# Prevalence and Spectrum of Chronic Liver Disease Among Patients Seeking Health Care in Ghana

## TL;DR

This study found that 24.5% of patients in Ghana had liver fibrosis or cirrhosis, mainly caused by hepatitis B, alcohol, and fatty liver disease.

## Contribution

The study highlights the high prevalence of chronic liver disease in Ghana and identifies key causes and risk factors in a resource-limited setting.

## Key findings

- 24.5% of participants had liver fibrosis or cirrhosis, as detected by transient elastography.
- Hepatitis B virus was the leading cause of chronic liver disease, followed by alcohol and fatty liver disease.
- Transient elastography proved effective as a non-invasive screening tool in resource-limited settings.

## Abstract

Chronic liver diseases (CLD) leading to liver fibrosis and cirrhosis are a major cause of morbidity and mortality in sub‐Saharan Africa and pose a significant burden on its health care systems. We aimed to elucidate the prevalence of fibrosis/cirrhosis in patients seeking health care in Kumasi, Ghana, and its underlying aetiologies.

In this cross‐sectional study, we performed sonography, transient elastography as well as biochemical and virological analyses.

Transient elastography indicated fibrosis/cirrhosis in 24.5% (113/461) of participants. Liver cirrhosis was significantly associated with known hepatitis B virus (HBV) infection, lack of formal education, hospitalisation, and male sex. Prevalence of active hepatitis B was significantly higher in patients with liver cirrhosis compared to controls (54.6% [30/55] vs. 17.1% [19/111]), as was anti‐HBc (94.6% [52/55] vs. 80.2% [89/111]). CLD was mainly attributed to HBV (27.3%, 30/110), alcohol abuse (11.8%, 13/110), a combination of both (10.9%, 12/110), and metabolic dysfunction‐associated steatotic liver disease (MASLD) (20%, 22/110). Antiviral treatment was indicated in 24 patients with active hepatitis B (number‐needed‐to‐screen: 19.2). Hepatitis C and D viruses were of minor importance (2.7% [3/110] and 0.9% [1/110], respectively).

We found a high prevalence of CLD, predominantly caused by HBV, MASLD and alcohol. We confirmed the use of transient elastography as a non‐invasive and easily applicable tool in resource‐limited settings. Our findings underscore the need for systematic screening of hospitalised patients, especially men, in sub‐Saharan Africa. Comprehensive screening, treatment, vaccination and prevention programs for HBV, as the leading cause of chronic liver disease, are warranted.

Chronic liver disease can lead to liver fibrosis and cirrhosis and has a strong impact on the healthcare systems in sub‐Saharan Africa, a resource‐limited region.In this study, we used a non‐invasive method to screen for chronic liver disease in people seeking health care in a Ghanaian hospital, which revealed that a quarter of study participants had indications for either liver fibrosis or cirrhosis.We found evidence for either non‐alcoholic fatty liver disease, hepatitis B virus infection or heavy alcohol consumption as apparent underlying causes in more than two thirds of all patients with chronic liver disease.

Chronic liver disease can lead to liver fibrosis and cirrhosis and has a strong impact on the healthcare systems in sub‐Saharan Africa, a resource‐limited region.

In this study, we used a non‐invasive method to screen for chronic liver disease in people seeking health care in a Ghanaian hospital, which revealed that a quarter of study participants had indications for either liver fibrosis or cirrhosis.

We found evidence for either non‐alcoholic fatty liver disease, hepatitis B virus infection or heavy alcohol consumption as apparent underlying causes in more than two thirds of all patients with chronic liver disease.