Application of serious games to sport, health and exercise

Use of interactive entertainment has been exponentially expanded since the last decade. Throughout this 10+ year evolution there has been a concern about turning entertainment properties into serious applications, a.k.a "Serious Games". In this article we present two set of Serious Game applications, an Environment Visualising game which focuses solely on applying serious games to elite Olympic sport and another set of serious games that incorporate an in house developed proprietary input system that can detect most of the human movements which focuses on applying serious games to health and exercise

Epidemiological study of trypanosome species in domestic animals in Mogadishu, Jowhar and Afgoye districts of Somalia

Orientador: Prof. Dr. Rafael Felipe da Costa VieiraCo-orientador: Prof. Dr. Abdalla Mohamed IbrahimTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 01/07/2020Inclui referênciasResumo: Tripanossomose Africana Animal e Humana (TAA e TAH, respectivamente) continua sendo uma preocupação econômica e de saúde significativa na África. Na Somália, a guerra civil da década de 1990 resultou na destruição de estruturas educacionais, de pesquisa, econômicas e sociais, tornando as pontuações do país muito baixas para a maioria dos indicadores humanitários. Estudos anteriores sobre a detecção de espécies de Trypanosoma em animais domésticos da Somália só foram realizados durante a década de 1990, usando métodos padrão de detecção de tripanossomas (MPDT), esfregaço de sangue e técnica Woo. Existem poucas informações sobre o status da Tripanossomose na Somália, especialmente em relação à epidemiologia molecular. Desta forma, o objetivo deste estudo foi avaliar a prevalência e a caracterização molecular de tripanossomas em animais domésticos da Somália. Esta tese de doutorado apresenta dois manuscritos e revisão de literatura sobre Tsé-tsé e Tripanossomose. O primeiro manuscrito é um levantamento parasitológico, sorológico e molecular de Trypanosoma spp. em camelos (Camelus dromedarius) da Somália. Um total de 182 amostras de sangue de Camelus dromedarius de nômades e de fazendas leiteiras foram avaliadas usando os métodos MPDT, sorológico (CATT/T. evansi) e molecular (ITS1-PCR). Todas as amostras de camelos foram negativas para Trypanosoma spp. por STDM. Um total de 125/182 (68,7%, 95% CI: 61,4-75,3%) camelos foram soropositivos para T. evansi por CATT / T. evansi. Os camelos criados no sistema nômade apresentaram mais chance de serem soropositivos para T. evansi do que aqueles sob sistema de produção leiteira (OR: 5,6, IC 95%: 2,1-15,2, P = 0,0001). Cinco dos 182 (2,7%, IC 95%: 0,9-6,3%) camelos apresentaram resultado positivo para Trypanosoma sp. por ITS1-PCR. O sequenciamento da região ITS1 da espécie Trypanosoma detectada revelou que os camelos estavam infectados com T. evansi e T. simiae. O segundo manuscrito versa a respeito da detecção parasitológica e molecular de Trypanosoma spp. em bovinos, caprinos e ovinos da Somália. Um total de 614 amostras de sangue de bovinos (n = 202), caprinos (n = 206) e ovinos (n = 206) foram avaliadas usando a técnica de papa leucocitária (TPL) e ensaios moleculares incluindo SRA-PCR para detectção de T. brucei rhodesiense, agente causador da TAH. Um total de 21/614 (3,4%; IC95%: 2,1- 5,2%) e 101/614 (16,4%; IC95%: 13,6-19,6%) ruminantes foram positivos para Trypanosoma spp. por BCT e PCR, respectivamente. Por PCR, a maior prevalência de espécies de Trypanosoma foi observada em bovinos (23,8%; IC: 18,4-30,1%), seguidos por caprinos (17,5%; IC: 12,9-23,3%) e ovinos (8,3%; 95% IC: 5,1-12,9%). Um total de 74/101 (73,3%; 95% IC: 63,5-81,6%) ruminantes mostraram coinfecção com pelo menos duas espécies de Trypanosoma. Trypanosoma evansi, T. godfreyi, T. vivax, T. brucei, T. simiae e T. congolense foram as espécies de Trypanosoma encontradas no presente estudo. Todas as amostras positivas para T. brucei pelo TBR-PCR foram negativas para T. b. rhodesiense, pelo ensaio SRA-PCR. Este é o primeiro estudo sobre a detecção molecular de Trypanosoma spp. em animais domésticos na Somália. Mais investigações epidemiológicas e medidas de controle sustentável são necessárias para gerenciar infecções por Trypanosoma spp. e sua propagação no país. Além disso, os estudos também devem se concentrar na detecção de T. b. rhodesiense, agente causador do TAH, no país. Palavras-chave: Tripanossomose, Glossina spp., AAT, HAT, Saúde Única, SomáliaAbstract: Animal and Human African trypanosomiasis (AAT and HAT, respectively) remain significant health and economic concern in Africa. In Somalia, the civil war of the 1990s resulted in the destruction of educational, research, economic and social structures, making the country scores very low for most humanitarian indicators. Previous studies on the detection of Trypanosoma species in Somali domestic animals have only been performed during the 1990s using standard trypanosome detection methods (STDM), blood smear and Woo techniques. Scanty information exists about the trypanosomiasis status in Somalia, especially regarding molecular epidemiology. Accordingly, the aim of this thesis was to evaluate the prevalence and molecular characterization of trypanosomes in domestic animals from Somalia. This doctoral thesis presents two manuscripts and a general literature review on Tsetse and Trypanosomiasis. The first manuscript is a parasitological, serological and molecular survey of Trypanosoma spp. in camels (Camelus dromedarius) in Somalia. A total of 182 blood samples from Camelus dromedarius from nomadic and dairy farms were evaluated using STDM, serological (CATT/T. evansi) and molecular (ITS1-PCR) methods. All camel samples were negative for Trypanosoma spp. by STDM. A total of 125/182 (68.7%, 95% CI: 61.4-75.3%) camels were seropositive for T. evansi by CATT/T. evansi. Camels reared in the nomadic system were more likely to be seropositive for T. evansi than those under dairy production system (OR: 5.6, 95% CI: 2.1-15.2, P = 0.0001). Five out of 182 (2.7%, 95% CI: 0.9-6.3%) camels tested positive for Trypanosoma sp. by ITS1-PCR. Sequencing of the ITS1 region of the Trypanosoma species detected herein revealed that camels were infected with T. evansi and T. simiae. The second manuscript deals with the parasitological and molecular detection of Trypanosoma spp. in cattle, goats and sheep from Somalia. A total of 614 blood samples from cattle (n = 202), goats (n = 206) and sheep (n = 206) were evaluated using the buffy coat technique (BCT) and molecular assays including SRA-PCR performed for T. b. rhodesiense, HAT causative agent. Twenty-one out of 614 (3.4%; 95% CI: 2.1-5.2%) and 101/614 (16.4%; 95% CI: 13.6-19.6%) ruminants were positive for Trypanosoma spp. by BCT and PCR, respectively. Using PCR, the highest Trypanosoma species prevalence was observed in cattle (23.8%; 95% CI: 18.4-30.1%) followed by goats (17.5%; 95% CI: 12.9-23.3%) and sheep (8.3%; 95% CI: 5.1-12.9%). A total of 74/101 (73.3%; 95% CI: 63.5-81.6%) ruminants were shown coinfection with at least two Trypanosome species. Trypanosoma evansi, T. godfreyi, T. vivax, T. brucei, T. simiae and T. congolense were the Trypanosoma species found in the present study. All T. brucei-positive samples by the TBR-PCR have tested negative for T. b. rhodesiense, by the SRA-PCR assay. This is the first study on the molecular detection of Trypanosoma sp. in domestic animals in Somalia. Further epidemiological investigations and sustainable control measures are needed to manage infections of Trypanosoma spp. and its spreading in the country. In addition, studies should also focus on the detection of HAT causative agents in the country. Keywords: Trypanosomiasis, Glossina spp., AAT, HAT, One Health, Somali

