Diagnosis of alcohol misuse and alcoholic liver disease among patients in the medical emergency admission service of a large urban hospital in Subsaharan Africa ; a cross sectional study

Opio, Christopher; Seremba, Emmanuel; Ocama, Ponciano; Lalitha, Rejani; Kagimu, Magid; Lee, William Martens

doi:10.11604/pamj.2013.15.23.2040

Cited by 13 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of AST/ALT ratio >2 in this population is 11%, suggesting potential alcoholic hepatitis, 37 concordant with a previous study in Uganda in which 10% of the population was estimated to have alcoholic hepatitis, 38 and with data from Uganda's non-communicable diseases risk factor survey which estimated that almost 10% of Ugandan adults have alcohol use disorders. 39 Data from emergency attendances at the Mulago Hospital in Kampala recorded 47% who reported alcohol use, while 21% and 10% met the study definitions of alcoholic misuse and alcoholic liver disease, respectively.…”

Section: Open Accesssupporting

confidence: 90%

“…39 Data from emergency attendances at the Mulago Hospital in Kampala recorded 47% who reported alcohol use, while 21% and 10% met the study definitions of alcoholic misuse and alcoholic liver disease, respectively. 38 Our data are based on self-reported alcohol consumption so may underestimate the true extent of alcohol use. We were unable to quantify alcohol intake or the nature of the alcohol consumed: this is challenging as alcohol is often home-brewed or home-distilled from locally grown grains or fruits, and the alcohol content may vary widely; for exmaple, the alcohol content of locally produced maizebased brews and liquor in Kenya ranged from 2% to 7% and 18% to 53%, respectively.…”

Section: Open Accessmentioning

confidence: 99%

See 1 more Smart Citation

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

et al. 2020

View full text Add to dashboard Cite

ObjectivesLiver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.DesignWe undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).SettingWe studied a population cohort in South-Western Uganda.ParticipantsData were available for 8099 adults (median age 30 years; 56% female).ResultsThe prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.ConclusionsFurther work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.

show abstract

Section: Open Accesssupporting

confidence: 90%

Section: Open Accessmentioning

confidence: 99%

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The prevalence of AST/ALT ratio >2 in this population is 11%, suggesting potential alcoholic hepatitis (34), concordant with a previous study in Uganda in which 10% of the population was estimated to have alcoholic hepatitis (35), and with data from Uganda’s non-communicable diseases risk factor survey which estimated that almost 10% of Ugandan adults have alcohol use disorders (36). Data from emergency attendances at Mulago Hospital in Kampala recorded 47% who reported alcohol use, while 21% and 10% met the study definitions of alcoholic misuse and alcoholic liver disease, respectively (35). Our data are based on self-reported alcohol consumption so may underestimate the true extent of alcohol use.…”

Section: Discussionsupporting

confidence: 90%

Liver function tests and fibrosis scores in a rural population in Africa: estimation of the burden of disease and associated risk factors

O’Hara

Mokaya

Hau

et al. 2019

Preprint

View full text Add to dashboard Cite

Introduction: Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa. However, its prevalence, distribution and aetiology have not been well characterised. We examined liver function tests (LFTs) and calculated liver fibrosis scores in a rural population in Uganda. Methodology: A cross-sectional survey of LFTs was undertaken in 2011 in a rural population cohort in South-Western Uganda. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (AST to Platelet Ratio Index, fibrosis-4, GGT to platelet ratio, red cell distribution width to platelet ratio, and S-index) to evaluate the potential prevalence of liver disease. We collected information about alcohol intake, and infection with HIV, HBV and HCV, to determine the contribution made by these factors to liver inflammation or fibrosis. Results: Data were available for 8,099 participants (median age 30 years; 56% female). The prevalence of HBV, HCV and HIV infection were 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared to the African reference range (e.g. for AST 13% vs 3%, respectively). The prevalence of AST/ALT ratio >2 was 11%, suggestive of alcoholic hepatitis. The highest prevalence of fibrosis was suggested by the GPR score, with 24% of the population falling above the threshold for fibrosis. By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, infection with HIV or HBV, and alcohol consumption. Based on population attributable risk, the highest proportion of elevated fibrosis scores was associated with alcohol use (e.g. 64% of elevated S-index scores). Conclusion: Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores, and to determine aetiology of liver disease.

show abstract

“…These finding are consistent with results from studies in other HIV clinic populations in Uganda [ 32 , 33 ], and some clinical settings in North America [ 34 ]. However, the prevalence of any alcohol consumption was relatively lower compared to studies done in the general medical settings [ 35 ] and general community populations [ 36 , 37 ] and far lower than those from fishing communities around Lake Victoria in central Uganda which reported that 62% of male and 52% of female had drank alcohol during the last month [ 38 ]. The relatively lower prevalence of alcohol use among patients in long-term HIV care, compared to the general population, may be a result of continued counseling and risk behavior change messages including reducing alcohol consumption.…”

Section: Discussionmentioning

confidence: 90%

Alcohol Consumption among HIV-Infected Persons in a Large Urban HIV Clinic in Kampala Uganda: A Constellation of Harmful Behaviors

et al. 2015

View full text Add to dashboard Cite

IntroductionAlcohol use by persons living with HIV/AIDS (PLWHA) negatively impacts the public health benefits of antiretroviral therapy (ART). Using a standardized alcohol assessment tool, we estimate the prevalence of alcohol use, identify associated factors, and test the association of alcohol misuse with sexual risk behaviors among PLWHA in Uganda.MethodsA cross-section of PLWHA in Kampala were interviewed regarding their sexual behavior and self-reported alcohol consumption in the previous 6 months. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). Gender-stratified log binomial regression analyses were used to identify independent factors associated with alcohol misuse and to test whether alcohol misuse was associated with risky sexual behaviors.ResultsOf the 725 subjects enrolled, 235 (33%) reported any alcohol use and 135 (18.6%) reported alcohol misuse, while 38 (5.2%) drank hazardous levels of alcohol. Alcohol misuse was more likely among subjects not yet on ART (adjusted prevalence ratio [aPR] was 1.65 p=0.043 for males and 1.79, p=0.019 for females) and those with self-reported poor adherence (aPR for males=1.56, p=0.052, and for females=1.93, p=0.0189). Belonging to Pentecostal or Muslim religious denominations was protective against alcohol misuse compared to belonging to Anglican and Catholic denominations in both sexes (aPR=0.11 for men, p<0.001, and aPR=0.32 for women, p=0.003). Alcohol misuse was independently associated with reporting risky sexual behaviors (aPR=1.67; 95% CI: 1.07–2.60, p=0.023) among males, but not significant among females (aPR=1.29; 95% CI: 0.95–1.74, p=0.098). Non-disclosure of HIV positive status to sexual partner was significantly associated with risky sex in both males (aPR=1.69; p=0.014) and females (aPR 2.45; p<0.001).ConclusionAlcohol use among PLWHA was high, and was associated with self-reported medication non-adherence, non-disclosure of HIV positive status to sexual partner(s), and risky sexual behaviors among male subjects. Interventions targeting alcohol use and the associated negative behaviors should be tested in this setting.

show abstract

Diagnosis of alcohol misuse and alcoholic liver disease among patients in the medical emergency admission service of a large urban hospital in Subsaharan Africa ; a cross sectional study

Cited by 13 publications

References 19 publications

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

Liver function tests and fibrosis scores in a rural population in Africa: estimation of the burden of disease and associated risk factors

Alcohol Consumption among HIV-Infected Persons in a Large Urban HIV Clinic in Kampala Uganda: A Constellation of Harmful Behaviors

Contact Info

Product

Resources

About