World Hepatitis Day: How Nigeria has fared in battling scourge

Doctors attending to patients used to illustrate the story
Doctors attending to patients used to illustrate the story

Tosan (surname withheld) was diagnosed with Hepatitis B in 2011, after her elder brother compelled the whole family to go for the test in order to know their status.

She said her brother made that decision after he was diagnosed of having the disease while taking some medical examination which was part of the requirements to travel out of the country.

“My brother was traveling out for his Master’s degree and he needed to do some medical examination or have evidences of vaccination against the diseases.

“One of the test was Hepatitis B. In short, I have never heard the name of the disease before. Only for my brother to test positive. At first, we were all scared. This is my family that we all believe are hale and hearty,” she said.

Tosan said her brother encouraged them to go for test and after he consulted with doctors, realised that the disease is treatable and curable.

“My brother started treatment, and that did not stop him from travelling. So when I eventually did the test and it came out positive, I started treatment immediately.

“It wasn’t an easy feat. I was always taking drugs, could not share with friends because of the scare of stigmatisation. I had to endure, changed my diet and kept hoping for the best.”

Tosan was one of the few people who detected their status early when there was still a chance for treatment.

Many victims of the disease have not been lucky to have the disease detected early. Most times, the disease is diagnosed at a late stage or after it had caused other damages to their bodies, especially the liver.

Many Nigerians unaware of status

Viral hepatitis is a public health threat that affects millions of people across the across the world and Nigeria has been a major contributor to the number of infected people.

Just like Tosan, many Nigerians have never heard of the disease or are they unaware of their status.

Every day, thousands of people become infected due to exposure through unsafe injection practices and insufficient information and tools for prevention.

A cross section of people interviewed in Abuja had verge knowledge of the disease. Some have heard of the disease but do not understand how it is been contacted or can be prevented.

Mr Hassan said he only heard of the disease last year when he went for his yearly medical screening and his result came out negative.

“My doctor advised me to get the vaccine which I started, took two doses but have not taken the third dose till date. I intend to start all over because I was told that vaccine can prevent the disease,” he said.

Another respondent who asked not to be named said though his brother died of Hepatitis B, he has not taken time to understand the disease.

He said he only knows some of the symptoms such as “yellowish eyes and whiteness of the hands”.

“My brother died of the disease, that is how I got to know there is a disease like that. I did not bother to know much about it and I don’t know it can be cured or have a vaccine,” he said.

According to World Health Organisation Global Hepatitis Report 2017, viral hepatitis caused 1.34 million deaths in 2015 a number comparable to deaths caused by tuberculosis and higher than those caused by HIV.

WHO said the number of deaths due to viral hepatitis is increasing over time, while mortality caused by tuberculosis and HIV is declining.

The agency said most viral hepatitis deaths in 2015 were due to chronic liver disease (720 000 deaths due to cirrhosis) and primary liver cancer (470 000 deaths due to hepatocellular carcinoma).

Hepatitis preventable, treatable and curable

The good news is that the Hepatitis B is vaccine preventable. Unfortunately, many Nigerians are unaware of this. Hepatitis is also treatable and curable when diagnosed early.

Nigeria has 20 to 30 million people affected with Hepatitis B according to the WHO and with a percentage of 13.7; Nigeria has one of the highest cases of Hepatitis B in the world.

The Hepatitis B vaccine, which is usually given in three dose gives more than 90 per cent protection to people who get it.

Meanwhile, most inhabitants of the world are not vaccinated against this while Hepatitis C remains without a vaccine.

There are two vaccines that protect against Hepatitis B: one protects the infants and children, while the other protects the adults.

The Nigerian government in 2004 introduced Hepatitis B vaccine into the National Program on Immunisation.

According to WHO, an early win in the global response to viral hepatitis was achieved through the effective scaling up of Hepatitis B vaccine making global coverage with the three doses of Hepatitis B vaccine in infancy reached 84 per cent.

“This substantially reduced HBV transmission in the first five years of life, as reflected by the reduction in HBV prevalence among children to 1.3 per cent. However, coverage with the initial birth dose vaccination is still low at 39 per cent. Other prevention interventions are available but insufficiently implemented,” the report said.

With the near effective coverage of vaccine for children, the adult population are being left behind.

Field Observations

The reporter noticed that lack of public knowledge on the diseases and the availability of the adult vaccine is part of the challenges faced in preventing the spread of the disease in Nigeria.

PREMIUM TIMES visited some health facilities in Abuja and observed that for an adult to get a HBV vaccine in Nigeria, they have to visit a secondary and tertiary health institution.

This is because most PHCs do not offer the services for adults.

All the PHCs visited said though hepatitis vaccines are available, they only administer to children (under five). It was also observed that some secondary health institutions also do not provide the service.

This implies that most adult Nigerians, even if they want to get the vaccine, might not be able to because of the lack of such services in their vicinity.

This means they would have to look for private hospitals offering the services or tertiary health facilities.

At the Byazhin Primary health care centre, the health officer said they only give to children.

“It is only children under the ages of five that are entitled to get the free Hepatitis B vaccines at the PHCs. We do not give Hepatitis B vaccine to adults. We only give to babies. I will advise you go to the General Hospital in Kubwa, they should have for adults. We give babies because it is part of the routine immunisation. It is part of the vaccines they get,” she said.

At the PHC in Kuchingoro, a surburb, the reporter was also directed to the National Hospital or Federal Medical Hospital, Jabi.

In the Wuse District Hospital, the reporter was told to try elsewhere as they only provide the vaccine services tochildren.

The immunisation agent at the immunisation point said they only attend to babies at the centre.

“We do not give vaccines to adults. I will advise you to go to private hospital or National hospital or Garki. You should be able to get it there. It is what the government gives us that we give. What they give us is for children,” he said.

At the Federal Medical Centre, Jabi, the vaccine officer told the reporter that the vaccine is available and costs N700 per dose.

“We operate between 9 to 12 pm. You can run your test from outside and bring your report once it is negative to collect the vaccine. We also run the test here. We can start the vaccine here and the person can go finish it elsewhere. We will give a card to show what the person has been given,” she said.

Also at the Kubwa General Hospital, the vaccine was also available. The price for collection was N500 per dose.

Experts speak on challenges

A virology lecturer at the University of Ibadan, Moses Adewumi (Phd), in a telephone interview said the best way to curb the spread of Hepatitis B is through immunisation.

Mr Adewumi said , like every viral infection, “prevention is always the key”.

He explains there are five different types of Hepatitis, ” but the major ones is the B and C”.

Mr Adewumi said though Hepatitis C is not prevalent in Nigeria, all hepatitis have the tendency of liver cirrhosis and hepatocellular carcinoma.

“It is good that people get to know that there is a vaccine for hepatitis B and the best way is to prevent this. There is a need to educate people on the disease because the mode of transmission is very similar to that of HIV.

“It is only when people go for test that they will know that they are infected. The prevalence of hepatitis is almost similar to that of HIV,” he said.

Mr Adewumi said the government needs to be more involve in the campaign, “talk to those who produce vaccines on how to get it to the people and also educate people on the need for the prevention and ensure that they do not get infected.

“People should go for proper testing, know their status and seek medical advice when positive. Collection of adult vaccine should also be encouraged and the cost of collection should be regulated because the cost is very high at some places.

“Though we do not provide vaccines in the country, the government needs to get to the point of knowing that the health of the people is very important and as such the vaccine should be made available and people should be educated on the need to access it,” he said.

Another health expert, Femi Akinyode who weighs said Hepatitis, mainly transmitted through “openings of the body”, needs to be taken seriously in the crafting of the nation’s health policies.

He explains that out of 10 persons who contract the ailment, nine will be cured while one may become a chronic carrier. “The chronic carriers are at risk of liver cancer and cirrhosis,” he adds.

He said that in other to achieve Universal Health Coverage and eliminate Hepatitis, people need to be more informed and vaccinated.

Hepatitis: An overview

Hepatitis has various modes of transmission but is commonly spread by exposure to infected bodily fluids.

It can be spread though sweat, needle-sharing, mother to child transmission at birth and unsafe blood transfusion.

Some of the symptoms of the diseases include: yellowing of the eyes, abdominal pain and dark urine. While some people particularly do not experience any symptoms, it could lead to chronic cases, liver failure, cancer or scarring.

Chronic cases require medication and possibly a liver transplant.


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