title: 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.
authors.affiliation: Faculty of Medicine, University of Mogadishu, Somalia.
authors.forename: K M
authors.initials: KM
authors.lastname: Bile
authors.forename: M
authors.initials: M
authors.lastname: Abdirahman
authors.forename: C
authors.initials: C
authors.lastname: Aden
authors.forename: H
authors.initials: H
authors.lastname: Norder
authors.forename: L
authors.initials: L
authors.lastname: Magnius
authors.forename: G
authors.initials: G
authors.lastname: Lindberg
authors.forename: L H
authors.initials: LH
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006508:Hepatitis Antibodies / Q000302:isolation & purification*; D006509:Hepatitis B / Q000150:complications; D006514:Hepatitis B Surface Antigens / Q000302:isolation & purification*; D006515:Hepatitis B virus / Q000276:immunology*; D003699:Hepatitis D / Q000150:complications; D003698:Hepatitis Delta Virus / Q000276:immunology*; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012998:Somalia / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins