Friday, December 2, 2022

Towards Achieving Nigeria’s Hepatitis Elimination Target 

World Hepatitis Day

A 69-year-old, retired civil servant and resident of Waru community in the Federal Capital Territory (FCT), Mr. Babagana Garuba, did not know he had hepatitis even though he had been to the hospital severally, after his eyes “turned yellow”.  

According to Garuba, the doctors would dismiss it as “typhoid” and only prescribe eye drops. 

Eight years after the symptoms started, he has now been diagnosed with liver cancer. 

“Long before I received my diagnosis, I was not aware that such a disease as hepatitis existed. 

“Before I retired from service around 2015, my wife battled cancer until her death. I must have picked up hepatitis during one of my many visits to see her at the hospital. 

“For the first five years that followed this time, I would develop increasingly severe health complications which had a drastic impact on my quality of life.  

“I saw one doctor after the other, visited one hospital after another and had a series of blood tests, only to end up right back at the start, frustrated and confused with no answer in sight,” he said.

Garuba said that the symptoms which led to his diagnosis included yellowing eyes, extreme fatigue “like falling asleep mid-day and even while driving”, insomnia and rapid weight loss. 

“I also experienced food allergies, memory loss, brain fog, stiff joints and yellowing skin,” he stated.

Health experts have raised the alarm that Nigeria contributes significantly to the burden of chronic viral hepatitis infection globally with a prevalence rate of 11 per cent and 2.2 per cent for viral hepatitis B and C, respectively. 

As a result, over 20 million Nigerians live with viral hepatitis B or C. Worse, they may be unaware and at risk of developing chronic complications like liver cirrhosis and primary liver cell cancers.  

Most worrisome is the risk of transmitting the infection to other unsuspecting members of the community. 

The experts said the increasing cases and related deaths due to the disease were because it was not well funded. 

They said that there was a lack of education and public health programmes supporting elimination efforts. 

Despite presenting a major public health challenge, viral hepatitis has been historically marginalised as a health and development priority. 

However, in 2015, the United Nations adopted a resolution calling for specific action to combat viral hepatitis as part of its 2030 Agenda for Sustainable Development. 

It was followed by the publication of the World Health Organisation’s (WHO) first global strategy on viral hepatitis in 2016. 

The large population and relatively high prevalence rates of hepatitis B and C suggest that the nation should be considered a key country for hepatitis elimination efforts. 

In response to high prevalence rates and alignment with the global effort toward elimination, the Federal Ministry of Health (FMoH) developed the National Viral Hepatitis Strategic Plan, 2016 to 2020. 

The plan mapped out actions to put the country on the path of hepatitis elimination. 

The national guidelines for the prevention, care and treatment of viral hepatitis B and C were also developed and published in 2016.

It centred on firmly establishing the management of viral hepatitis as part of the Universal Health Coverage (UHC). 

Although there is a paucity of data on modes of viral hepatitis transmission within Nigeria, local intelligence suggests that there are some particularly relevant modes of transmission. 

They include mother-to-child transmission, healthcare-related transmission due to poor infection control and traditional cultural practices, including scarification, female genital mutilation, male circumcision and uvulectomy. 

A study was recently conducted by conversation.com, a meta-analysis consisting of studies published between 2010 and 2019, to determine HBV prevalence.

There were 47 studies and a sample size of 21,702 people. The prevalence rate of 9.5 per cent that emerged from the analysis means that the country meets the WHO’s criteria for high endemicity. 

The study found differences in infection levels across different geo-political zones and settings. 

Higher rates of HBV infection were found in the northwestern zone of the country (12.1per cent) compared to the southeast (5.9 per cent).

Infection rates in rural areas were also much higher (10.7 per cent) than those in the cities (8.2 per cent). 

The study could not provide the reasons for this but suggested that it may be due to inequalities in access to health services and differences between culturally diverse groups. 

