Chronic Liver Disease in Ethiopia with a Particular Focus on the Etiological Spectrums: A Systematic Review and Meta-Analysis of Observational Studies.

Background: In Ethiopia, chronic liver disease (CLD) is the 7th leading cause of death, accounting for about 24 deaths per 100000 populations in 2019. Despite its burden, there is a lack of compiled pieces of evidence on CLD in the country. Thus, this systematic review and meta-analysis is intended to provide the pooled estimates of CLD etiologies and mortality rate in CLD patients in Ethiopia.

Method: PubMed, Google Scholar, ScienceDirect, institutional repositories, national digital library, and the bibliography of the eligible articles information were the source of data for the present review. The keywords "hepatitis, chronic" [Mesh], "end-Stage Liver Disease" [Mesh], "chronic liver disease", "liver cirrhosis" [Mesh], and "Ethiopia" were used for the searches. Overall, we retrieved 199 records and 12 were included in this review. We used the DerSimonian-Laird random-effects models to perform the meta-analysis. We conducted subgroup and meta-regression analyses to account for the heterogeneity of the estimates.

Result: Hepatitis B virus, alcohol, and hepatitis C virus are the three most common etiologies of CLD in Ethiopia accounting for a pooled estimate of 40.0% [95% CI: 29.0, 51.0,  = 96.3, < 0.001], 17.0% [95% CI: 9.0, 25.0,  = 96.7, < 0.001], and 15.0% [95% CI: 9.0, 21.0,  = 95.8, < 0.001], respectively. Unidentified etiology report has a substantial contribution accounting for an estimated pooled proportion of 45% [95% CI: 34.0, 56.0%,  = 32.08, < 0.001,  = 87.53] of the CLD cases in the country. On the other hand, the overall hospital mortality rate in CLD patients is 25.0% [95% CI: 2.0, 47.0, I = 94.6, < 0.001] in Ethiopia.

Conclusion: Hepatitis B virus, hepatitis C virus, and alcohol are the three most common contributors to CLD cases in Ethiopia. The authors warrant routine screening and strengthening of preventive and treatment programs for viral hepatitis B and C, further enhancing the alcohol policy of the country.