With the transition of our Institute into the Global Health Institute Düsseldorf–Arsi (GHIDA), we are expanding its research agenda beyond infectious diseases and traditional tropical medicine to address the broader spectrum of health challenges relevant to Ethiopia and the region. Non-communicable diseases (NCDs), including chronic liver disease, cancer, and metabolic diseases, represent an increasingly important part of this burden and are therefore becoming an integral component of GHIDA’s Global Health research activities. 

This expanded focus builds on long-standing research activities in hepatology and chronic disease at the institute. Previous and ongoing projects have investigated, among other topics, the prevalence, causes, and progression of chronic liver diseases in Asella as well as risk factors for drug-induced liver injury during tuberculosis treatment. Building on these established collaborations, clinical infrastructure, and expertise, GHIDA aims to further develop interdisciplinary research on NCDs with a particular focus on locally relevant risk factors, prevention, early detection, and strengthening clinical care in resource-limited settings. 

Occupational and environmental risk factors for esophageal cancer in Ethiopia

Esophageal cancer is an important health challenge in Eastern Africa, with particularly high incidence rates reported from the Arsi-Bale region of Ethiopia. Prognosis is often poor, as many patients are diagnosed at an advanced stage and access to resource-intensive curative treatment remains limited. Identifying modifiable and locally relevant risk factors is therefore an important step towards effective prevention. 

The project investigates two widespread occupational and environmental exposures that may contribute to the high burden of esophageal cancer in Ethiopia: pesticide exposure during agricultural work and household air pollution from cooking with solid fuels. Both exposures are common in Ethiopia and involve substances with known or suspected carcinogenic properties. However, their individual and combined contribution to esophageal cancer risk remains insufficiently understood. 

A case-control study will be conducted at Asella Referral and Teaching Hospital, Adama Hospital Medical College, and St. Paul’s Hospital in Addis Ababa. Patients diagnosed with esophageal cancer will be compared with matched controls. Standardized interviews and, household visits will be used to assess long-term pesticide exposure, agricultural working practices, cooking fuels, stove type, kitchen ventilation and other relevant environmental and lifestyle factors. Particular attention will be paid to the combined effects of pesticide exposure and household air pollution. 

Beyond identifying risk factors, the project has a strong focus on prevention. It will investigate whether readily implementable measures may attenuate exposure-related cancer risks, i. e. personal protective equipment and improved hygiene when handling pesticides, better kitchen ventilation, improved stove designs and reduced exposure to cooking smoke. The findings could therefore contribute to practical and cost-effective prevention strategies for Ethiopia and other resource-limited settings. 

The project is led by the Institute of Occupational, Social and Environmental Medicine at Heinrich Heine University and University Hospital Düsseldorf in close collaboration with the GHIDA, Arsi University and Ethiopian clinical partners and funded by the by the research commission of the medical faculty of the Heinrich Heine University. By combining expertise in occupational and environmental health, epidemiology, gastroenterology and tropical medicine, the project builds on the long-standing research partnership between Düsseldorf and Ethiopia.

Drug-Induced Toxic Hepatitis During Tuberculosis Treatment

Ethiopia is one of the countries with a high burden of tuberculosis. A major challenge of treatment is the development of drug-induced liver injury (DILI) as a result of antituberculosis therapy. This complication can lead to treatment interruptions, compromise treatment success, and increase the risk of disease progression or the development of resistance.

In a study funded by the Research Commission of the University Hospital Düsseldorf, GHIDA investigated the prevalence, clinical consequences, and risk factors of tuberculosis-associated DILI. Particular focus was placed on analyzing genetic variants of bile acid transporters and their potential significance for individual susceptibility to drug-induced liver injury.

Chronic Liver Diseases

Chronic liver diseases are also becoming increasingly prevalent in Ethiopia. Another GHIDA study is investigating the prevalence, causes, and risk factors of chronic liver diseases in Asella.

Using transient elastography (FibroScan®), a non-invasive method for assessing liver fibrosis and stiffness, patients are examined and factors influencing the course of the disease are identified. Concurrently, clinical training sessions on the management of chronic liver diseases and their complications are conducted to sustainably strengthen local healthcare capacity.