| dc.description.abstract | Hepatocellular carcinoma (HCC) or liver cancer is a malignant cancer of the liver. It is a global public health problem which is often ignored, under diagnosed or diagnosed late when patients already have severe symptoms. HCC pathogenesis is preceded by chronic inflammation of the liver. It exhibits poor response to treatment, leading to high mortality rates. Common risk factors of HCC include viral hepatitis B- (HBV) and C (HCV) and non-viral causes such as aflatoxins, excess alcohol intake, tobacco, iron overload, genetic predisposition, ur-antitrypsin deficiency, diabetes mellitus, obesity and about 18% of cases are of unknown cause. Human immunodeficiency virus (HIV) is known to independently cause liver inflammation but its relevance in the causation of liver cancer is not clear. Data to inform management and prevention of HCC is generally lacking in the developing countries such as Kenya. The general objective was to develop a predictive analysis of risk factors associated with HCC Western Kenya. The specific objectives included (i) ascertain the risk factors which play a role in the causation of HCC in western Kenya, (ii) ascertain the relevance of HIV in the causation of HCC in western Kenya, (iii) to develop a predictive mathematical model to predict the dynamics of risk factors of and burden of HCC in Western Kenya. The study was un-marched case control, prospective, of participants who were diagnosed to have liver cancer and controls. The study was based at the Kisumu County and Referral Hospital and it included 257 participants with liver cancer and 257 controls who had no liver cancer. Male: female ratio was 2.2: 1 for cases and 3 .2: 1 for controls. Mean age was 46.2 ± 25 .1 years for cases and 3 7.4 ± 14.99 years for controls. 2. 7% of cases had previous history of excessive alcohol intake compared to 8.2% of controls (p < 0.617). Mean CD4+ cell count was low in cases at 237. 7 ± 96.4 [range 50-417] cells/µ] compared to 626.3 ± 267.6 (340-910) cells/µl for controls (p < 0.001). Using adjusted odds ratio (aOR), the risk factors which were identified included; age> 35 years in cases compared to controls (88.3% vs 11.7%), [aOR =51.6; 95% confidence interval (CI) (27.8 -95.6), p < 0.001)]; HBV infection, more likely in cases than controls (47.1% vs 30.4%), [aOR = 3.3; 95% confidence interval (CI) (1.7-5.0), p < 0.0001]; HIV sero-status, more positive in cases than controls (33.5% vs 10.9%), [aOR =4.3, 95% confidence interval (CI) (2.2-8.4)), p < 0.001] and males more at risk than females (32.7 % vs 23.7), [aOR=0.4, 95% confidence interval (CI) (0.3-0.7), p < 0.001]. A compartmental model and a hybrid predictive model combining Susceptible-Infected¬Recovered and Incidence-Prevalence-Mortality of the risk factors was developed. The model shows that liver cancer burden will increase in western Kenya from 257 to 10,232 cases in two years. The study concludes that, hepatitis B virus is still a major risk factor of HCC and human immunodeficiency virus is established as a significant risk factor of liver cancer in western Kenya. Other risk factors include gender, males more than females and age greater than 35 years. The burden of liver cancer disease is likely to increase unless it is controlled. | en_US |