AS the global community celebrates this year’s World Hepatitis Day today, themed, “We Are Not Waiting,” stakeholders are highlighting the rising prevalence of the disease in Nigeria and urgency of taking more effective action to tackle it. With an estimated 20 million Nigerians living with the illness, and most of them unaware until it becomes life-threatening, the need for stronger proactive measures is inescapable.
The absence of sustained action is not for lack of official awareness of the problem. Recently, the wife of the Cross River State Governor, Eyoanwan Otu, emphasised the need for strong collaboration between the government and the private sector while receiving a federal health ministry delegation. Among other things, she urged greater public awareness campaigns on the nature and dangers of hepatitis, and increased public access to treatment.
This underscores the thrust of this year’s anti-hepatitis campaign. To this end, the World Hepatitis Alliance called on countries to accelerate elimination efforts and recognise the urgent need for testing and treatment for the real people who need it.
In July 2022, the Nigerian government announced a national strategic framework for eliminating viral hepatitis in the country. The then Minister of Health, Osagie Ehanire, had said, “The core pillars identified for attaining the 2030 target include infant vaccination, prevention of mother-to-child intervention, blood and injection safety, harm reduction, diagnosis, and treatment. As a country committed to the elimination of viral hepatitis by 2030, the need to create massive public awareness cannot be over-emphasised.”
These laudable targets should not go the way of other official unfulfilled promises.
Viral hepatitis has become a national and global public health challenge. There are five distinct forms of the disease – A, B, C, D and E – each attributed to a different type of virus. Chronic forms of Hepatitis B and C cause 95 per cent of hepatitis-related sicknesses and untimely deaths.
Hepatitis D is less common and occurs only in association with hepatitis B. The others, A and E, are spread via contaminated food and water and cause acute infections and outbreaks in areas with poor sanitation and inadequate waste disposal.
The spread of hepatitis B (HBV) and C (HCV), like HIV, is fuelled by unsafe sexual behaviour and injection practices, unsafe blood transfusion, and other harmful practices such as sharing of toothbrushes or sharp objects for scarification marks, tattoos, and mother-to-child transmission.
Sadly, most people who have serious forms of the disease, particularly the B and C viruses, are unaware of the infection. This allows the infection to spread unchecked, leading to serious damage to the liver.
In Africa, including Nigeria, hepatitis is a silent epidemic. A 2018 report by the Nigeria HIV-AIDS Indicator and Impact Survey declared,“More than 90 million people are living with hepatitis in the region, accounting for 26 per cent of the global total. Nigeria has a prevalence rate of 8.1 per cent, and 1.1 per cent for HBV and HCV among adults aged 15-64 years respectively.”
GAVI, the vaccine alliance, says HBV is 100 times more infectious than HIV and kills 884,000 people annually. The Joint UN Programme on HIV/AIDS said there were 1.3 million new HIV infections worldwide in 2022, while about 630,000 persons died from AIDS-related illnesses.
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Data from the WHO reveals an estimated 354 million people worldwide living with hepatitis B or C. For most, testing and treatment remain beyond reach. Every 30 seconds, a person dies of hepatitis-related disease, amounting to an average of 3,600 deaths every day.
Nigeria’s case is alarming; it has more than 20 million people living with hepatitis B, C, or both; more than 80 per cent of them do not know their status.
Like other ailments, women and children are vulnerable segments. While HEV has a higher case fatality rate among pregnant women, newborns and children are most at risk of all forms of viral hepatitis. Nine out of 10 infected infants usually go on to develop chronic hepatitis B, and a quarter will develop severe liver disease.
Though official awareness and donor-enabled vaccines have been available in the country since 2004, Nigeria has the largest number of children living with HBV infection worldwide. Protection is afforded by universal hepatitis B vaccines within 24 hours of birth, but the US Centers for Disease Control laments that over half of newborns worldwide miss the vaccination. In 2022, only 52 per cent of infants in Nigeria received the recommended birth dose, and just 62 per cent completed the additional recommended three-dose series.
Nigeria’s laxity is reinforced by a 2022 World Bank report indicating that its spending on health, social protection and education is very low. This undermines the quality of health and education services available in the country.
Experts say hepatitis B is both preventable and treatable. It can be prevented through vaccination; and it is treatable through oral antiviral drugs that in most cases, however, must be taken for life to suppress the viral load.
However, to prevent its progression, it is highly recommended that treatment begins within the first three months of infection. The Nigerian government should implement policies that will ensure that citizens have access to hepatitis testing and treatment.
Uganda, Rwanda, and Cape Verde have committed more resources to ensure a 99 per cent birth dose vaccination rate, free national hepatitis B treatment, and free treatment for hepatitis B and C respectively. The Cape Verde government funds all vaccine services, and has implemented hepatitis screening and vaccination for pregnant women. Nigeria should adopt similar policies.
States should not leave the fight to the Federal Government alone but should implement holistic programmes and align them with national and global initiatives.
Hepatitis care should be adequately funded as other priority areas such as HIV, immunisation, and reproductive health. Hepatitis care should also be further integrated into programmes promoting access to healthcare, and regular screening of women visiting health facilities for antenatal services, and for patients taking HIV treatment.
Hepatitis is another killer; the various governments should take strong measures to neutralise it. ,
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