Prevalence and Risk Factors of Metabolic Associated Fatty Liver Disease in sub-Saharan Africa: A Systematic Review and Meta-Analysis

Emmanuel M Sindato ¹ Violet Dismas Kajogoo ^2,3* Gloria Ngajiro ⁴ Wondwossen Amogne Degu ⁵ Zahid Khan ⁶ Gideon Mlawa ⁷

• ¹ University of Dodoma, Dodoma, Tanzania
• ² Tanzania Diabetes Association, Dar-es-salaam, Tanzania
• ³ College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
• ⁴ Benjamin Mkapa Hospital, Dodoma, Tanzania
• ⁵ Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
• ⁶ Mid and South Essex NHS Foundation Trust, Essex, England, United Kingdom
• ⁷ Barking, Havering And Redbridge University Hospitals NHS Trust, Romford, United Kingdom

Background: Sub-Saharan Africa (SSA) is undergoing an epidemiological transition with a steady rise in non-communicable diseases. Among these diseases, metabolic associated fatty liver disease (MAFLD) has emerged as a rapidly increasing public health burden but it is imprecisely documented. We characterized MAFLD prevalence and identified risk factors associated among adults in SSA.We searched PubMed/Medline, Cochrane, Embase, Web of Science, Google Scholar, and African Journals On-line for studies looking into Prevalence and Risk Factors of MAFLD in SSA. Studies from 1990 in English language were included and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Randomeffects models was used to estimate prevalence and risk factors with 95% confidence interval [CI]. Meta regression was used for subgroup analysis to account for heterogeneity. Stata 17 software was used for analysis. This study was registered with PROSPERO, registration number: CRD42024506067.Findings:538 studies were identified and 22 included for analysis.Overall prevalence of MAFLD was 29•21% (95% CI 22.09 -36.88: p<0.05). Regionally: West 34.36%, South 26.92% and East 24.56%. The prevalence of MAFLD among people living with HIV was 13.02%, diabetic 37.06%, hypertensive 36.75%, and people with body mass index above twenty-five was 46.05%. The prevalence was higher in females than males, 27.13% vs 23.01%, as shown in studies conducted from 2000+ as compared to those conducted between 2009-2019, 30.23% vs 28.4%, and in studies with small sample sizes <500 than in studies with large sample sizes >500; 32.42% vs 12.17%.Interpretation: MAFLD is highly prevalent in SSA, with a steady increasing magnitude.Significant risk factors include: diabetes, hypertension, obesity and female sex. This study underscores the emerging need of clinicians in SSA to screen MAFLD among patients with high risk and instigate tailored care.