risk factors associated with
CLD and its aetiologic agents. This is aimed at reducing the transmission of the
hepatotrophic viruses in addition the deleterious effect of alcohol on the liver.
All these in effect may lower the burden of CLD in our environment.

AETIOLOGY AND RISK FACTORS AMONGST PATIENTS WITH CHRONIC LIVER DISEASE IN CALABAR, NIGERIA