Indigestible foreign bodies in the forestomach of slaughtered goats in Mogadishu, Somalia

Background and Aim: The primary domestic animal in Somali communities is the goat. Their main economic importance is as a food source and a main form of agriculture in the country. There has been a recent decline in the goat population in Somalia, which may be due to the shortage of feed and an increasingly contaminated environment that is affecting the population’s food supply and nutritional status. This study aimed to estimate the prevalence and the factors associated with indigestible foreign bodies (IFBs) ingestion in goats in Mogadishu, Somalia. Materials and Methods: A cross-sectional study was conducted at the Somalia Meat Company in Mogadishu, Somalia, in February 2022. A total of 250 goats were included in this study, and records were kept on age, sex, body condition, and location. Following the slaughter, goats were inspected for IFBs, and their stomach compartments were incised and examined. Indigestible foreign body classifications was noted and subjected to analysis using the Statistical Package for the Social Sciences version 26.0. Results: A total of 90/250 (36%; 95% confidence interval [CI]: 30.1-42.3) goats presented IFBs, being 71/90 (79%; 95% CI: 69-87) in the rumen, 12/90 (13%; 95% CI: 7-22) in the reticulum, and seven/90 (8%; 95% CI: 3-15) on both. The most observed IFBs were plastic in 71/90 (79%; 95% CI: 69-87), followed by ropes in eight/90 (10%; 95% CI: 5-18). A high IFB prevalence was observed in goats aged >2–≤3 years (44%), followed by >3 years (36%). The lowest frequency was observed in goats aged <2 years (30%). Overall, there was an association between IFBs in goats and poor body conditions (χ2 = 47%, p < 0.04). Conclusion: The absence of a plastic waste disposal system in the area, and communal free-grazing of livestock in highly contaminated sites, appeared to be significant contributors to the high occurrence of IFBs in goats. Therefore, appropriate policies for solid waste management should be implemented

