A spatiotemporal analysis of liver disease and its determinants in urban and rural Malawi: Identifying disparities in disease burden and opportunities for public health intervention

The impact of liver disease in sub-Saharan Africa (SSA) is increasing over time, including deaths from liver cirrhosis and liver cancer. Treatment options are limited in this setting and most cases present late with poor outcomes.

Current evidence indicates that the leading risk factor is viral hepatitis, followed by excess alcohol consumption and non-alcoholic fatty liver disease. Often these interact to produce more severe disease.

All are either preventable or can be controlled on treatment, highlighting the critical importance of prevention, early diagnosis and treatment.

Nested within a large population study in Malawi, my work will screen approximately 50,000 people for alcohol consumption across urban and rural sites. A sub-sample of 6,000 people from within this group will then have blood samples taken for viral hepatitis testing.

Evidence on who is at risk, and in which areas, will inform policy, including the design of preventative interventions and approaches to improve access to clinical care.

Participants at high risk of liver disease will be invited to undergo further investigations and clinical assessment which will improve understanding of the burden of liver disease in Malawi, the unmet need for antiviral treatment, and how best to identify cases in future.