Fred Ezeh, Abuja
On Tuesday, July 28, 2020, Nigeria joined the rest of the world to commemorate “World Hepatitis Day,” with the global theme “Hepatitis Free Future.” This was to raise local and global awareness about hepatitis and the dangers of contracting the virus.
The virus, medical records say, is in five main stages, notably, Hepatitis A, B, C, D and D. Hepatitis B and C are the most common cause of death with over 1.3 million lives lost annually.
Regrettably, amid the COVID-19 pandemic, viral hepatitis continues to claim thousands of lives across the world, with poor attention given to it. The level of knowledge of viral hepatitis remains low among Nigerians despite the fact that it is a leading infectious cause of death and claims the lives of many each year.
As a consequence, most of the 17-21 million Nigerians estimated to be living with viral hepatitis do not know that they are infected, thus placing them at greater risk for severe, even fatal, complications from the disease, and increasing the likelihood that they would spread the virus to others.
Unlike other diseases like HIV/AIDS, Tuberculosis, Malaria, and recently, Coronavirus (COVID-19) that had received massive support from world leaders, hepatitis, unfortunately, has received unimpressive financial and logistics support from world leaders and international donor agencies.
Evidently, poor knowledge of the disease among global population, particularly Nigerians, could largely be attributed to low level of sensitisation and enlightenment about the disease. As a result, there is significant rise in number of positive cases in Nigeria.
Globally, the prevalence of hepatitis is staggering. A recent report from the World Health Organization (WHO) estimated that more than 325 million people live with viral hepatitis B and C, with an estimated 2.8 million people were infected in 2018 alone.
Regrettably, most people living with hepatitis lack access to testing opportunity and vaccination, which are preventive measures. Also, those tested positive seem to lack adequate access to treatment.
Data from the Federal Ministry of Health indicated that Nigeria is one of the countries with the highest burden of viral hepatitis with a prevalence of 8.1 per cent of Hepatitis B and 1.1 per cent of Hepatitis C, though with regional variations.
The statistics confirmed that male to female distribution varies and children are not spared. Cases of viral hepatitis are most commonly found among the age group of 21 to 40 years. But in Nigeria, there is a strong relationship between Hepatitis B virus infection and various forms of chronic liver disease, including chronic hepatitis, liver cirrhosis and hepatocellular carcinoma.
Facts about hepatitis
Hepatitis is said to be an inflammation of the liver, which can be chronic or acute. According medical books, hepatitis viruses are the most common cause of hepatitis infection, but reckless consumption of alcohol, drugs, and autoimmune diseases can also cause hepatitis.
With Nigeria having an average prevalence of 8.1 per cent and 1.1 per cent for hepatitis B virus and hepatitis C virus, there are indications that nine out of ten people living with the viral hepatitis are unaware of their status.
Viral hepatitis is responsible for the death of over one million people across the world each year. It’s also responsible for two of every three liver cancer deaths. Hepatitis A, B, C, D, and E, are the different types of Hepatitis virus; and all of the viruses cause liver disease.
Major risk factors
Dr Mike Omotoso, President, Nigerian Commission Hepatitis Zero Representative to the African Union (AU), said the risk factors in Nigeria are majorly cultural practices that have been on for decades across different ethnic groups in Nigeria. Such practices included local circumcision and scarification on the body, tribal marks, surgical procedures, body piercing, delivery at home and receiving blood transfusion.
Research confirmed that hepatitis viruses are transmitted through contact with the infected body fluids, contaminated injection drug needles, sharing personal items with someone who has the virus, sexual contact with someone with the virus, among several others.
He said many people engage in such cultural activities having no knowledge of health implications, particularly making them vulnerable to viral attacks. He said viral hepatitis is a major cause of liver cirrhosis and liver cancer in Nigeria, and eliminating hepatitis by 2030 as contained in the Sustainable Development Goals (SDGs), will require enduring innovation, better access to medicines, and improved health services.
The World Health Organisation’s (WHO) new recommendation, according to him, is that “everybody should have access to Hepatitis C testing and curative treatment, and global health communities should come together to officially begin moving towards the elimination of viral hepatitis by 2030. With the transmission of indigenous programs in the country in over 15 languages while being Nigeria’s public radio network, Radio Nigeria has proven itself a trailblazer, a feat worthy of note.”
