Liver cirrhosis in sub-Saharan Africa: neglected, yet important

Abstract

Clinical efforts and research on liver diseases have been scarce in sub-Saharan Africa. The first Conference on Liver Disease in Africa (Nairobi, Sept 13–15, 2018), gathering all stakeholders from the continent, is a welcome step towards greater attention to the problem, and the important issue of liver cirrhosis. Cirrhosis-related deaths doubled in sub-Saharan Africa between 1980 and 2010, and the Central African Republic, Gabon, Malawi, Uganda, and Cote d'Ivoire were among the highest 10% of countries for these deaths in 2010.1 Most cases of cirrhosis were attributed to hepatitis B virus (HBV), alcohol misuse, and hepatitis C virus (HCV), but around 30% were unrelated to these causes.1 The understudied non-alcoholic fatty liver disease probably has a role in these latter cases, considering the increase in obesity in sub-Saharan Africa, and traditional herbal medicine could also contribute, because its use is associated with a substantial increase in liver fibrosis.