Taming thorny hepatitis, keeping Malawians at safe distance
By Richard Chirombo:
Pushed left by malaria, right by HIV and Aids, and centre by tuberculosis (TB), Malawi still seems not to have enough in its plate.
This is because other ailments, notably viral hepatitis, seem to be pushing hard to establish their presence in the crowded, at times competitive, sphere that is the country’s health sector.
As the World Health Organisation (WHO) has it, in its latest scorecard, hepatitis has, slowly but surely, found a way to sneak its counter-development interests into progress Malawi has made in eliminating diseases such as polio and containing others, notably malaria, through a vaccine rolled out in April this year.
Not surprisingly, WHO has lamented poor progress in Malawi and other African countries’ response to viral hepatitis.
Ministry of Health Principal Secretary, Dan Namarika, acknowledged that viral hepatitis was a global public health challenge, comparable to communicable diseases such as Aids, TB and malaria.
“It is one of the leading causes of death globally, accounting for 1.34 million deaths. Viral hepatitis is also a growing cause of mortality among people living with HIV.
“It is therefore critical that the Ministry of Health establishes the burden of HBV [hepatitis B] and HCV [hepatitis C] by, among other things, re-testing samples collected from population-based HIV survey,” he said.
The development comes at a time a new scorecard — the first to examine hepatitis prevalence and response in the WHO African region— shows that only three of the 47 countries are on track to eliminate the disease that affects one in 15 people in the region.
It observes, among other things, that dying of viral hepatitis in Africa is becoming a bigger threat than dying of Aids, malaria or TB.
Viral hepatitis is an infection that causes liver inflammation and damage. Inflammation, according to WHO, is a swelling that occurs when tissues of the body become injured or infected.
Researchers have discovered several different viruses that cause hepatitis, including hepatitis A, B, C, D and E. Hepatitis A and hepatitis E typically spread through contact with food or water that has been contaminated by an infected person’s stool. People may also get hepatitis E by eating undercooked pork, deer or shellfish.
Hepatitis B, hepatitis C, and hepatitis D are spread through contact with an infected person’s blood. Hepatitis B and D may also spread through contact with other body fluids. This contact can occur in many ways, including sharing drug needles or having unprotected sex.
“This analysis is the first to track each country in the region and to assess progress towards the goal of saving the lives of more than two million Africans who may develop progressive hepatitis B or C liver disease in the next decade if countries fail to ramp up their efforts,” said Matshidiso Moeti, WHO Regional Director for Africa.
The scorecard was presented at the first African Hepatitis Summit held in Kampala, Uganda, from June 18 to 20.
It provides vital information about the status of the regional hepatitis response, measuring progress against the Framework for Action for the Prevention, Care and Treatment of Viral Hepatitis in the African Region (2016–2020).
It was created as a guide for member States on the implementation of the Global Health Sector Strategy on Viral Hepatitis, which calls for the elimination of hepatitis by 2030— defined as a 90 percent reduction in new cases and 65 percent reduction in cases of death.
WHO indicates that, every year, more than 200,000 people in Africa are dying from complications of viral hepatitis B and C-related liver disease, including cirrhosis and liver cancer.
Sixty 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 five years old. A further 10 million are infected with hepatitis C, most likely due to unsafe injection practices within health facilities or by communities.
The analysis shows that 28 countries have developed a national hepatitis strategic plan for viral hepatitis; however, most are still in draft form, with only 13 officially published and disseminated.
“Only 15 percent (7/47) countries are leading prevention efforts with national coverage of both hepatitis B birth dose and childhood pentavalent vaccination exceeding 90 percent. There are major gaps in hepatitis testing and treatment with less than eight countries providing subsidised testing and treatment for viral hepatitis. Uganda has started free nationwide hepatitis B treatment, and Rwanda is providing free treatment for both hepatitis B and C. These two countries are championing the regional response and are on track to reach the 2020 Framework targets for testing and community awareness,” WHO said in its findings.
It suggests that the administration of hepatitis B vaccination at birth and in early infancy is the most effective way to halt the transmission of the virus because 95 percent of the burden of chronic disease is due to infections among children, acquired before their fifth birthday, including mother-to-child transmission.
Nash Mepukori, Senior Associate at Global Health Strategies, said the scorecard should spur countries into action.
Mepukori said this is because hepatitis B, for example, “which spreads through blood and bodily fluids, and mother to child transmission, affects over 60 million people, yet only one in 10 infants in Africa receives the hepatitis B vaccine at birth, despite the low vaccine cost – at less than $0.20 per child”.
Although the exact burden of viral hepatitis is unknown in Malawi, a rapid assessment on viral hepatitis in the country— which WHO conducted at Kamuzu Central Hospital in 2005 — indicated that the prevalence of HBV and HCV was 15 and 1.5 percent, respectively.
Malawi commemorates World Hepatitis Day on July 28. The day is designed to build and leverage political engagement following official endorsement of the Global Health Sector on viral hepatitis at the world health assembly in 2016. Countries were, among other things, asked to highlight their response efforts, as outlined in WHO’s Global Hepatitis Report of 2017.
Sustainable Development Goal 3 encourages United Nations member states to “ensure healthy lives and promote wellbeing for all at all ages”.
Among other measures, it encourages countries to, by 2030, end the epidemics of Aids, TB, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
It also says, by 2030, governments have to reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
Nations are also expected to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
It could be time Malawi found a way to keep viral hepatitis and other health menaces away from its citizens
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