Epidemiological study of trypanosome species in domestic animals in Mogadishu, Jowhar and Afgoye districts of Somalia

Orientador: Prof. Dr. Rafael Felipe da Costa VieiraCo-orientador: Prof. Dr. Abdalla Mohamed IbrahimTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 01/07/2020Inclui referênciasResumo: Tripanossomose Africana Animal e Humana (TAA e TAH, respectivamente) continua sendo uma preocupação econômica e de saúde significativa na África. Na Somália, a guerra civil da década de 1990 resultou na destruição de estruturas educacionais, de pesquisa, econômicas e sociais, tornando as pontuações do país muito baixas para a maioria dos indicadores humanitários. Estudos anteriores sobre a detecção de espécies de Trypanosoma em animais domésticos da Somália só foram realizados durante a década de 1990, usando métodos padrão de detecção de tripanossomas (MPDT), esfregaço de sangue e técnica Woo. Existem poucas informações sobre o status da Tripanossomose na Somália, especialmente em relação à epidemiologia molecular. Desta forma, o objetivo deste estudo foi avaliar a prevalência e a caracterização molecular de tripanossomas em animais domésticos da Somália. Esta tese de doutorado apresenta dois manuscritos e revisão de literatura sobre Tsé-tsé e Tripanossomose. O primeiro manuscrito é um levantamento parasitológico, sorológico e molecular de Trypanosoma spp. em camelos (Camelus dromedarius) da Somália. Um total de 182 amostras de sangue de Camelus dromedarius de nômades e de fazendas leiteiras foram avaliadas usando os métodos MPDT, sorológico (CATT/T. evansi) e molecular (ITS1-PCR). Todas as amostras de camelos foram negativas para Trypanosoma spp. por STDM. Um total de 125/182 (68,7%, 95% CI: 61,4-75,3%) camelos foram soropositivos para T. evansi por CATT / T. evansi. Os camelos criados no sistema nômade apresentaram mais chance de serem soropositivos para T. evansi do que aqueles sob sistema de produção leiteira (OR: 5,6, IC 95%: 2,1-15,2, P = 0,0001). Cinco dos 182 (2,7%, IC 95%: 0,9-6,3%) camelos apresentaram resultado positivo para Trypanosoma sp. por ITS1-PCR. O sequenciamento da região ITS1 da espécie Trypanosoma detectada revelou que os camelos estavam infectados com T. evansi e T. simiae. O segundo manuscrito versa a respeito da detecção parasitológica e molecular de Trypanosoma spp. em bovinos, caprinos e ovinos da Somália. Um total de 614 amostras de sangue de bovinos (n = 202), caprinos (n = 206) e ovinos (n = 206) foram avaliadas usando a técnica de papa leucocitária (TPL) e ensaios moleculares incluindo SRA-PCR para detectção de T. brucei rhodesiense, agente causador da TAH. Um total de 21/614 (3,4%; IC95%: 2,1- 5,2%) e 101/614 (16,4%; IC95%: 13,6-19,6%) ruminantes foram positivos para Trypanosoma spp. por BCT e PCR, respectivamente. Por PCR, a maior prevalência de espécies de Trypanosoma foi observada em bovinos (23,8%; IC: 18,4-30,1%), seguidos por caprinos (17,5%; IC: 12,9-23,3%) e ovinos (8,3%; 95% IC: 5,1-12,9%). Um total de 74/101 (73,3%; 95% IC: 63,5-81,6%) ruminantes mostraram coinfecção com pelo menos duas espécies de Trypanosoma. Trypanosoma evansi, T. godfreyi, T. vivax, T. brucei, T. simiae e T. congolense foram as espécies de Trypanosoma encontradas no presente estudo. Todas as amostras positivas para T. brucei pelo TBR-PCR foram negativas para T. b. rhodesiense, pelo ensaio SRA-PCR. Este é o primeiro estudo sobre a detecção molecular de Trypanosoma spp. em animais domésticos na Somália. Mais investigações epidemiológicas e medidas de controle sustentável são necessárias para gerenciar infecções por Trypanosoma spp. e sua propagação no país. Além disso, os estudos também devem se concentrar na detecção de T. b. rhodesiense, agente causador do TAH, no país. Palavras-chave: Tripanossomose, Glossina spp., AAT, HAT, Saúde Única, SomáliaAbstract: Animal and Human African trypanosomiasis (AAT and HAT, respectively) remain significant health and economic concern in Africa. In Somalia, the civil war of the 1990s resulted in the destruction of educational, research, economic and social structures, making the country scores very low for most humanitarian indicators. Previous