Minor role of hepatitis B virus in the causation of chronic liver disease in Somalia indicated by a case-control study

Abstract

Chronic liver disease (CLD) is frequent in Somalia. In a case-control study, 116 in-patients with CLD were compared with the same number of age and sex matched controls. Demographic variables, use of drugs, symptoms and signs, serological markers for hepatitis B virus (HBV) and serum alpha-foetoprotein (AFP) were assessed. Hepatitis B surface antigen (HBsAg) was found in 44 cases of which 17 had antibodies to hepatitis D virus (anti-HD) and 7 had hepatitis B e antigen (HBeAg). Twenty-three controls were HBsAg-positive, of whom 3 had anti-HD and one HBeAg. Increased relative risks (95% confidence intervals in parentheses) were 2.5 (1.3-4.5) for HBsAg, 6.5 (1.7-21.5) for anti-HD, and 7.4 (0.9-66.5) for HBeAg. Despite the association between the presence of HBV markers and CLD, 62% of the cases had no markers indicating current HBV infection. This was reflected in the low risk attributable to chronic HBV infection (22.6%), which was lower than that in patients with CLD in other African populations with a high HBsAg carrier rate. The prevalence of HBV markers did not differ between cases with AFP greater than 100 ng/ml and those with AFP less than 100 ng/ml. The former were characterized by male predominance, shorter duration of symptoms, and larger mean liver size, indicative of malignancy. The mean age of HBsAg-positive cases with AFP greater than 100 ng/ml was significantly lower (by 7.7 years) than that of HBsAg-negative cases with AFP greater than 100 ng/ml. Among the CLD patients with AFP less than 100 ng/ml, 48 were HBsAg-negative. These cases differed significantly from the other 68 cases in that more were females (35% against 16%), more originated from an agricultural area (56% against 30%), and more were regular consumers of drugs (48% against 28%). In conclusion, factors as yet undefined play a considerable role in the causation of CLD in Somalia. The possibility of determining the role of hepatitis C virus (HCV) awaits the development of more specific assays for anti-HCV antibodies.

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

“…In 1989, a total of 1138 subjects with HBsAg were examined from different regions of Somalia; the results showed that 19.3% (220/1138) of subjects were HBsAg-reactive[ 31 ]. Bile KM and his colleagues conducted a case-control study that detected that 28.8% (67/232) of the overall prevalence was HBsAg subjects, including cases and control groups[ 32 ].…”

“…Six studies met the inclusion criteria for the meta-analysis of the prevalence of HBV infection among patients with chronic liver disease, including patients with hepatocellular carcinoma, in Somali people. Their prevalence ranges from 17.9% to 50%[ 30 , 32 , 34 , 36 - 38 ] (Table 6 ). The pooled effect size for the prevalence of hepatitis B among chronic liver disease patients in Somali people was 39.2% (95%CI: 33.4% to 45.4%).…”

“…In a 1993 study by Khalif Bile and his colleagues with 62 Somali patients with chronic liver disease, including hepatocellular carcinoma, 37.1% (23) of cases with chronic liver disease were positive for HBsAg, and 34.6% (8) of chronic liver disease patients had anti-HDV. Meanwhile, in the control group, 14.3% of those who were positive for HBsAg had anti-HDV[ 32 ]. Another study conducted among 67 HBsAg-positive patients showed that 30% (20) of these patients were anti-HDV-positive.…”

Prevalence of Hepatitis D in the Eastern Mediterranean Region: Systematic Review and Meta Analysis

“…Thus, the 62 (5, 87-143) studies to be included were identified assessing the HDV prevalence in the EMRO countries and fulfilling inclusion criteria. Out of these,19 studies (95-113) were in Iran, nine studies (129-137) in Saudi Arabia, seven studies (5, 119-124) in Pakistan, six studies (89-94) in Egypt, four studies (138-141) in Tunisia and Somalia (125-128) and two studies (142, 143) in Yemen. There was one study of other countries which consisted of: Afghanistan (87), Djibouti (88), Jordan (114), Kuwait (115), Lebanon (116), Morocco (117), and Oman (118).…”

Seroepidemiological Studies of Hepatitis Viruses in the Dominican Republic. I. The Prevalence of Markers of Hepatitis A, B and C Viruses.

“…HBV infection is highly endemic in many developing countries, including those in Asia, Africa and the Western Pacific (Hawkes et al, 1981;Hyams et al, 1989;Boutin et al, 1990;Bile et al, 1991;Tan et al, 1991) . In such a setting, most persons are infected in early childhood though both perinatal transmission (mother to infant at birth) and horizontal transmission (close contact with other infected persons) .…”