World Hepatitis Day: Poor awareness, stigma hindering eradication in Nigeria

As World Hepatitis Day is commemorated around the globe, with the theme ‘We’re Not Waiting’ in Nigeria, more urgent attention needs to be placed on the ‘silent epidemic’.

Despite how deadly hepatitis could be, efforts to eradicate it in Nigeria have not produced much success owing to some factors.

The World Health Organisation (WHO) defines hepatitis as an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading.

The infection, sometimes, could be fatal.

THE SILENT KILLER

Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus.

There are five main types of hepatitis virus — A, B, C, D and E. The strains differ in modes of transmission, severity of the illness and prevention methods.

Hepatitis A and E are usually caused by ingestion of contaminated food or water. Vaccines are available for these strains but that of hepatitis E are not widely available.

Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. It can be transmitted from infected mothers to infants at the time of birth, from family member to infant in early childhood, through transfusions of contaminated blood, use of contaminated injections during medical procedures, and through injection drug use. Vaccines are available to prevent HBV.

Hepatitis C virus (HCV) is mostly transmitted through exposure to contaminated blood which usually happens through transfusions of HCV-contaminated blood, the use of contaminated injections during medical procedures, and injection drug use. While sexual transmission is also possible, it is much less common. There is no vaccine for HCV.

Lastly, hepatitis D virus (HDV) is less common and occurs only in those who are infected with HBV. The dual infection of the two hepatitis types can result in more serious disease and worse outcomes. Hepatitis B vaccines provide protection from HDV infection.

Many people with hepatitis do not have symptoms and so do not know they are infected. But if symptoms do occur with an acute infection, they can appear from two weeks to six months after exposure.

The symptoms of acute hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured stools, joint pain, and jaundice.

But symptoms of chronic viral hepatitis can take years to develop.

Because many people who have the chronic form of the disease, particularly the B and C viruses, are unaware of the infection, it allows the infection to spread, leading to serious damage to the liver and even death.

POOR AWARENESS, STIGMA HINDERING ELIMINATION AND TREATMENT IN NIGERIA

According to the WHO, an estimated 354 million people worldwide live with hepatitis B or C and in Nigeria, many are unaware of the risks, which has allowed the virus to continue its spread.

Nigeria is reported to have a prevalence rate of 8.1 and 1.1 percent for HBV and HCV among adults aged 15 to 64, with more than 80 percent of the people who have the disease not knowing their status.

In 2022, the ministry of health said nearly 20 million Nigerians were infected with viral hepatitis, attributing the high figure to low awareness and stigma.

Emuobor Odeghe, a consultant gastroenterologist at the Lagos State University Teaching Hospital (LUTH), told TheCable that poor knowledge of the existence of the virus, lack of understanding of the importance of the virus as a cause of serious liver disease and liver disease complications, the asymptotic nature of the disease and poor levels of screening for the virus are all significant challenges to eliminating hepatitis.

She added that stigma prevents people from getting screened and prevents people with symptoms similar to those caused by hepatitis from getting tested.

“Those who test positive may refuse to go to the hospital or disclose their status to their close family, including spouses, for fear of losing their families or jobs. Some who eventually are given treatment may refuse to take this treatment,” she said.

“The result is that people remain undiagnosed or untreated and only go to see their doctor when they have developed symptoms by which time they may already have advanced liver disease such as liver cirrhosis, liver failure or liver cancer. In addition, these people are a reservoir of infection and unwittingly continue to spread the infection.”

On her part, Opeyemi Owoseni, a consultant gastroenterologist at the Federal Medical Centre, Abeokuta, said one major challenge with detecting the disease in Nigeria is the refusal by many to visit a hospital unless when sick.

She explained that this “poor health seeking” behaviour is particularly dangerous with hepatitis since it usually shows no physical symptoms for a long time.

On stigma, the expert added that the fear of losing employment or marriage prospects causes many to either not get tested or hide their status.

“If one goes through the standard testing process for employment and tests positive for hepatitis, the organisation who wants to employ then is more likely than not going to cancel the employment. So they’d rather not come out and tell anybody their status because it will affect chances of getting a job, getting married, and how society sees them” she said.

‘ALL HOPE IS NOT LOST’

Odeghe believes that all hope is not lost in the fight against hepatitis. She said the government along with its development partners should work to eradicate the stigma attached to the illness. The expert added that the government should make it a crime for a person to lose their job or to be denied employment simply because they are positive for hepatitis.

“The government should also make hepatitis screening compulsory at all levels and free of charge to all persons, and ensure the vaccinations, tests and treatment for hepatitis are available and affordable to all,” she added.

On the part of health professionals, the gastroenterologist said mass awareness campaigns using mass media or social media need to be done and done on a regular basis.

“The Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), a body of doctors who are trained to manage and care for hepatitis and other liver diseases, has actively taken up this role, with its members providing public education on hepatitis as well as training other doctors on hepatitis. But more still needs to be done,” she said.

The battle against hepatitis in Nigeria is not merely a medical challenge but also a struggle against ignorance. But by spreading knowledge, Nigeria can hope to eliminate this disease in the coming years.