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Meta-Analysis
. 2018 Sep 14;24(34):3927-3957.
doi: 10.3748/wjg.v24.i34.3927.

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

Mohamed Abdulkadir Hassan-Kadle  1 , Mugtaba Sulaiman Osman  2 , Pavel Petrovich Ogurtsov  1
Affiliations
Meta-Analysis

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

Mohamed Abdulkadir Hassan-Kadle et al. World J Gastroenterol. .

Abstract

Aim: To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.

Methods: A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.

Results: Twenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: < 1 year old, 61.54% (95%CI: 40.14% to 79.24%); 1-10 years old, 91.91% (95%CI: 87.76% to 94.73%); 11-19 years old, 96.31% (95%CI: 92.84% to 98.14%); 20-39 years old, 91.3% (95%CI: 83.07% to 95.73%); and > 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups < 20 years old, 20-39 years old and > 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate among patients with chronic liver disease, including HCC, was 43.77% (95%CI: 35.09% to 52.84%). The overall pooled prevalence of HEV was 46.86% (95%CI: 5.31% to 93.28%).

Conclusion: Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease. This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease.

Keywords: Hepatitis A virus; Hepatitis B virus; Hepatitis C virus; Hepatitis D virus; Hepatitis E virus; Meta-analysis, Somalia; Systematic review; Viral hepatitis.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
Schematic flow diagram of the studies reviewed for inclusion in analysis.
Figure 2
Figure 2
Meta-analysis and forest plot presentation of the anti-hepatitis A virus antibody from 1984 to 1994.
Figure 3
Figure 3
Bias assessment plot of studies reporting of hepatitis A virus prevalence in Somalia from 1984 to 1994.
Figure 4
Figure 4
Forest plot of hepatitis A virus prevalence rates for studies conducted in Somalia from 1984 to 1992.
Figure 5
Figure 5
Forest plot of hepatitis A virus infection prevalence rates according to age groups from 1984 to 1994.
Figure 6
Figure 6
Bias assessment plot of studies reporting hepatitis A virus and age groups.
Figure 7
Figure 7
Forest plot of hepatitis B virus infection prevalence rates in Somalia in published and unpublished studies from 1977 to 2014.
Figure 8
Figure 8
Bias assessment plot of studies reporting hepatitis B virus prevalence rate in Somalia from 1977 to 2014.
Figure 9
Figure 9
Forest plot of hepatitis B virus prevalence rates for studies conducted according to setting from 1977 to 2014.
Figure 10
Figure 10
Forest plot of hepatitis B virus prevalence rates for studies conducted according to population from 1977 to 2014.
Figure 11
Figure 11
Forest plot of hepatitis B virus infection prevalence rates among pregnant women.
Figure 12
Figure 12
Forest plot of hepatitis B virus infection prevalence rates among Somali children.
Figure 13
Figure 13
Forest plot of hepatitis B virus infection prevalence rates among patients with chronic liver disease, including hepatocellular carcinoma.
Figure 14
Figure 14
Bias assessment plot of studies reporting among patients with chronic liver disease, including hepatocellular carcinoma.
Figure 15
Figure 15
Forest plot of hepatitis B virus infection prevalence rates among age groups.
Figure 16
Figure 16
Bias assessment plot of studies reporting among age groups.
Figure 17
Figure 17
Forest plot of hepatitis B virus infection prevalence rates among risk groups.
Figure 18
Figure 18
Bias assessment plot of studies reporting among risk groups.
Figure 19
Figure 19
Forest plot of studies reporting chronic hepatitis C virus infection prevalence in Somalia.
Figure 20
Figure 20
Funnel plot of studies reporting chronic hepatitis C virus infection prevalence in Somalia.
Figure 21
Figure 21
Forest plot of hepatitis C virus infection for studies conducted in Somalia and Outside of Somalia.
Figure 22
Figure 22
Forest plot of studies reporting chronic hepatitis C virus prevalence amongst the local population and Somali immigrants.
Figure 23
Figure 23
Forest plot of studies reporting chronic hepatitis C virus prevalence among blood donors in Somalia.
Figure 24
Figure 24
Forest plot of studies reporting on distribution genotypes of hepatitis C virus infection in Somalia.
Figure 25
Figure 25
Bias assessment plot of studies reporting among the distribution of genotypes of hepatitis C virus.
Figure 26
Figure 26
Forest plot of studies reporting chronic hepatitis C virus prevalence among risk groups in Somalia.
Figure 27
Figure 27
Bias assessment plot of studies reporting among risk groups in Somalia.
Figure 28
Figure 28
Forest plot of studies reporting chronic hepatitis C virus prevalence among Somali children.
Figure 29
Figure 29
Bias assessment plot of studies reporting among children in Somalia.
Figure 30
Figure 30
Forest plot of studies reporting chronic hepatitis C virus prevalence among patients with chronic liver disease, including hepatocellular carcinoma, in Somalia.
Figure 31
Figure 31
Bias assessment plot of studies reporting chronic liver disease.
Figure 32
Figure 32
Forest plot of studies reporting hepatitis D virus infection prevalence in Somalia.
Figure 33
Figure 33
Bias assessment plot of studies reporting of hepatitis D virus infection in Somalia.
Figure 34
Figure 34
Forest plot of hepatitis D virus infection prevalence rates among patients with chronic liver disease in Somalia.
Figure 35
Figure 35
Bias assessment plot of studies reporting of hepatitis D virus infection among chronic liver disease in Somalia.
Figure 36
Figure 36
Forest plot of studies reporting hepatitis E virus infection prevalence in Somalia.
Figure 37
Figure 37
Funnel plot of studies reporting hepatitis E virus infection prevalence in Somalia.
Figure 38
Figure 38
Bias assessment plot of studies reporting hepatitis E virus prevalence in Somalia.
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References

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