Liver diseases continue to pose a significant global health challenge, contributing to approximately 2 million deaths annually and accounting for nearly 4% of all global deaths. Chronic liver conditions such as cirrhosis, hepatitis B and C infections, alcohol-related liver disease, and metabolic-associated steatotic liver disease (MASLD) are among the leading causes of liver-related morbidity and mortality. While high-income countries have made strides in managing liver diseases through early screening and advanced therapeutics, low- and middle-income countries (LMICs) face disproportionate burdens due to limited healthcare infrastructure and inadequate surveillance systems.
In sub-Saharan Africa (SSA), the burden of liver disease is particularly acute, with some of the highest liver-related death rates globally, especially among males. The region faces a complex interplay of risk factors, including viral hepatitis, alcohol use, aflatoxin exposure, and emerging metabolic disorders such as MASLD, type 2 diabetes mellitus (T2DM), and hypertension. A recent meta-analysis estimated the prevalence of MASLD in SSA at 29.2%, with higher rates among individuals with diabetes, hypertension, and elevated body mass index (BMI). Despite this growing burden, liver diseases in the region remain underdiagnosed and underreported.
Rwanda’s Epidemiological Transition
Rwanda is undergoing a rapid epidemiological transition, with non-communicable diseases (NCDs) accounting for 47.7% of health facility-based deaths and 59.3% of community deaths in 2024. The country’s aging population and increasing prevalence of diabetes, hypertension, and obesity have raised concerns about the potential silent burden of liver dysfunction, particularly among older adults. However, national data on liver enzyme abnormalities remain scarce, and liver health is often overlooked in NCD management programs.
Emerging evidence suggests that gender differences play a critical role in liver disease presentation and progression. Men tend to have higher baseline levels of alanine amino transferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT), while women are more susceptible to autoimmune liver diseases and benign liver tumors. Despite these differences, gender-stratified analyses of liver enzyme abnormalities are rarely conducted in African settings.
Study Design and Key Findings
This descriptive cross-sectional study was conducted at the NCD outpatient clinic of the University Teaching Hospital of Butare (CHUB) in Southern Rwanda. The study aimed to examine the prevalence and gender-specific patterns of liver enzyme abnormalities among adult patients with NCDs, contributing to more equitable and targeted liver health interventions.
A total of 185 adult patients were enrolled between February and April 2025. The study found that 27.6% of participants exhibited abnormal liver enzyme levels, with distinct patterns of elevation across AST, ALT, and GGT. Notably, the De Ritis ratio (AST/ALT) was significantly higher in females compared to males. Gender-specific trends suggest alcohol-related liver injury in males and metabolic or environmental factors in females.
“The prevalence of liver enzyme abnormalities was observed in 27.6% of participants, with isolated GGT elevation emerging as the most common pattern at 9.7%.”
Implications and Future Directions
The findings underscore the need for integrating liver function screening into routine NCD care. The study also highlights the importance of gender-sensitive liver health strategies, as men and women differ in NCD prevalence, metabolic profiles, and liver disease progression. The trends observed, such as higher prevalence among daily alcohol users and those with lower physical activity, warrant further investigation.
Globally, a meta-analysis of 278,000 participants reported significantly higher ALT, AST, and GGT levels in individuals with metabolic syndrome, reinforcing the link between NCDs and liver dysfunction. These comparisons emphasize the need for gender-sensitive liver health strategies in NCD care across SSA.
While this study provides valuable insights, it also has limitations. The cross-sectional design restricts causal inferences, and the reliance on self-reported alcohol consumption introduces potential biases. Future research should explore longitudinal outcomes and incorporate imaging and fibrosis assessments to better characterize liver disease burden in this population.
As Rwanda continues to navigate its epidemiological transition, addressing liver health within the broader context of NCD management will be crucial. The integration of liver function tests into routine care could significantly improve early detection and intervention, ultimately reducing the burden of liver-related diseases in the region.
