Fatty liver biomarkers and insulin resistance indices in the prediction of non-alcoholic fatty liver disease in Ghanaian patients.

BACKGROUND: Scant West African data on non-alcoholic fatty liver disease (NAFLD) means there is little representation of this population in the modelling used to derive biomarkers and predictive indices for risk stratification of patients for the presence of hepatic steatosis. This study evaluates the performance of the fatty liver index (FLI), hepatic steatosis index (HSI) and triglyceride-glucose (TyG) index and its derivatives in predicting ultrasound detected NAFLD in a locally resident population of Ghanaian participants. METHODS AND FINDINGS: A post hoc analysis of data from a cross sectional assessment of NAFLD and cardiovascular risk was performed. Data from 210 participants without significant alcohol intake, or secondary causes of fatty liver and not on steatogenic drugs was evaluated. A structured questionnaire had been used to collect demographic data, medical and drug history. Anthropometry, blood sampling for liver chemistry and fasting lipids were performed. Hepatic steatosis was detected by ultrasonography. A retrospective analysis involving multivariate binary logistic regression assessed FLI, HIS, TyG (and its derivatives) as predictors of NAFLD with p < .05 considered statistically significant. Sensitivity, specificity, predictive values, likelihood ratios were calculated and accuracy of the proxies evaluated from area under the receiver operating characteristics curve (AUROC). All the biomarkers and indices were significantly associated with NAFLD (p ≤ .001). All the lipid and fatty liver indices assessed performed acceptably as predictors of NAFLD. FLI (AUC = 0.8, 95% CI [0.74-0.87]), TyG-WC (AUC = 0.81, 95% CI [0.75-0.88]) and TyG-WHtR (AUC = 0.81, 95% CI [0.74-0.88]) performed best at predicting NAFLD. Whilst in all cases the markers had good specificity (>90%) they lacked sufficient sensitivity with FLI having the highest sensitivity of 36.7%. Their overall accuracy was greater than 70% in each case. CONCLUSION: The overall accuracy of HSI, FLI, TyG index and its derivatives (TyG WHtR, TyG BMI, TyG WC) was acceptable for predicting NAFLD in this population. Given their performance in this study and in light of their low cost, accessibility, easy interpretation and non-invasive nature; they are suitable tools for screening in the Ghanaian population.

Migration intentions of Ghanaian medical students: the influence of existing funding mechanisms of medical education ("the fee factor").

BACKGROUND: To explore the effects of fee paying status on migration intentions of Ghanaian medical students. DESIGN: Cross sectional questionnaire based survey. SETTING: All established Ghanaian medical schools with students in their clinical years. PARTICIPANTS: Fee-paying and non-fee-paying Ghanaian medical students in their clinical years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Migration intentions of Ghanaian medical students after graduation, Allegiance to Government of Ghana. RESULTS: Approximately half (49%) of the medical students surveyed had intentions of migrating after school. Over 48% of those with migration intentions plan on doing so immediately after completing their house job, while 44% plan to migrate at least one year after their house job. The most popular destination chosen by the potential migrant doctors was North America (38%). Fee-paying students were significantly more likely (OR=2.11, CI=1.32, 3.38) than non-fee-paying students to have intentions of migrating after their training. Secondly, fee-paying students were more likely (OR=9.66, CI=4.42, 21.12) than non-fee paying students to feel they owe no allegiance to the Government of Ghana because of their fee-paying status. CONCLUSIONS: Medical Students' fee-paying status affects their intentions to migrate and their allegiance to the country after completion of their training.