The liver is a unique organ   

The liver is vital for good health. Perhaps that is why nature made it the largest solid organ in the body and the only one capable of regenerating itself. It is no surprise that when the liver ‘sneezes’, the whole body ‘catches a cold’.

The liver performs hundreds of essential functions. It filters out toxins and processes/stores sugar and other nutrients. From its location in the right upper abdomen where it is protected by the rib cage, the liver influences virtually every organ in the body.    

…But the liver has its limits  

The liver works extra hard to compensate and repair itself when a part of it is damaged. However,  the healing process is imperfect and scar tissue build-up leads to liver fibrosis and ultimately cirrhosis. The cirrhotic liver is stiff and distorted, unable to perform its critical functions; some persons with chronic liver disease develop liver cancer.

Liver cirrhosis causes fatigue, poor appetite, yellow discoloration of the eyes (jaundice), and swollen belly and legs among other symptoms. Quality of life plummets just as frequent clinic/hospital visits and mental sluggishness take a bite out of work productivity.  For some people, a new liver (liver transplantation) is the only solution; however, liver transplantation is currently unavailable in sub-Saharan Africa, except in South Africa.

Cirrhosis-related deaths are on the rise in sub-Saharan Africa due to shortage of resources to tackle it. A case in point is the huge shortage of hepatologists,(doctors with advanced training to manage chronic liver diseases). There is also inadequate access to liver biopsy (a procedure used to obtain liver samples for examination) and specialized ultrasound services to determine the severity of liver damage.

  • Only 2% of Africans with chronic hepatitis B receive a diagnosis.   
  • Deaths from cirrhosis are more common in sub-Saharan Africa than in most parts of the world

Managing chronic liver diseases

“An ounce of prevention is worth a pound of cure” applies to chronic liver diseases. Some preventative measures such as proper diet and avoidance of alcohol slow down the progression from fibrosis to cirrhosis.

The WHO recommends hepatitis B vaccination for all infants, beginning as soon as possible after birth. This is because hepatitis B  is a leading underlying cause of liver cirrhosis in sub-Saharan Africa and this viral infection is mostly acquired from the mother during birth or from siblings and other playmates before the age of 5. Hepatitis C, another viral infection for which there is no vaccine, is also an important cause of chronic liver disease.  Though effective antivirals are available to treat hepatitis B and C, poor access to these treatments illustrates health system gaps that must be closed.

  • According to one estimate, only 11 out of 100 newborns in Africa receive the hepatitis B vaccine soon after birth.   
  • Approximately 1 in 10,000 Africans with hepatitis B receive treatment.   

Alcohol is the most common non-infectious cause of chronic liver disease and should be avoided by those with liver disease. Meanwhile, fatty liver lurks in the shadows. Scientists project that fatty liver due to obesity will become a prominent cause of chronic liver disease in Africa unless Africans halt the adoption of western habits and return to traditional lifestyles and diets.

 

 

The use of unregulated herbal concoctions is an under-appreciated cause of chronic liver disease. There is a fine line, however, as some herbal supplements have been formulated to slow down liver damage and improve the quality of life in people with chronic liver disease. Expert guidelines that are backed by scientific evidence and regulatory oversight are needed for the safe and effective use of herbal products.

In summary, chronic liver diseases loom large in the public health landscape of sub-Saharan Africa. Appropriate messaging and infrastructure for prevention and treatment will minimize associated deaths and suffering.

This article was created by Cutica Health.