Bringing hepatitis care closer to primary health facilities and communities – By: . .

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Paul John

According to the World Health Organization (WHO), every 30 seconds someone dies from hepatitis B or C, and the world is currently facing a new epidemic of unexplained acute hepatitis affecting children. .

WHO, in collaboration with scientists and policy makers in affected countries, is working to understand the cause of this infection which does not appear to belong to any of the 5 known types of hepatitis virus: A, B, C, D summer.

The WHO argues that this new outbreak highlights the thousands of acute viral hepatitis infections that occur each year among children, adolescents and adults. Most acute hepatitis causes mild illness and even goes unnoticed. But in some cases, they can lead to complications and be fatal. In 2019 alone, an estimated 78,000 deaths occurred worldwide due to complications from acute hepatitis A to E infections.

Hepatitis is a medical condition characterized by the presence of inflammatory cells in the tissues of the liver. It can be self-limiting (self-healing) or can simply progress to fibrosis (scarring), cirrhosis, liver failure or liver cancer. Hepatitis can be acute when it lasts less than six months or chronic when it lasts more than six months.

Viral hepatitis is mainly classified into five groups: Hepatitis A, B, C, D and E. There are other classifications of hepatitis such as autoimmune hepatitis, alcoholic hepatitis, etc., but the main objective of World Hepatitis Day is to raise awareness and encourage people on how to prevent, diagnose and treat these five VIRAL hepatitis.

Global efforts are prioritizing the elimination of hepatitis B, C and D. Unlike acute viral hepatitis, these 3 infections cause chronic hepatitis that lasts for decades and culminates in more than one million deaths per year due to cirrhosis and liver cancer. These three types of chronic hepatitis are responsible for more than 95% of deaths from hepatitis.

Although we have the guidance and tools needed to diagnose, treat and prevent chronic viral hepatitis, these services are often beyond the reach of communities and are sometimes only available in centralized/specialty hospitals.

The main objective of July 28, World Hepatitis Day, is to raise awareness and encourage people on how to prevent, diagnose and treat viral hepatitis.

It hurts me when patients who have had a blood transfusion in the past later get hepatitis B or C infection and the cause cannot be attributed to any other source except the previous blood transfusion .

In view of this, our hospitals should switch to the use of polymerase chain reaction (PCR) in the screening of blood samples (especially blood units from donors with questionable lifestyles). This is because the current tests used to detect virus infections in many hospitals in developing countries aim to detect the antigen or antibody against the infecting virus particles in the serum, so it takes some time (the period of incubation, etc.) prior to actual testing. in many developing countries can detect the antigen/antibody in a newly infected individual. PCR can detect infection at each stage of the disease.

We cannot forget, in a hurry, the 2006 incident at Lagos Teaching Hospital (LUTH) where baby Oyinkansola Eniola was transfused with HIV positive blood at a tertiary hospital where the highest form of medical treatment was expected in accordance with international best practice. It is a crime and unethical to transfuse a unit of blood without first testing it for HIV 1 and 2, Hepatitis B and C, and VDRL, among other preliminary tests.

Was the blood checked before the transfusion? Believe me, the answer will be yes; so why didn’t the screening detect HIV in the donor’s blood? The window period for HIV infection cannot be easily ruled out when screening this blood. Therefore, PCR screening remains the only reliable test at all stages of infection. If this was possible with HIV, it is still possible with certain viral hepatitis, in particular hepatitis B and C.

WHO, in its theme for this year, emphasizes the need to bring hepatitis care closer to primary health care facilities and communities so that people have better access to treatment and care, regardless of the type of disease. hepatitis they may have.

Brief history of World Hepatitis Day

Initially, World Hepatitis Day was celebrated on May 19 each year, but in 2010 the World Health Assembly changed the date to July 28 in honor of the Nobel laureate’s birthday. Professor Baruch Samuel Blumberg, who discovered hepatitis B.

Coming to data available in Nigeria, Dr. Chukwuma Anyaike, a community health physician, argued a few years ago that around 20 million Nigerians are infected with Hepatitis B and C. The physician, who was then head of the Department of Public Health Prevention at the Federal Ministry of Health, said this during a one-day stakeholder outreach workshop on Viral Hepatitis Awareness organized by the Yakubu Gowon Foundation in Abuja. He further pointed out that “viral hepatitis is a very big public health problem in Nigeria.

It was further revealed that out of approximately 20 million of Nigeria’s 170 million people who are infected with the virus, 25% develop chronic liver disease and between 500,000 and 700,000 die annually.

According to the survey (2000-2013), Kano had the highest number of people infected with the B variant of the virus, while Kwara State had the highest number of people with hepatitis C.

Prevention

Hepatitis A can be prevented by an adequate supply of clean water; proper disposal of wastewater within communities; personal hygiene such as regular hand washing with clean water and soap; get vaccinated against hepatitis A.

Hepatitis B can be prevented by quality-assured screening of all donated blood and blood components used for transfusion; safe injection practices; safer sex practices, including reducing the number of partners and using barrier protection measures (condoms).

Hepatitis C and D infections have almost the same preventive measures as hepatitis B, except the hepatitis C vaccine is currently not available worldwide although research is still ongoing.

Hepatitis E can be prevented by maintaining quality standards for public water providers; establish appropriate disposal systems to dispose of sanitary waste; maintain hygienic practices such as washing hands with potable water, especially before handling food; avoid water/ice of unknown purity; following WHO safe food practices.

In view of the above, our government should develop comprehensive national guidelines to combat this silent killer known as viral hepatitis, especially in our rural communities, as many women learn about their status during the prenatal period when hospitals force all pregnant women to be tested for HIV 1 and 2, hepatitis B and C, VDRL (for syphilis) among other relevant tests. Hepatitis B can easily be passed from mother to baby during pregnancy or at birth.

Dr John writes from Port Harcourt.

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