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Effect of Community-Based Liver Health Screening on Liver Disease Detection among Adults in Nigeria

Abstract

Liver diseases remain an important public health concern among adults in Nigeria and include conditions such as viral hepatitis, fatty liver disease, liver cirrhosis, and other chronic liver disorders that may result in substantial morbidity, disability, healthcare expenditure, and premature mortality. Adults may be exposed to several risk factors for liver disease, including viral hepatitis infections, harmful alcohol consumption, obesity, diabetes, unsafe medical practices, exposure to hepatotoxic substances, and other environmental and behavioural factors. Many liver diseases may remain undetected for prolonged periods because they can progress without obvious symptoms until significant liver damage has occurred. Delayed detection may result in advanced disease, complications, reduced treatment effectiveness, and increased healthcare costs. Community-based liver health screening provides an opportunity to bring liver disease assessment closer to adults through community outreach programmes, primary healthcare centres, mobile health services, health campaigns, and other community platforms. Screening may involve assessment of risk factors, hepatitis testing, liver function assessment, and other appropriate diagnostic investigations followed by referral for further clinical evaluation. Early detection may facilitate timely treatment, monitoring, lifestyle modification, and prevention of disease progression and complications. However, inadequate screening coverage, limited diagnostic facilities, shortages of trained healthcare personnel, low awareness, financial barriers, stigma associated with some liver diseases, and weak referral and follow-up systems may limit the effectiveness of community-based liver health screening programmes in Nigeria. Against this background, this study investigates the effect of community-based liver health screening on liver disease detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Community Health Theory, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to liver disease, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based liver health screening. Community Health Theory emphasizes the delivery of accessible health services through community structures and the involvement of communities in disease prevention, health promotion, and early detection activities. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective liver health screening and healthcare programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based liver health screening may influence liver disease detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based liver health screening will be measured using indicators such as availability of screening services, screening coverage, frequency of community screening activities, accessibility of screening locations, liver disease risk assessment, hepatitis B and C screening where appropriate, liver function assessment, availability of trained healthcare personnel, screening and diagnostic equipment, liver health education, and referral arrangements. Liver disease detection will be assessed using indicators such as positive hepatitis screening results, abnormal liver function findings, suspected fatty liver disease, suspected chronic liver disease, abnormal liver-related clinical findings, newly identified cases, confirmed liver disease following appropriate clinical evaluation, referrals for further assessment, and linkage to appropriate treatment and follow-up care. Data will be collected using structured questionnaires, community screening registers, laboratory reports, liver health assessment records, healthcare facility records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, liver health findings, and patterns of liver disease detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based liver health screening on liver disease detection. Where appropriate, liver disease detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based liver health screening has a significant positive effect on liver disease detection among adults in Nigeria. Adults who participate in community-based liver health screening are expected to have a higher likelihood of having previously undetected liver disease or liver-related abnormalities identified than adults without access to such services. Community-based screening may facilitate early identification of viral hepatitis, abnormal liver function, and other liver-related conditions and provide opportunities for confirmatory testing, clinical assessment, treatment, lifestyle modification, monitoring, and referral to specialist services where necessary. Bringing liver health screening closer to adults may reduce geographical, financial, and time-related barriers and increase awareness of liver disease risk factors and preventive practices. Early detection may also improve opportunities for timely management and reduce the risk of disease progression and complications. Conversely, inadequate screening coverage, limited diagnostic capacity, shortage of trained healthcare personnel, low awareness, stigma, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of community-based liver health screening. The study therefore expects accessible and well-organized community-based liver health screening to contribute significantly to improved detection and early management of liver diseases among adults in Nigeria. The study is expected to contribute to the literature on community-based liver health screening, liver disease detection, adult health, viral hepatitis, chronic liver disease, preventive healthcare, community health services, health promotion, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, laboratory services, hepatology and gastroenterology providers, community health workers, development partners, and policymakers regarding strategies for improving early detection of liver diseases. The study will also provide evidence-based recommendations for expanding community-based liver health screening programmes, improving access to hepatitis testing and appropriate liver health assessments, strengthening community education on liver disease prevention, increasing availability of trained healthcare personnel and diagnostic resources, improving referral and follow-up systems, reducing financial and geographical barriers to screening, strengthening linkage to treatment, and promoting early detection and management of liver diseases among adults across Nigeria.

Keywords: Community-based liver health screening, liver disease detection, adults, liver health, viral hepatitis, chronic liver disease, liver function screening, preventive healthcare, community health services, early detection, Nigeria, public health.