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

BACKGROUND: 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. METHODS: In this cross-sectional study, we performed sonography, transient elastography as well as biochemical and virological analyses. RESULTS: 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). CONCLUSIONS: 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.