A hepatologist, Dr. Paul Oboro, said for the country to be on course to the elimination targets, she must improve access to affordable diagnosis and care for her population. 

“People living with hepatitis B virus (HBV) should not have to wait for care until their infection becomes chronic and liver disease reaches an advanced stage. 

“HBV diagnostics need to be affordable and accessible now, so people can be linked to care promptly. 

“Ensuring high uptake of the vaccine at birth for babies is crucial to preventing new infections. In Nigeria, the current coverage for HBV vaccination is 57 per cent and offers room for improvement,” she explained. 

Oboro said that other measures like robust pre-conception screening and the implementation of the “test and treat” interventions at low cost for infected couples were important to prevent mother-to-child transmissions. 

The expert said that stigma and discrimination were notable barriers that prevented Nigerians from accessing health services and these can delay diagnosis and care. 

“Marginalising populations who are vulnerable to HBV often lead to their exclusion from testing and clinical care. 

“Hepatitis B elimination will only be possible if the Federal Government ensures no one is left behind,” she said.

A consultant gastroenterologist at the University of Ilorin Teaching Hospital (UITH), Dr. Aminu Aliyu advised healthcare providers to discuss options for the management of hepatitis and the side effects of drugs with their patients. 

Aliyu observed that treatment of Hepatitis B could be life-long, requiring healthcare providers to discuss options of management with their patients. 

“The clinical goal of treatment is to improve the quality of life of affected patients,” he added. 

The hepatologist explained that transmission of viral infections was the most common cause of hepatitis and could happen vertically or horizontally.

According to him, vertical transmission occurs between mother and child during pregnancy or labour, while horizontal transmission can occur from child to child at schools, especially where there is a cut in the skin or mucosal surface.

He further stated that unprotected sexual activities with an infected partner were another major source of contraction. 

“Even though hepatitis is common across the country, it is prevalent in the north-central, especially Nasarawa State,” he disclosed. 

Aliyu advised patients to ensure that all their immediate family members were screened for the disease. 

He encouraged an abstinence from ingestion of alcohol, smoking and herbal concoctions as a preventive measure. 

“Immunity against the disease can either come naturally or via vaccinations,” he said. 

Also, Aliyu canvassed for improved healthcare education, sustained vaccination exercise, proper screening, faithfulness to sex partners and robust contact tracing as some of the veritable measures that would lead to a drastic reduction of infection in the country. 

In his comments, the executive director, Elohim Foundation, Dr. Ibecheole Julius said that the country needed greater investment in tackling viral hepatitis. 

Julius, who is also the national secretary of the Civil Society Network on Hepatitis, Nigeria (CiSNH, N), said that the major hurdle to achieving hepatitis elimination in the country was the lack of finances to support the hepatitis programme. 

“None of the major global donors are committed to investing in the fight against hepatitis. It will be very difficult for low and middle-income countries to fund their hepatitis control programme. 

“Hepatitis elimination needs strong financial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe. 

“The Global Fund helps to fight HIV, TB and malaria, but no such mechanism for viral hepatitis. Ideally, the remit of the global fund could expand but without it, other organisations can help; particularly, UNITAID, a global health initiative with a mandate for improving access to diagnostics and treatment in low-income settings such as Nigeria,” he said. 

He said unless something drastic was done, the country and most of Africa risked missing the SDGs Goal 3.3 and the WHO Global Health Sector Strategy on Viral Hepatitis Elimination target for 2030. 

“Nigeria, with its vast mineral, natural resources and human capital, has what it takes to eliminate viral hepatitis by 2030. 

“But what it lacks is the strong political will and financial commitment by governments at all levels to finance an elimination strategy,” he said. 

Meanwhile, World Hepatitis Day is commemorated annually. Today, July 28, 2022 is globally recognized as World Hepatitis Day. This year’s theme is, ‘Bringing hepatitis care closer to you.’ The idea of this theme is to focus on raising awareness of the need to make hepatitis care more accessible.

Racheal Abujah
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