studies on the detection of Trypanosoma species in Somali domestic animals have only been performed during the 1990s using standard trypanosome detection methods (STDM), blood smear and Woo techniques. Scanty information exists about the trypanosomiasis status in Somalia, especially regarding molecular epidemiology. Accordingly, the aim of this thesis was to evaluate the prevalence and molecular characterization of trypanosomes in domestic animals from Somalia. This doctoral thesis presents two manuscripts and a general literature review on Tsetse and Trypanosomiasis. The first manuscript is a parasitological, serological and molecular survey of Trypanosoma spp. in camels (Camelus dromedarius) in Somalia. A total of 182 blood samples from Camelus dromedarius from nomadic and dairy farms were evaluated using STDM, serological (CATT/T. evansi) and molecular (ITS1-PCR) methods. All camel samples were negative for Trypanosoma spp. by STDM. A total of 125/182 (68.7%, 95% CI: 61.4-75.3%) camels were seropositive for T. evansi by CATT/T. evansi. Camels reared in the nomadic system were more likely to be seropositive for T. evansi than those under dairy production system (OR: 5.6, 95% CI: 2.1-15.2, P = 0.0001). Five out of 182 (2.7%, 95% CI: 0.9-6.3%) camels tested positive for Trypanosoma sp. by ITS1-PCR. Sequencing of the ITS1 region of the Trypanosoma species detected herein revealed that camels were infected with T. evansi and T. simiae. The second manuscript deals with the parasitological and molecular detection of Trypanosoma spp. in cattle, goats and sheep from Somalia. A total of 614 blood samples from cattle (n = 202), goats (n = 206) and sheep (n = 206) were evaluated using the buffy coat technique (BCT) and molecular assays including SRA-PCR performed for T. b. rhodesiense, HAT causative agent. Twenty-one out of 614 (3.4%; 95% CI: 2.1-5.2%) and 101/614 (16.4%; 95% CI: 13.6-19.6%) ruminants were positive for Trypanosoma spp. by BCT and PCR, respectively. Using PCR, the highest Trypanosoma species prevalence was observed in cattle (23.8%; 95% CI: 18.4-30.1%) followed by goats (17.5%; 95% CI: 12.9-23.3%) and sheep (8.3%; 95% CI: 5.1-12.9%). A total of 74/101 (73.3%; 95% CI: 63.5-81.6%) ruminants were shown coinfection with at least two Trypanosome species. Trypanosoma evansi, T. godfreyi, T. vivax, T. brucei, T. simiae and T. congolense were the Trypanosoma species found in the present study. All T. brucei-positive samples by the TBR-PCR have tested negative for T. b. rhodesiense, by the SRA-PCR assay. This is the first study on the molecular detection of Trypanosoma sp. in domestic animals in Somalia. Further epidemiological investigations and sustainable control measures are needed to manage infections of Trypanosoma spp. and its spreading in the country. In addition, studies should also focus on the detection of HAT causative agents in the country. Keywords: Trypanosomiasis, Glossina spp., AAT, HAT, One Health, Somali

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

AIM To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia. METHODS A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems. RESULTS Twenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate among patients with chronic liver disease, including HCC, was 43.77% (95%CI: 35.09% to 52.84%). The overall pooled prevalence of HEV was 46.86% (95%CI: 5.31% to 93.28%). CONCLUSION Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease. This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease. © The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

AIM To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia. METHODS A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems. RESULTS Twenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate among patients with chronic liver disease, including HCC, was 43.77% (95%CI: 35.09% to 52.84%). The overall pooled prevalence of HEV was 46.86% (95%CI: 5.31% to 93.28%). CONCLUSION Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease. This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease. © The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved