Worried about the spread of the infection and its current rampaging consequences on the global health system, the World Health Organisation (WHO) launched the first global strategy on hepatitis in 2016. The strategy, among other efforts, aims to eliminate hepatitis as a public health threat by 2030.
Also in February 2020, African heads of states and governments including Nigeria’s pledged their commitment to the Cairo Declaration, which resolved to address viral hepatitis as a public health threat.
But in Nigeria, with an estimated 12 per cent of the country’s roughly 200 million population currently down with chronic hepatitis B, and two per cent of the population battling chronic hepatitis C, there seems to be no sign of the country’s commitment towards ending the disease burden by 2030.
On Tuesday, when PREMIUM TIMES attempted to speak to Nigerian officials in charge of the hepatitis programme, there was no one to be directed to.
The spokesperson of the federal ministry of health, Olusegun Adesola, simply told our reporter on the phone that he did not know who to recommend for the requested interaction.
He said; “I don’t know anyone that can speak on hepatitis for the ministry.”
Mr Adesola’s response reflects Nigeria’s ill-preparedness towards ending the disease in the country.
A lecturer at the College of Medicine, University of Lagos, who doubles as a gastroenterologist at the Lagos University Teaching Hospital, Idi Araba, Emuobor Odeghe, described hepatitis simply as an inflammation of the liver.
According to her, inflammation is how the liver “responds to any dangerous or injurious substance it is exposed to.”
She said; “There are different types and causes of hepatitis. But the type that is infectious is caused mainly by the hepatitis viruses such as hepatitis A or B viruses.
“Hepatitis B is very infectious and can be spread from person to person through body fluids, and sharing of personal items that have been contaminated with infected blood. It is more infectious than hepatitis C virus and HIV.”
The health expert added that the most common way the infection is spread is in early childhood through bruises, cuts, and skin infections. She said the situation informed the policy of birth-dose vaccination.
“The two types of hepatitis B infection are acute and chronic, and they are differentiated by their duration, that is, how long the individual remains infected with the virus. In acute infection, the virus is cleared from the body within six months from when the person first got the virus. But in chronic infection, the body is unable to clear it, and the virus persists or remains permanently in the body. This is the type that can cause liver cirrhosis and liver cancer,” Mrs Odeghe added.
According to WHO, every 30 seconds, a person dies of hepatitis-related disease, amounting to an average of 3,600 deaths every day.
The global health organisation also said that both hepatitis B and C, which are regarded as the commonest of the five strains, cause an average of 1.1 million deaths and 3 million new infections globally every year.
The annual aggregate of the new infections, WHO said, now presents the world with the total figure of more than 325 million people living with hepatitis infections globally.
Of this global figure, WHO said more than 90 million people are living with hepatitis in Africa, representing 26 per cent of the global total.
In a statement shared on Tuesday ahead of this year’s annual Hepatitis Day celebration, the WHO’s regional director for Africa, Matshidiso Moeti, said more than 124,000 Africans die every year from the consequences of undetected and untreated hepatitis.
According to Ms Moeti, about 4.5 million African children under five years old are infected with chronic hepatitis B, “reflecting an enormous 70 per cent of the global burden in this age group.”
She added that; “The global target of less than 1 per cent incidence of hepatitis B in children under 5 years has been reached, but the African region is lagging behind at 2.5 per cent.
“Yet only 14 countries in the region are implementing hepatitis B birth-dose vaccination. Among people who are infected, nine out of 10 have never been tested because of limited awareness and access to testing and treatment. Even among countries offering hepatitis B birth-dose vaccines, health systems are facing challenges in ensuring pregnant women and mothers are tested and that those who test positive are treated.”
As part of activities marking the world hepatitis day in 2020, Nigeria’s health minister, Osagie Ehanire, confirmed that an estimated 20 million Nigerians suffer from chronic hepatitis infections.
“We could estimate that about 20 million people are chronically infected with hepatitis B and C. Therefore, we recognise the importance of vaccination as a critical intervention in our determination to eliminate HBV infection by 2030,” the minister said then.
But an associate professor and consultant gastroenterologist at the Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Abiodun Jemilohun, told PREMIUM TIMES that the figure has since risen above the minister’s claim.
According to Mr Jemilohun, the current data shows that about 12 million of the country’s population are down with chronic hepatitis B disease while roughly two per cent battles the hepatitis C variant. When combined, he said between 24 and 25 million Nigerians are estimated to be suffering from the hepatitis challenge.
Speaking to the 2021 theme of the World Hepatitis Day, which is, “Hepatitis can’t wait,” the WHO director-general, Tedros Ghebreyesus, said the clock is ticking against the global goal to eliminate the disease as a public threat by 2030, and urged countries of the world to buckle up.
Mr Ghebreyesus added that the WHO’s global hepatitis strategy aims to reduce new hepatitis B and C infections by 90 per cent and death by 65 per cent between 2016 and 2030.
