Development of an assessment and referral tool for alcoholic liver injury among adults in selected counties in Kenya

Abstract

Alcohol consumption has been practised for many years in different cultures and societies in the world. Persons who consume alcohol for long periods usually experience adverse bodily harm yet the assessment and referral system on the harm caused is inadequate. Alcohol screening through the use of Alcohol Use Disorders Identification Test (audit) tool is widely acceptable globally. Other alcohol testing tools that are paramount in detection of alcoholic liver injury include the laboratory test for liver biomarkers. This study aimed to correlate the alcohol use disorder identification tests results with the results of the liver biomarkers and then develop an assessment and referral tool for alcoholic liver injury among adults in selected Counties in Kenya. The study was a non-experimental correlational study carried out in Murang’a and Uasin Gishu Counties. The study was divided into three phases. Phase I which included the use of audit tool to evaluate alcohol consumption, was achieved through administration of a structured questionnaire. Participants were required to donate blood samples for evaluation in the laboratories for liver biomarkers. An indpth interview was conducted on clinicians regarding their referral system. Phase II involved analysis of data from the audit tool and laboratory tests for liver biomarkers. Correlation of the blood samples with the audit screening results was an activity of phase II. Phase III involved formulation of an assessment and referral tool for alcoholic liver injury guided by the results of phase II. The study adopted Cochran formula for determination of the sample size. Data was scrutinized, cleaned and entered into a spread sheet using Statistical Package for Social Sciences version 24. Quantitative data was analyzed using descriptive statistical methods of mean, mode, median and standard deviation. Inferential statistics involves Chi-square to show relationships between variables. The analyzed data was then presented in tables, pie charts and frequency graphs. Cumulative score for the audit results were correlated with the biomarker results to develop an assessment and referral tool. Study results on Alcohol Use Disorder Identification Test from the domain of hazardous alcohol use found that on the sequence of alcohol consumption, 71% of the participants consumed alcohol 4 or more times in a week. The test on dependence alcohol use found that on daily or almost daily most of the participants were unable to stop drinking once started, were unable to meet expectations due to drinking and needed a first drink in the morning after a heavy session, they were represented by 51.6%, 51.6% and 66.7% respectively. On harmful alcohol use 82% of the participants desired to cut down on their drinking. Results from the liver biomarkers found that majority (97%) of the participants had alanine aminotransferase levels of 41 to 80 IU/L. Eighty two (88.2%) participants had aspartate aminotransferase elevated to between 35 and 68 IU/L. Gammaglutamyl aminotransferase was elevated in all 93 (100%) of the participants. From the qualitative data the clinicians were not well informed about the World Health Organization and the government referral system for alcoholic liver disease