Omotoso said the Global Hepatitis Eradication Initiative (GHAI) is a commission dedicated to a vision of a hepatitis free world through advocacy, screening, prophylaxis and treatment.
Studies confirmed that hepatitis can be prevented through a change in lifestyle that pre exposes someone to the risk factors. In addition, vaccination has proven to be effective in preventing the disease.
An official of Federal Ministry of Health, Dr Clement Adesegbe, admitted that vaccine has proven to be effective in case of prevention. He insisted that before the vaccine can be administered on someone, he or she must have been tested and certified hepatitis free before vaccination as preventive option. In the event that the test result returned positive, treatment will be the next action and not vaccination:
“There is vaccine for Hepatitis A and B. Vaccinating against Hepatitis B will also protect against Hepatitis D, because only those with Hepatitis B stand a chance of contracting Hepatitis D. Adequate funds should be raised, domestically, to support the fight against the disease, since notable international donor agencies are yet to financially support the fight against hepatitis.
“We have to look inward to get solutions to the problem. Interestingly, state governments are beginning to show positive response by committing their finances. Nasarawa and Lagos states have committed funds to the project against hepatitis. We are, equally, getting positive responses from Taraba, Adamawa, Zamfara and Cross River states.”
Consequences of poor funding
Heartland Alliance International (HAI), human rights organisation committed to protecting and promoting the rights of extremely vulnerable populations attributed the rising cases of hepatitis in Nigeria to lack of awareness among the people. Its Chief Executive Officer, Bartholomew Ochonye, appealed for commitment from government and other individuals to the fight against hepatitis:
“I am concerned that the level of knowledge of the disease is low in Nigeria and that has been responsible for the rise in figure of confirmed cases. Many are unaware that they are carrying the disease because of high cost of testing.
“We are working with key populations to enlighten the people about hepatitis using different platforms and our 25 centres in Lagos, Akwa Ibom and Cross River states to do that. In a society where figures of diseases like HIV/AIDS are going largely because of increase in awareness, that of hepatitis is rising significantly due to poor knowledge about the disease. It should be a cause for concern for us all.
“Viral hepatitis is the only disease in Nigeria that is on the increase. People must improve on their health seeking behaviour, even though it has become complicated because of COVID-19 pandemic that disrupted socioeconomic activities, globally. People must be mindful of what they eat, drink and other lifestyle particularly sexual related activities.”
He commended the intervention of the Federal Government in the fight against hepatitis, but requested for more actions, particularly in the areas of testing and vaccination.
In his presentation at the commemoration, Adesegbe said: “Hepatitis B can best be prevented by vaccines that are safe, available and highly effective. It is not usually necessary to treat a new Hepatitis B infection in the first six months. Nine out of 10 new infections in adults clear up on its own, with or without treatment.
“In early stage of the disease, treatment makes very little difference to the chances of a cure. Anti-viral drugs may only be necessary and helpful in rare cases, if the acute infection causes very aggressive liver inflammation.
“In chronic (long-lasting) Hepatitis B, it is advisable to consult medical doctor about the situation. Some people need treatment, while others don’t. Treatment does not usually cure Hepatitis B, but it can turn an aggressive Hepatitis B infection into a mild infection. This can stop the liver from being damaged. If the infection is considered mild, it might be better to monitor it and wait until later for treatment.
“Vaccinating against Hepatitis B will also protect against Hepatitis D. Studies have shown that only those with Hepatitis B can contract Hepatitis D. In addition to vaccination, other ways to prevent hepatitis infections include: regular hands washing after use of the restroom, washing your hands after coming in contact with another person’s blood, stool, or other bodily fluids, avoiding contaminated water and foods, do not share toothbrushes or razors, avoid illegal drugs, clean and cover cuts and wounds.
“The aim of treatment for Hepatitis C is to achieve a Sustained Virological Response (SVR), meaning that the virus is not detectable in blood originally 24 weeks, now more frequently 12 weeks, after treatment has stopped. This is the equivalent of a cure because the virus does not return, unless the person is newly infected. The new drugs are showing SVR rates of approaching 100 per cent in trials.