He said; “We have made real progress in some countries on preventing and treating viral hepatitis, and expanding infant vaccination. But globally, access to prevention, testing and treatment for viral hepatitis remains far too low. Over 250 million people have chronic viral hepatitis, and estimated 80 per cent of them can’t access the care they need.
“We have the tools to reach this target but only if all the countries commit to making sure that they have access to them. So let’s get to work because hepatitis can’t wait.”
Towards achieving the target, the African leaders held a summit in Cairo, Egypt, in 2020 and rolled out plans for execution of the strategies against the hepatitis spread.
According to WHO, the Egyptian government pledged to provide hepatitis C treatment for 1 million Africans. So far, the initiative has reached more than 50,000 people in South Sudan, Eritrea and Chad.
The organisation added that Rwanda, Uganda and Benin Republic have established free testing and treatment programmes for hepatitis, and that 16 other countries are starting pilot projects in that direction.
Ms Moeti said; “To guide action on hepatitis, 28 African countries now have strategic plans in place and at the global level WHO guidelines were launched last year on prevention of mother-to-child transmission of hepatitis B. The WHO Regional Office for Africa is developing training materials in order to help countries to implement the five hepatitis core interventions and decentralize the diagnosis and treatment.
“Going forward, as WHO we are seeking to integrate hepatitis B interventions into antenatal care services. We also want to strengthen collaboration with key partners, such as the Organization of African First Ladies for Development, which have championed progress towards a HIV-free generation. By expanding programmes to incorporate hepatitis, action can be quickly scaled-up.”
She, therefore, urged stakeholders in the maternal and child health sector to consider how hepatitis could be integrated into existing initiatives such as the First Ladies’ “free to shine” initiative which she noted is working in countries for an AIDS-free generation in Africa.
“Health systems also play vital roles in preventing transmission by making sure blood donations are screened and that syringes are only used once and then safely disposed of. Finally, I want to encourage individuals to seek testing and treatment for hepatitis and to learn more about this disease, to end the silent epidemic,” Ms Moeti concluded.
While countries such as Rwanda, Uganda and Benin Republic have established free testing for hepatitis and Egypt has made treatment almost free, access to hepatitis testing and treatment in Nigeria comes at a cost.
Speaking on the development, Mr Jemilohun, said it would cost about N5,000 (about $12), one-sixth of Nigeria’s minimum wage, to be tested for hepatitis B and C.
Also, the health expert said birth-dose vaccination, which is aimed at nipping the infection rise in the bud at the early stage, has its national coverage standing at 34 per cent.
He said; “We cannot say Nigeria is not making efforts at all but the issue is that the efforts aren’t enough. For instance, vaccination is a sure strategy to limit the spread and we have a vaccination programme but how accessible is this vaccination for Hepatitis B programme? We only have about 34 per cent coverage.
“Also, the other measure that could help is compulsory testing for adults but we don’t have that. It should be a national programme that all those tested for Hepatitis B and deserving treatment should be enrolled for treatment because it is not every positive case that requires treatment. But all Hepatitis C cases require treatment and should be treated as such.”
He added that the availability of health experts to attend to such cases is another major challenge, saying less than 100 gastroenterologists are available to the country’s estimated 200 million people.
“The truth is that, definitely, those who have undergone postgraduate training in gastroenterology and are working in Nigeria are less than 100. And the majority is also in the cities, especially where teaching hospitals are located, because only a very few are in full private practice.
“For instance, in Ogun State, only about three of us are resident here. There could be others who come in to work and go but those of us who are resident here are between three and four,” he said.
Also speaking, Mrs Odeghe identified low awareness as well as cost of testing and medications as a challenge. She said the development makes many patients visit hospitals late with advanced liver disease for which treatment options are limited.
She said; “Hepatitis B usually doesn’t cause symptoms until advanced liver damage has occurred, so many people remain unaware of their infection. It is not uncommon for us to see patients who only know that they have hepatitis B or C when they develop symptoms of liver cancer.
“Other challenges will be the frequent use of traditional and complementary drugs. Stigmatisation of infected people is another challenge, such that infected people are ashamed to disclose their status. Some people have lost their jobs or marriages because they revealed that they were hepatitis B positive.
“Currently, only 10 per cent of infected individuals are aware that they are infected, and only 5 per cent of people who are eligible for treatment are actually receiving treatment. Rates of vaccination are also low.”
The World Health Organisation has pleaded with countries of the world to recognise the urgency required in the testing and treatment of hepatitis cases, noting that the spread of the infection is a threat to the global health system.
Both Mr Jemilohun and Mrs Odeghe also recommended the institution of free testing policy in Nigeria, and that the disease management should be heavily subsidised to encourage those infected to present themselves for treatment.
Meanwhile, Mr Jemilohun recommended that the country should expand its HIV/AIDS programme to include testing for hepatitis, saying that some of the drugs used in the management of HIV are also used to manage hepatitis B in particular.
“The HIV/AIDS programme has been very successful and will be a very good channel to address the hepatitis challenge because the testing and treatment are almost similar,” Mr Jemilohun said.
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