Health impact of hepatic-venous-occlusive disease in a small town in Ethiopia—Case study from Tahtay koraro district in Tigray region, 2017

Abstract

BackgroundHepatic venous-occlusive disease is blockage of microscopic veins in the liver causing 20–50% mortality. Ingestion of pyrrolizidine alkaloid plant, radiation therapy, and post-bone-marrow-transplant reactions are the commonest causes. In Ethiopia, a venous-occlusive disease outbreak was identified in 2002 in Tahtay Koraro district, Tigray. Suspected due to ingestion of the toxic pyrrolizidine alkaloid plant Ageratum conyzoids, found throughout the district. We aimed to describe the surveillance data of venous-occlusive disease from September 2006 to August 2016 in Tahtay koraro district, Ethiopia, 2017.MethodologyWe defined a possible Hepatic venous-occlusive disease case as any patient with abdominal pain for at least 2 weeks, abdominal distention, and hepato-splenomegaly during September 2006-August 2016. We reviewed previous district line lists, weekly reports, and clinical records to identify and describe cases. Agricultural interventions were obtained from the agricultural offices of the district.ResultWe identified 179 possible cases with 83 deaths with a case-fatality rate of 46.3%. Among cases, 110 (61.5%) were males and 113 (63%) were >15 years. In total, 164 (91.6%) cases were from one village (Kelakil). The pick number of cases of VOD in this village was during 2008/09 which was 1076. The highest incidence (86/100,000) occurred in 2008. During the study period, 2,746 years of potential life were lost due to Hepatic venous-occlusive disease. Mechanical removal of the Ageratum started in 2011.ConclusionHepatic venous-occlusive disease was an ongoing problem in Tahtay Koraro; However, the problem has largely been alleviated by displacing people from the affected area and removing the causative weed. More research is needed to understand why Kelakil village was more affected despite the widespread presence of the weed. Chemical and mechanical removal of the Ageratum could strengthen intervention activities.

Pyrrolizidine alkaloid contamination of food in Africa: A review of current trends and implications

“…It is therefore not surprising that the earliest reports of human PA poisoning on the continent were in 1920 in South Africa when many people in the Western Cape suffered from liver cirrhosis after eating bread made with wheat contaminated with Senecio burchellii DC [ 27 , 35 ]. Since then, similar PA poisonings have been reported in Egypt [ 26 , [36] , [37] , [38] , [39] ]. Recently, in Africa, high levels of PAs have been detected in plant-derived products such as honey [ 18 , 20 , 40 ] and herbal remedies [ 14 , 18 , 27 ], while trace amounts have been found in maize grains cultivated on farmland previously dominated with PA plant, Chromolaena odorata [ 3 ].…”

“…Further unintended contamination can occur during harvesting when the seeds of PA weeds are co-harvested with edible grains [ [50] , [51] , [52] ]. This has previously resulted in a high case-fatality rate in Egypt [ 36 ] and Ethiopia [ 26 , [37] , [38] , [39] ] where locally produced grains were contaminated with the seeds of PA plants. Also, livestock feed and forage can become contaminated with PAs if they contain plant materials that have been infested with PA plants.…”

“…Again, intended adulteration of some herbal products with PA weeds by unscrupulous producers for economic benefits has recently been reported in Ghana [ 14 ]. Ingestion of PA-containing plants through this route has been implicated in the high rates of liver cancer and cirrhosis on the continent [ 39 ].

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“…In acute toxicity, high amounts of PA-contaminated foods are consumed over a short period of time. This exposure has been associated with the development of veno-occlusive disease/sinusoidal obstructive syndrome (HVOD/SOS) [ 12 ], a condition characterized by the obstruction of small liver veins, which then progresses to liver fibrosis, cirrhosis and ultimately to cancer of the liver [ 39 , 64 ]. Chronic toxicity, on the other hand, involves the intake of smaller amounts of PAs over an extended period of time which has been linked to blocked of hepatic veins and breakdown of the surrounding liver tissues, eventually leading to death [ 29 ].…”