Liver Disease United States vs Egypt

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Etiology

Acute liver failure can happen for a variety of reasons and through a variety of mechanisms. Liver disease may be mild, moderate, or extreme, acute or chronic, localized or widespread, reversible or irreversible, and reversible or irreversible. Patients will also recover with no long-term medical complications. On the other hand, patients’ symptoms are severe enough that they need to see a medical professional. The liver’s function in bile formation is harmed (cholestasis). Acute liver damage resulting from causes like a virus, may result in liver cell death and multiorgan failure. A high mortality rate is associated with this acute liver failure syndrome; however, in recent years, the use of emergency liver transplantation has greatly increased survival.

Pathophysiology

The majority of cases of ALF result in a large amount of hepatocyte necrosis which will result in liver failure. The cerebral edema and hepatic encephalopathy that are seen in acute liver failure are a result of multiple factors (Cholankeril, G, et al). The blood-brain barrier becomes altered due to inflammatory mediators that cause microglial activation, glutamine accumulation from ammonia, and oxidative stress. leading to less ATP and GTP (Cholankeril, G, et al). This ultimately leads to swelling and cerebral edema (Cholankeril, G, et al).

Risk Factors

In this study, the risk factors included sex, ethnicity, education level, smoking status, cardiovascular disease, cancer, and COPD (Atsawarungruangkit, A., et al, 2018). Specifically, the independent risk factors that they found were subjects who are males, have a lower education level, and Mexican Americans. Someone who does not have a high school education and any history of smoking were also significantly associated with higher mortality (Atsawarungruangkit, A., et al, 2018). According to one analysis, 23 variables were connected to NAFLD. For instance, waist circumference, fasting C-peptide, total protein, being Mexican American, triglyceride level, and ferritin level were found to be associated with NAFLD. (Atsawarungruangkit, A., et al, 2018).

As found in some of the research in Egypt, age was found to be a risk factor for DILI, with rates peaking in the fifties. This may be due to the accumulated risk of drug exposure over time, or it may be due to the vulnerability of drug metabolizing and excreting hepatic enzyme consumption. These findings were in line with several other studies that have identified age as a risk factor for DILI (Medina-Caliz, et al, 2019). recently proposed one year as the best end point for defining chronic DILI. Chronic DILI is linked to older age, dyslipidemia, and the seriousness of the acute episode, according to the researchers. The only predictors of successful DILI outcomes in this cohort group were younger age and higher prothrombin concentrations, according to multivariate analysis. Egypt is cursed with the highest prevalence of HCV, which is a major risk factor in DILI morbid outcomes (Medina-Caliz, et al, 2019).

Incidence and Prevalence for United States and Egypt

In the United States, there were significant differences in the causes of mortality rates among patients with NAFLD in the United States population (Fouad, Y., et al, 2020). The mortality rates for those in the 5 and 8 year group were significantly higher than those for subjects without NAFLD (Fouad, Y., et al, 2020). Likewise, NAFLD patients with a high risk of advanced fibrosis were associated with cardiovascular disease and cancer (Fouad, Y., et al, 2020).

Egypt has the highest rate of hepatitis C virus (HCV) infection in the world. According to the 2008 Demographic Health Survey (DHS), national seroprevalence was 14.7 percent among those aged 15 to 59 years, with viremic prevalence of 9.7 percent in this age group, which increased with age and was higher in males than females in all age groups studied (Devex 2019). While the number of cases of viremic infections in people under the age of 25 fell from 805,000 to 300,000 (a reduction of 505,000 cases), the overall prevalence in the population only fell by 325,000 cases. This indicates that the infection is still present in the older age groups (Devex 2019).

Social Determinants of Health

Healthcare Access

The healthcare system in Egypt is pluralistic, involving various healthcare providers from the private and public sectors. The Egyptian government provides universal health coverage even though there are private hospitals whereby those with the ability to pay for such services are free to do so. Most Egyptians tend to avoid public hospitals due to poor services, inadequate staff training, patient delays in treatments, and poor sanitation. This is one of the causes of the aggravation of the disease in Egypt. Accessibility to healthcare services is much easier in the United States. The provision of Medicaid and Medicare insurance programs has made it easier to access and get quality care from the hospitals. There are many hospitals both public and private to cater to the needs of the population. Thus, management of liver diseases is much better in the U.S. as compared to Egypt.

Technology

The implementation of the latest technology in the healthcare sector is an essential step for Egypt. The risk of liver disease is higher for Egyptian health workers due to a lack of knowledge of and compliance with infection prevention and control procedures across different hospitals (Devex, 2019). A nationwide vaccination program to combat schistosomiasis, also known as snail fever, began between the 1950s and 1980s. Schistosomiasis is caused by parasites of the urinary or intestinal tract. Despite over 36 million vaccines being administered by medical personnel, they did not adequately sterilize the syringes (Devex, 2019). The country has done less to implement the latest medical equipment and screening procedures in combating liver diseases. Technology in the United States is much more advanced in the area of healthcare than other underdeveloped countries. For instance, the introduction of electronic health records reduces patient delays and improves patient outcomes. Most liver disease cases are detected and treated before they become chronic.

