Magnitude of liver diseases discovered during medico legal autopsies at Muhimbili National Hospital, Dar-Es-Salaam, Tanzania.

Abstract

ABSTRACT Background The liver is susceptible to various injuries including metabolic, circulatory, environmental and socioeconomic leading to acute or chronic liver diseases. The impact of resultant chronic diseases in many low- and middle-income countries is steadily growing (Naghavi M., et al), but scarcely documented. Lack of awareness about frequencies and patterns of these diseases limits benefiting from treatment and preventive measures (WHO. 2008, Vol 8, number 1). Unlike other chronic diseases which can be detected during routine check-ups with diagnostic tools such as sphygmomanometer and glucometer, most liver diseases including fatty liver requires histological work up, with special stains to describe their patterns (Orah N., et al). To date no data has been documented on the prevalence of liver diseases discovered during autopsy in our country and thus, occurrence and frequency of these diseases in our settings is not known. Autopsy based studies including those determining the histopathological patterns of the liver diseases are very useful in elucidating occurrence and magnitude of such diseases in our community and this is the aim of the current study. Objective: To determine the magnitude of liver diseases discovered during medico-legal autopsies at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Methodology: We conducted a prospective cross-sectional study, which was autopsy based at Muhimbili National Hospital Histopathology Laboratory premises in which Medical-legal autopsies received at MNH mortuary facility (part of laboratory unit) with causes of death other than liver diseases were enrolled for the study. Demographic information and circumstance of death were established from respective Police Form number 99 (PF 99) and cross-checked with the information from the identifying witnesses of deceased person. Gross appearance of the liver was recorded prior to sampling of the tissue. Specimen sections were stained by routine H&E protocol, then additional sections were prepared from tissue blocks for selected special stains as directed by H&E sections results, including Reticulin, Per-iodic acid Schiff and Pearl‘s Prussian Blue special stains for necessary. Results: This study recruited 253 forensic autopsy cases. Majority were males 218(86%) and the mean apparent age in years at death was 36 +/- 12.98(SD). The age range was from 16 to 78 years (M:F ratio of 6:1). The peak age group of the study participants was 26-35years 77(30.4%). The mean ages in years for males and females were 36.74+/-13.23(SD) and 38.23+/-13.38(SD) respectively, and a median of 36years. Bulk of cases had fatty change 83(32.8%), followed by steatohepatitis 37(14.6%), and combined granulomatous lesions 27(10.7%).All six (100%) of liver cirrhosis cases had livers with decreased weight. Regardless of specific disease types majority of cases were crowded in the younger age groups while steatosis cut across all age groups. Conclusion: There are fatal and prevalent liver diseases afflicting younger forensic decedents in our setting. Steatosis was found to be the most common liver disease entity, reflecting the possible picture in the general population in this demographic region, these were followed by steatohepatitis and combined granulomatous lesions of the liver. Recommendations: Basing on disclosure of histopathological patterns from this study, modalities for liver biopsy in patients, for evidence of hepatopathy should be scaled up and made widely available in our public health systems. Pathologists performing forensic autopsies should consider liver histology as routine practice to scale up diagnosis of clinically unnoticed liver diseases. More studies to underpin the evidence for viral hepatitis and determinants of steatosis among study cases are crucial to elucidate their cause specific magnitude alongside their biochemical and molecular profiles.