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OPINION: Limited Public Attention To Hepatitis Infection Affecting Intervention Outcomes

By Daraus Bahikire

Although the world continues to venerate the World Hepatitis day every 28th of July, public attention to the disease remains a challenge amidst global and national intercessions.  

Viral hepatitis is a group of infectious diseases classified as hepatitis A, B, C, D, and E which affects millions of people worldwide,

Hepatitis is an inflammation of the liver. The condition can progress to fibrosis, cirrhosis (degeneration of cells, inflammation,) or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances such as alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

Although there are five different types of viral hepatitis (A, B, C, D, and E), chronic hepatitis B and C cause the extreme burden and lead to 95% of hepatitis-related sickness and untimely deaths from liver cirrhosis and cancer, Hepatitis D is less common. Acute infections are often brief and resolved within a few weeks. In pregnant women, hepatitis E virus infection (HEV) has a higher case fatality rate. The incubation period of the infection ranges between 45 to 180 days, and rarely from as early as 2 weeks to as late as 9 months.

Daraus believes Individual responsibility coupled with available health interventions will see us eliminate Hepatitis infections in Uganda and Africa.

Hepatitis infections of worry and interest are Hepatitis A, B, C, D because of the burden of illness and death they cause, and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people.  Hepatitis B infection is preventable, treatable and hepatitis C virus infection is now curable.

The signs and symptoms of the 5 types don’t diverge meaningfully and these include: fever; loss of appetite; nausea and vomiting; abdominal pain (especially in the right upper abdomen); yellow skin or eyes (jaundice) (see image); dark coloured urine and pale faeces; muscle and joint pain and rash.

Hepatitis A and E are spread via contaminated food and water and cause acute infections and outbreaks in areas of poor sanitation and inadequate waste disposal.

Common transmission channels for Hepatitis B, C and D include Birth (spread from an infected mother to her baby during birth); Sex with an infected partner; Sharing needles, syringes, or drug preparation equipment; Sharing items such as toothbrushes, razors or medical equipment such as a glucose monitor with an infected person; Direct contact with the blood or open sores of an infected person; exposure to blood from needle sticks or other sharp instruments of an infected person and any other contact with body fluids .

Hepatitis B is a global public health threat and the world’s most common serious liver infection. It is up to 100 times more infectious than the HIV/AIDS virus. As per the 2015 World Health Organisation (WHO) Global Hepatitis Report, 325 million people, or roughly 4% of the world’s population, lives with viral hepatitis, causing about 1.34 million deaths per year. This prevalence is comparable to HIV, tuberculosis, and malaria.

Unlike those diseases, deaths from viral hepatitis are increasing. Since 2000, deaths from viral hepatitis increased by 22%, (WHO ,2019).

The World Health Organization (WHO) data shows an estimated 257 million people living with chronic hepatitis B, and 71 million people living with chronic hepatitis C worldwide. Viral hepatitis causes more than one million deaths each year.

The hepatitis virus is present worldwide, but some populations in sub-Saharan Africa, Southeast Asia, Eastern Europe, and the Middle East, as well as in indigenous communities are Hepatitis B carriers.

Annually, more than 200 000 people in Africa are dying from viral hepatitis B and C-related liver disease related complications, including cirrhosis and liver cancer. 60 million people in the WHO Africa Region were living with chronic hepatitis B infection in 2015. More than 4.8 million of them are children under 5 years of age. Another 10 million are infected with hepatitis largely due to unsafe injection practices within health facilities or by communities, (WHO Hepatitis report ,2015).

According to the 2016 Uganda Population –based HIV Impact Assessment (UPHIA) survey, prevalence of Hepatitis B infection among adults stands at 4.1%. The survey indicates that the highest infection rates are in Northern Uganda with 4.6% in mid North, 4.4% North East and 3.8% in West Nile. Lower rates were noted in Eastern region (2.7%), Central (2.0%), Kampala (1.9%), Mid –West (1.8%) and South-West (0.8%).

Global and national energies in the fight against hepatitis continue to take course with the most recent being the Africa first African Hepatitis Summit held in Uganda in June themed: “Eliminating Viral Hepatitis in Africa; Implementing the viral hepatitis strategy” organised by Ugandan Ministry of Health in partnership with WHO Regional Office for Africa (WHO AFRO), Uganda National Organization for people living with hepatitis B and Uganda Gastroenterology society, among others.

The summit brought together researchers, civil society, academicians, development partners, international organisations from all over the globe to share best practices, experiences, develop sustainable strategies in bringing an end to Hepatitis infection.

The ministry of Health, Uganda has been implementing Hepatitis B control activities in the country since September, 2015. These activities are being carried out in a phased approach based on the prevalence of the disease and the activities consist of screening, vaccination and or treatment. The program control activities include; testing/screening, vaccination or treatment of all adolescents and adults born before 2002. The hepatitis B vaccine was introduced into the routine childhood immunization schedule-the pentavalent vaccine which is given at 6, 10 and 14 weeks.

Similarly, the Ministry working with local government and other health development partners continues to carry out health education and communication campaigns coupled with capacity building of health workers on management of hepatitis infection.

The intervention is phased and started with regions of high prevalence to regions of low prevalence. This is in line with the country’s National Hepatitis Strategic plan 2014/2019.

Currently, the phase 3 activities are ongoing in central 2 and mid-west regions this FY 2019/2020 after Northern West Nile, Karamojong, Teso sub regions and Busoga and Bugisu regions in phase 1 and 2 respectively. The central 2 districts include: Buikwe, Buvuma, Kayunga, Kiboga, Kyankwanzi, Luwero, Mityana, Mukono, Wakiso, Nakaseke, Nakasongola.

Mid-West districts include: Buliisa, Bundibugyo, Hoima, Kikuube, Kabarole, Mubende Kamwenge, Kasese, Kibaale, Kiryandongo, Kyegegwa, Kyenjojo, Masindi, Kakumiro, Ntoroko, Kagadi and Bunyangabu, targeting a population of 3,497,485 people.

One key factor hindering all these intervention activities is lack of adequate attention towards the virus. Many people do not take the disease serious leading to a high incidence. For example, very few people would not mind finishing the 3 dose hepatitis B vaccination as there is general perception of low fatality of the disease.

“One of the greatest challenge in implementing Hepatitis interventions the high loss of follow up after the first dose of vaccination”, Hon. Sarah Opendi, the then state minister of health (general duties) while appearing before Parliament last year.

It is undisputable that there are challenges related to finances, equipment and infrastructure, however, the general public should take higher responsibility over their lives by observing all the aforementioned risk factors, undertaking Hepatitis screening, comply with advice from medical personnel and most importantly complete the vaccination doses.

Individual responsibility coupled with available health interventions will see us eliminate Hepatitis infections in Uganda and Africa.

For God and My country

Bahikire Daraus is a communications Officer at the Ministry  of ICT and National Guidance & a student pursuing a Masters degree in Public Health

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