Risk factors of chronic liver disease among adult patients in tertiary hospitals, Northern Ethiopia: An unmatched case-control study

Abstract

Abstract Introduction Chronic liver disease imposed substantial health and economic burden causing 1.75 million deaths and increased hospital admission rates. However, it is a neglected health issue in resource-limited countries like Ethiopia, with the paucity of data on the determinants of chronic liver disease. Besides, available studies considered single or limited factors. Thus, the aim of this study was to assess the determinant factors of chronic liver disease among patients who were attending at the gastroenterology units. Methods An unmatched case-control study was conducted on 281 (94 cases and 187 controls) systematically selected subjects at tertiary hospitals in Northern Ethiopia from November 2018 to June 2019. Data were collected using an interviewer-administered questionnaire and checklists, entered to Epi data version 4.4.2, and analyzed using SPSS version 25. Bi-variable and multivariate analyses were done using binary logistic regression. Variables with p< 0.25 in the bi-variable analysis were fitted to the final model. An adjusted odds ratio with 95% CI was used to declare significance and associations. Results An overall 281 (94 cases and 187 controls) patients attending at the gastroenterology units had been included with a response rate of 100%. Being chronic alcohol consumer (AOR=2.8; 95% CI: 1.1-7.0), having a history of herbal medication use (AOR=14; 95% CI: 5.2-42), history of injectable drug use (AOR=8.7; 95% CI: 3-24.8), and hepatitis B infection (AOR=12; 95% CI: 3.0-49) were found to have an independent association with chronic liver disease. Conclusion Alcohol consumption, history of herbal medication use, hepatitis B infection, and history of parenteral medication use were found to be determinant factors of chronic liver disease. Strengthening viral hepatitis screening activities, interventions focused on behavioral change, and linking traditional healers to the healthcare system is crucial. What is known about the subject? Chronic liver disease (CLD) causes substantial health and economic burden where more than 1 million deaths occurred due to CLD complications annually. Studies reported that CLD causes 1.8-10% of all deaths and responsible for increased hospital admission rates. From 1980 to 2010, chronic liver disease-related deaths doubled in sub-Saharan African countries. Despite measures have been designed and on implementation to decrease this burden, the access to these interventions is limited, and the number of patients increased dramatically. What does this study add? Different behavioral, socio-cultural, and clinical factors had a statistically significant association with chronic liver disease. Alcohol consumption, history of herbal medication use, hepatitis B infection (HBV + ), and history of parenteral medication use were found to be determinant factors of chronic liver disease (CLD). Strength and limitations of the study Despite this study presented important findings that could input for the scientific world in the area of CLD, the study had its own limitations. Since almost all participants did not have documented medical checkups, it was challenging to extract previous history of chronic viral hepatitis. Hence, the effect of this pertinent variable was left unevaluated in this study.