ArticleBMJ open2020
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.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis.BMC public health · 2023Pooled it
- Exploring the liver-kidney axis in the Ghanaian population: the RODAM prospective study.Journal of global health · 2026Article
- Diagnosing and defining MASLD in people living with chronic hepatitis B.Communications medicine · 2026Review
- Prevalence and Spectrum of Chronic Liver Disease Among Patients Seeking Health Care in Ghana.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Article
- Longitudinal retrospective cohort study to examine liver, cardiovascular and metabolic factors as predictors of all-cause mortality in a rural population in South-West Uganda.BMJ public health · 2026Article
- Screening for metabolic-associated fatty liver disease in type 2 diabetes patients using non-invasive scores and ultrasound: a cross-sectional study in Egypt.BMC gastroenterology · 2025Article
- Whole genome sequencing of hepatitis B virus using tiled amplicon (HEPTILE) and probe based enrichment on Illumina and Nanopore platforms.Scientific reports · 2025Article
- Red cell distribution width/platelet ratio predicts decompensation of metabolic dysfunction-associated steatotic liver disease-related compensated advanced chronic liver disease.World journal of gastroenterology · 2025Article
- Letter regarding "Prevalence of clinically significant liver fibrosis in the general population".Clinical and molecular hepatology · 2025Article
- Correspondence to letter to the editor on "Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis".Clinical and molecular hepatology · 2025Article
- The Prevalence of Liver Enzyme Abnormalities Among Adult Patients with Non-Communicable Diseases in Rwanda: A Gender-Stratified Analysis.Hepatic medicine : evidence and research · 2025Article
- Anti-hepatitis C antibody carriage and risk of liver impairment in rural-Cameroon: adapting the control of hepatocellular carcinoma for resource-limited settings.BMC infectious diseases · 2023Observational
- Where do those data go? Reuse of screening results from clinical trials to estimate population prevalence of HBV infection in adults in Kilifi, Kenya.Journal of virus eradication · 2023Article
- Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus.JHEP reports : innovation in hepatology · 2023Review
- Multivariate GWAS analysis reveals loci associated with liver functions in continental African populations.PloS one · 2023Article
- Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana.Pathogens (Basel, Switzerland) · 2020Article
- Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort.The Journal of infection · 2020Article
- Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
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.
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