Assessing primary healthcare workers’ knowledge of nonalcoholic fatty liver disease in a marginalized community in Mexico Nonalcoholic fatty liver disease (NAFLD) is a growing health concern globally, and particularly in marginalized communities in Mexico. As the prevalence of this condition increases, understanding its risk factors, symptoms, and treatment options becomes vital for healthcare workers. Yet, how well are primary healthcare providers equipped to diagnose and manage NAFLD in these underserved regions? A recent cross-sectional pilot study sought to evaluate the knowledge of primary healthcare workers about this increasingly common yet underdiagnosed disease.
Nonalcoholic fatty liver disease (NAFLD) is a chronic condition affecting approximately 25% of the global adult population. The highest rates of prevalence are seen in South America (30.45%) and the Middle East (31.79%)1. In the United States, a study revealed that Hispanics of Mexican origin have a higher prevalence of NAFLD (33%) compared to other Hispanic groups (Puerto Rican 18% and Dominican 16%, P < 0.01)2. In Mexico, NAFLD prevalence is estimated at around 29%3.
NAFLD is linked to an increased risk of liver fibrosis, cirrhosis, and hepatocellular carcinoma4. A study conducted across primary healthcare centers in four European countries (UK, Spain, Italy, and The Netherlands) showed a lower prevalence (1.85%, 95% Confidence Interval [CI]: 0.91–2.79) than expected based on the 24% prevalence (95% CI: 16%–34%), indicating potential underdiagnosis and underreporting5.
In a study by Polanco-Briceno et al.6, involving 152 primary care physicians, it was found that up to 50% of physicians were unfamiliar with the term “nonalcoholic fatty liver disease” and the distinction between steatosis and steatohepatitis. Despite this, 58% of physicians reported managing patients diagnosed with NAFLD.
Another study7 revealed that while 91% of primary healthcare workers recognize the link between metabolic syndrome and NAFLD, only 46% reported having screened high-risk patients for the disease. While 58% considered weight loss and calorie restriction as treatment for NAFLD, only 27% referred patients for further evaluation by specialists. A major barrier to optimal care was a lack of understanding of the disease.
On the positive side, training nursing staff through educational tools has been shown to enhance the detection, treatment, and timely referral of NAFLD patients, as compared to a single intervention from general practitioners8.
The purpose of this study was to assess the level of knowledge about NAFLD among primary healthcare professionals in a marginalized region of Mexico, with the aim of identifying educational gaps and improving care for at-risk populations.
Abstract
The incidence of nonalcoholic fatty liver disease (NAFLD) in primary healthcare settings is lower than expected, indicating a lack of awareness among healthcare professionals. Research shows that implementing educational tools can improve timely referrals and treatments for patients. This study aimed to assess the knowledge of healthcare workers regarding NAFLD and identify their educational needs in a marginalized region of Mexico. We conducted a cross-sectional survey of 261 healthcare professionals in Tlapa de Comonfort, Guerrero, Mexico, between October and December 2019. A questionnaire was developed to evaluate knowledge in key areas related to NAFLD. A total of 246 questionnaires were completed, with 38.3% of respondents being nurses and 63.4% women. The majority of nurses (89%) recognized NAFLD as a prevalent condition, and 93% understood that it is preventable. Hypertension (33%) and obesity (84%) were identified as key risk factors. The links between NAFLD and cancer, cirrhosis, and cardiovascular disease were acknowledged by 53%, 67%, and 72% of respondents, respectively. The greatest knowledge gaps were in diagnostic procedures, therapeutic approaches, and current treatments. These findings highlight modifiable gaps in NAFLD knowledge, and educational interventions for primary care workers could improve the identification and management of NAFLD, reducing complications in the community.
The Growing Threat of Nonalcoholic Fatty Liver Disease in Mexico
NAFLD is the most common cause of chronic liver disease worldwide, and its prevalence has significantly increased in Mexico, where poor diet and sedentary lifestyles are becoming more prevalent. A study published in 2020 estimated that 25% of the global population suffers from NAFLD, with rates in Mexico reaching alarming levels.
In marginalized communities, where access to healthcare services is limited, the disease often goes undiagnosed until significant liver damage occurs, leading to complications like cirrhosis and liver cancer.
The Importance of Primary Healthcare Workers in NAFLD Management
Primary healthcare workers (PHWs) are often the first line of defense against diseases like NAFLD, especially in rural and economically disadvantaged areas. They play a crucial role in identifying at-risk individuals, educating patients about lifestyle changes, and coordinating further care. However, for PHWs to be effective, they must have sufficient knowledge about NAFLD.
Key Findings from the Pilot Study
A recent cross-sectional pilot study conducted in a marginalized community in Mexico aimed to assess the level of knowledge about nonalcoholic fatty liver disease among primary healthcare workers. Here are the key findings:
- Knowledge Gaps: Over 60% of healthcare workers were unfamiliar with the diagnostic criteria for NAFLD and its connection to metabolic syndrome.
- Lack of Training: Most PHWs reported not having received formal training on liver diseases, particularly NAFLD.
- Barriers to Diagnosis: Inadequate resources, lack of diagnostic tools, and insufficient follow-up care hindered effective management of NAFLD.
Why This Matters for Marginalized Communities
In marginalized areas, where healthcare access is already strained, the lack of awareness and training among primary healthcare workers leads to a critical gap in healthcare delivery. Early detection and intervention are key to preventing the progression of NAFLD and improving patient outcomes, but this is impossible without proper knowledge and resources.
Recommendations for Improving Knowledge and Care
- Increase Training and Education: A targeted educational program for PHWs on NAFLD’s risk factors, symptoms, and diagnostic protocols is essential.
- Improve Diagnostic Access: Investing in basic diagnostic tools such as liver function tests and ultrasound machines could aid in early detection, particularly in remote areas.
- Community Outreach: Engaging with local communities to raise awareness about the importance of regular health check-ups and lifestyle changes can help prevent the onset of NAFLD.
- Policy and Resource Allocation: The Mexican government should prioritize funding and support for healthcare initiatives aimed at tackling nonalcoholic fatty liver disease, especially in underserved regions.
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Conclusion
This pilot study highlights significant knowledge gaps among primary healthcare workers in marginalized communities in Mexico when it comes to nonalcoholic fatty liver disease. To improve outcomes, it is essential to invest in healthcare worker education, enhance diagnostic capabilities, and implement community-based awareness campaigns. By addressing these issues, we can ensure better management of NAFLD and reduce the burden of liver disease in these vulnerable populations.
FAQ
What is nonalcoholic fatty liver disease (NAFLD)?
NAFLD is a condition where fat builds up in the liver without alcohol consumption, often linked to obesity, diabetes, and metabolic syndrome.
Why is NAFLD a concern in marginalized communities in Mexico?
In these areas, lack of awareness, limited access to healthcare, and poor dietary habits contribute to the growing prevalence of NAFLD.
What is the role of primary healthcare workers in NAFLD management?
PHWs are essential for early detection, patient education, and referral to specialists for further care.
How can healthcare workers improve their knowledge of NAFLD?
Providing targeted training on NAFLD, its risk factors, and diagnostic criteria is key to improving healthcare delivery.
How does the lack of resources affect the diagnosis of NAFLD?
Limited access to diagnostic tools such as ultrasound machines and liver function tests prevents early detection and proper management.
What steps can be taken to prevent NAFLD in marginalized communities?
Community education on healthy lifestyles, regular check-ups, and improved access to healthcare are essential for preventing NAFLD.
