World Hepatitis Day: Poor awareness threatens Nigeria’s battle to eliminate disease

Doctors performing surgery on a patient
Doctors performing surgery on a patient

In 2017, Shehu Akowe, a rights activist, tested positive for Hepatitis B when he volunteered to donate blood for an ailing friend’s son admitted at the National Hospital, Abuja.

If not for the donation of blood, Mr Akowe would not have known he had the viral infection that can cause a chronic infection, cirrhosis, and liver cancer, if not managed.

“Not until that day I don’t know anything about hepatitis though I have been hearing the name. I never noticed or felt any symptoms,” he told PREMIUM TIMES on Monday evening.

Like Mr Akowe, many Nigerians have very little knowledge of this disease transmitted through unsafe injection practices.

If you are not aware, you will not get tested and if you are not tested, the disease will not be detected.

At least 30 Nigerians interviewed by this newspaper on Monday did not know some of the common symptoms of hepatitis which include abdominal pain and fatigue. Some have been screened for the disease but do not know there is a vaccine that can protect them against the viral infection.

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

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

“The doctors said my test result showed my immune systems had been protecting me against the disease and that was why I was having no symptoms,” he said. “They said I was lucky to have come for screening on time, I was prescribed drugs to boost my immune system.”

World Hepatitis Day

World Hepatitis Day (WHD) takes places every year on July 28, to bring the world together under a single theme and to raise awareness of the global burden of viral hepatitis in order to influence real change.

This year’s theme, Hepatitis-free future, holds a strong focus on preventing hepatitis B among mothers and newborns, and spreading awareness about the disease amid COVID-19 pandemic.

So, it becomes all the more crucial to know about the nature, prevention, and treatment of these viral illnesses.

Health experts have repeatedly pointed to poor awareness and screening for Hepatitis as a major reason why the infection has remained endemic in Nigeria.

2030 target

According to the World Health Organisation (WHO), dying of viral hepatitis in Africa is now a bigger threat than dying of AIDS, malaria, or tuberculosis. Yet, hepatitis does not usually get the awareness and funding it deserves.

Nigeria is among African nations that signed to a Global Health Sector Strategy (GHHS) target set by the WHO in 2016 to eliminate viral hepatitis as a public health threat by 2030, and provided to run from 2016–2021.

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This strategy has been adopted and endorsed by 194 countries. The aim is to reduce new hepatitis infections by 90 per cent and deaths by 65 per cent between 2016 and 2030.

Currently, only 12 countries are on track to eliminate hepatitis by 2030.

Viral hepatitis kills more than 1.3 million people each year, more than HIV/AIDs or Malaria, yet there is a cure for hepatitis C and a vaccine and effective treatment for hepatitis B.


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The 4,000 deaths each day caused by viral hepatitis are preventable. Currently, 290 million people live with viral hepatitis, completely unaware, and one of the key reasons is a lack of knowledge about the disease.

Nigeria is off-track from meeting its target.

Hepatitis B, according to the Ministry of Health, has a national prevalence of 11 per cent while hepatitis C has a prevalence of 2.2 per cent. Both have become leading silent killers in the country; more than half of the nation’s population are believed to never have been tested and, therefore, do not know their infection status.

Ignorance

Mike Omotosho, a public health expert and President of Hepatitis Zero Nigeria Commission, said about 17 to 21 million Nigerians estimated to be living with viral hepatitis do not know that they are infected, “placing them at greater risk for severe, even fatal, complications from the disease”.

According to him, the level of knowledge of the viral infection remains low amongst Nigerians despite the fact that it is a leading cause of death and claims the lives of many each year.

“The major problem is that a lot of people are not aware of. It is so bad that when you talk to 10 people, each of them will have ‘something’ to say about hepatitis. Most people do not know what hepatitis really is or even its symptoms, causes or prevention.

“Almost 20 million Nigerians are working around with the hepatitis virus. Also, less than 5 million of those people know their status.

“If you truly do not know your status, you may not be able to know what to do next. So, testing is very important. If a person gets tested and he or she is unfortunate that it is hepatitis B, there are luckily HIV management facilities and some of those drugs are actually similar.

“As scary as COVID 19, there is actually another disease that kills more people than COVID. Hepatitis actually kills more people than COVID. Almost 500 million people globally suffer hepatitis and out of these numbers, 1.4 million die every year globally, meaning that about 4000 people die from hepatitis and it’s related illness daily. Hepatitis is a silent killer.”

Poor funding

Besides poor awareness and lack of screening, there are also gaps in the diagnosis and treatment of viral hepatitis in Nigeria. The cost of diagnosis and treatment is another challenge.

Nnabuchi Chidinma, a consultant gastroenterologist & hepatologist, Asokoro District Hospital, said a lot of NGOs and Civil Society Organisations have taken it upon themselves to go out into the community to screen people and also educate them on the infection “but the government has not done much in putting funds together to fight this disease”.

Nigeria does not have the political will and a robust budget line to support the elimination of this silent killer disease that infects more than 20 million people in our country every year, Ifeanyi Ekeh, a public health expert said.

Most donor agencies have traditionally focused on HIV and TB rather than hepatitis, which means the disease been grossly underfunded.

In Nigeria, the hepatitis B vaccine has been included as part of the immunisation schedule for children since 2004. This has helped reduce hepatitis B rates in children. However, rates in adults have gone up.

This stems from a lack of knowledge about the disease, and poor health-seeking behaviours, which makes screening for viral hepatitis difficult, according to an article published by the Nigerian Health Watch during last year’s World Hepatitis Day.

If the Nigerian government is to reduce the burden of viral hepatitis by 2030 in line with global objectives, it must also find a way to reduce the cost of hepatitis treatment for Nigerians and make screening free, health experts say.

Low coverage of testing and treatment is the most important gap to be addressed if Nigeria is to achieve the global elimination goals by 2030.

Ailment

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

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

Some of the symptoms of the disease 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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