Education

Most people in Egypt suffer from a lack of quality education and illiteracy. With a literacy rate of 71.17 percent as of 2017, about 29 percent of the population is not literate, which is a significant hindrance to managing the disease (Marco Trends, n.d.). Education plays a crucial role in an individual’s health and has been shown to aggravate healthy behaviors and enhance health outcomes. As stated by the Daily News in Egypt, the “Illiteracy rate among Egyptian females stood at 30.8%, or 10.6 million, compared to the 21.1%, or 7.8 million, reported among Egyptian males” (Marco Trends, n.d.). According to this statistic, women are the most affected by illiteracy, which means promoting health awareness is a challenge. Unfortunately, many male and female students have been dropping out of schools, making it even harder to comprehend how liver disease progresses. In contrast with Egypt, the rate of the United States literacy is significantly higher. For this reason, most people are conscious about specific diseases, their causes, how they can be prevented and managed. Furthermore, it is more accessible to promote healthcare and education programs to build disease awareness and help manage the disease in the United States than in Egypt.

HealthCare Interventions

Some healthcare interventions for combating liver diseases in Egypt include introducing an integrated national approach that had subsidized anti-hepatitis C virus treatment, education, awareness campaigns, and strengthened infection control within the healthcare facilities (Ventura-Cots et al., 2019). The United States has formulated healthcare policies that focus on providing preventive care like a vaccination against liver diseases and alcohol avoidance — alcohol liver-based disease is the primary cause of liver-related mortalities globally. In the U.S., public education and awareness campaigns have been extensively used to educate people about the disease, how it can be prevented or managed. These measures are incredibly efficient in the fight against the disease. For instance, Ali Yehia and other scholars argue that education against liver disease and their risk factors prevention have successfully reduced the percentage of insufficient knowledge about liver disease from a pre-intervention of 33.5 percent to a post-prevention of 1.1 percent (Yehia et al., 2020).

Sustainable Development and Healthy People 2020 Goal

The Healthy People 2020 goal chosen is to improve access to health services (Healthy People 2020. n. d). Improving the quality of health care services will help the chances of early detection of liver disease. The Sustainable Development Goal selected is poverty eradication and its forms everywhere (United Nations Development Program. n.d.). This health goal will improve the conditions of people who are poor presenting them with an incredible opportunity to be able to pay for medical bills in either the public or private sector. Poverty eradication will ensure that people get better education and also provide universal access to basic social services.

Application of an Upstream Approach

Upstream healthcare is an approach to interrupt these structural barriers and change the quality of life of people and health outcomes. An improvement of financial stability will transform the ramifications in health outcomes (James, 2020). By mitigating and eradicating the gaps that are creating stress within the healthcare system in Egypt, predictable health outcomes, and violence in the community, it is possible to create a sustainable enhanced quality of life trajectory for the patients. The healthcare systems’ resources should not just be used to treat injuries and diseases but for problem resolution and upstream innovation. They are ensuring the country’s financial stability and different regions, especially those languishing in poverty and the ones inhabited by the racially prejudiced populace, with help in eliminating liver disease in both countries (James, 2020). The nurses have a role to play, such as formulating policies that will eradicate healthcare disparities to ensure the resources are utilized efficiently.

References

Atsawarungruangkit, A., Chenbhanich, J., & Dickstein, G. (2018). C-peptide as a key risk factor for non-alcoholic fatty liver disease in the United States population. World Journal of Gastroenterology, 24(32), 3663–3670. https://doi.org/10.3748/wjg.v24.i32.3663

Cholankeril, G., & Ahmed, A. (2018). Alcoholic Liver Disease Replaces Hepatitis C Virus Infection as the Leading Indication for Liver Transplantation in the United States. Clinical Gastroenterology and Hepatology, 16(8), 1356–1358. https://doi.org/10.1016/j.cgh.2017.11.045

Devex. (2019). The impact of Egypt’s mass hepatitis C screening on health care workers. https://www.devex.com/news/the-impact-of-egypt-s-mass-hepatitis-c-screening-on-health-care-workers-95311

Fouad, Y., Elwakil, R., Elsahhar, M., Said, E., Bazeed, S., Ali Gomaa, A., … Attia, D. (2020). The NAFLD‐MAFLD debate: Eminence vs evidence. Liver International, 41(2), 255–260. https://doi.org/10.1111/liv.14739

Healthy People 2020. (n.d.). Access to health services. |https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services.

James, T. (2020). What Is Upstream Healthcare? Health City. https://www.bmc.org/healthcity/population-health/upstream-healthcare-sdoh-root-causes

Le, M. H., Devaki, P., Ha, N. B., Jun, D. W., Te, H. S., Cheung, R. C., & Nguyen, M. H. (2017). Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. PLOS one, 12(3). https://doi.org/10.1371/journal.pone.0173499

Macro Trends. (n.d.). Egypt Literacy Rate 1976–2021. https://www.macrotrends.net/countries/EGY/egypt/literacy-rate.

Prevalence of Hepatitis C Infection among Diabetics Type 2 at Sharkia Governorate, Egypt. (2015). International Journal of Science and Research (IJSR), 4(11), 1713–1720. https://doi.org/10.21275/v4i11.nov151497

StackPath. (2020). Egypt’s illiteracy rate decreased to 24.6% in July 2019: CAPMAS. https://dailynewsegypt.com/2020/09/08/egypts-illiteracy-rate-decreased-to-24-6-in-july-2019-capmas/.

United Nations Development Program. (n.d.). Sustainable development goals. https://www.undp.org/content/undp/en/home/sustainable-development-goals.html.

Ventura-Cots, M., Ballester-Ferré, M. P., Ravi, S., & Bataller, R. (2019). Public health policies and alcohol-related liver disease. JHEP reports: innovation in hepatology, 1(5), 403–413. https://doi.org/10.1016/j.jhepr.2019.07.009

Yehia, S. A., Morad, W. S., Hendy, O. M., & Dorgham, L. S. (2020). Effect of health education intervention on hepatocellular carcinoma risk factor prevention in Menoufia governorate, Egypt. Egyptian Liver Journal, 10(1), 1–8.

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