VIRAL HEPATITIS IN GHANA: THE ROLE OF THE GOVERNMENT

Mr. President, I am honored to address this issue today on viral hepatitis, a salient and underestimated public health problem worldwide, and which is particularly endemic in the Sub-Saharan Africa and Ghana.

Incidence, Prevalence and Mortality
“Hepatitis” means inflammation of the liver. It refers to a group of viral infections that affects the liver. There are five main hepatitis viruses, referred to as types A, B, C, D, and E. The most common types are the A, B, and C.

Mr. President, nearly one out of every three people in the world (approximately 2 billion people) has been infected by the hepatitis B virus (HBV), and one in twelve (more than 520 million people) live with chronic HBV or/and hepatitis C (HCV) infection. Most of the people infected with these viruses are unaware of their infection because viral hepatitis, particularly HBV, can persist for decades without symptoms.

Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. In 2005, HBV, for example, was officially recognized as one of 58 known agents that cause human cancer, and it is second only to tobacco as a known human carcinogen. Together, HBV and HCV are the leading cause of liver cancer in the world, accounting for 78 percent of cases. About 1 million deaths per year are attributed to viral hepatitis infections. Many die at their prime of life (35-65 years old).

Infection and Transmission
In the Sub-Saharan Africa or Ghana, the major mode of transmission is mother to child infection. However, it is also commonly transmitted through the following:

 Blood transfusions and blood products using unscreened blood. Infectious diseases transmissible through blood transfusion are highly prevalent in the Sub-Saharan African region, and in 2004, donated blood was not screened in 22 percent of countries for HBV and in 51 percent of countries for HVC.

 Medical or dental interventions without adequate sterilization of equipment. Inadequately sterilized needles and syringes cause up to 69 percent of infections in some places in the Sub-Saharan Africa.

 Sharing razors, toothbrushes, nail-clippers or other household items

 Tattooing, ear-piercing, tribal-marks, and piercing of other body parts if done using unsterilized equipment

Mr. President, the fight against viral hepatitis in Ghana is at a crossroad when it comes national policies to raise awareness and to address issues regarding prevention, control, treatment, and stigmatization of infected citizens.

It is time to think about where we go from here, and how we can set the right courses of action or policies to address the problems once-and-for-all. We can do better than what we have been done so far. Let me touch on couple of examples of what our governments have been doing and what they should do.

1. Public Awareness and Education--Viral hepatitis is more common than HIV/AIDS in Sub-Saharan Africa. Unfortunately, many people are unaware of their infection until they develop liver cancer because viral hepatitis most often presents no symptoms. While Sub-Saharan Africa has the second highest prevalence levels for HBV (after South-East Asia) and the highest prevalence levels for HCV in the world, little do people know about their own status because of lack of public awareness and education. Awareness of viral hepatitis is low. A Chinese proverb says, “The beginning of health is to know the disease.” Education is the key! Knowledge is the key to prevention!

A study conducted by the World Hepatitis Alliance (WHA) in partnership with the World Health Organization (WHO) between July 2009 to March 2010 show that only three percent of African governments provide funds for public awareness campaign to educate and improve understanding of viral hepatitis. Seventy-five percent of African countries reported that no government-funded public awareness activity has taken place in the past five years. Action plans to reduce the stigmatization of, and discrimination against, people with chronic viral hepatitis are very rare or non-existent.

Mr. President I must say, however, that in 2008, the introduction of the HBV vaccine in the Central African Republic was marked with an event to raise awareness of the need for infants to be immunized and to enlist political and religious authorities in promoting the vaccine among their communities.

I must also add that only Kenya has a policy in place to combat stigma and discrimination against people affected by HBV and HVC.

2. Testing and Treatment--Testing is inaccessible in most of the Africa region. In the WHA/WHO study that I referred to a moment ago, only 20 percent of African countries have testing facilities that are accessible to more than 50% of their population. Testing facilities are available only in major cities. Most Sub-Saharan African governments do not provide funds for testing and treatment, which are very expensive, and unfortunately, most of the people affected by these deadly conditions are unable to afford the cost of treatment, and consequently, die.

Policy Suggestions
What should African governments do? African governments should consider viral hepatitis as an urgent public health issue, and come out with comprehensive strategies (of course, in collaboration with the WHO and other development partners) to prevent and control viral hepatitis on the continent. We might need to fine-tune our national health policies.

The primary focus of any national strategy to combat the menace of viral hepatitis on the continent should be prevention for the common adage has it that “prevention is better than cure”. Vaccinating newborn infants against HBV is cost effective than to treat the virus in adulthood. For example, recent studies in the Gambia showed that when compared with no intervention a HBV vaccination programme would cost US$28 per disability-adjusted life year averted from the societal perspective, or US$47 per disability-adjusted life year averted from the payer's perspective. Further, comparable results have been obtained in Mozambique.

Mr. President, any preventive strategy adopted should be targeted at three levels:

 Primary level—to eliminate new infection

 Secondary level—to reduce risk of transmission from chronically infected to others

 Tertiary level—to reduce risk of chronic liver disease.

The strategy should also have the following key elements:

 Increasing national awareness of viral hepatitis through the commemoration of a World Hepatitis Day on 28 of July every year, as the world agreed upon at 63rd World Health Assembly in Geneva on 21 May, 2010

 Providing screening facilities at all local health centres, district polyclinics, and regional government hospitals (e.g. all pregnant women should be tested)

 Enhancing prevention tools: injection safety, blood safety and immunization of all newborn infants; and vaccination of all health-care professionals. At least 85-90 percent of HBV-associated deaths are vaccine-preventable. Infant HBV vaccination programmes have been implemented in almost all of the 46 African countries, 6 in the 1990s and at least 37 since 2000. For example, in 1999 Ghana added hepatitis vaccine for infants in its “5 in 1 vaccination” programme. Still, much is needed to be done in other countries.

 Strengthening disease surveillance, such as establishing national database to monitor spread of the virus in order to establish patterns of progression would be in the right direction. In the WHA/WHO study I referred to earlier, it was found that disease surveillance for HBV and HCV is present in only 17 countries in Sub-Sahara Africa. All local health centres, district polyclinics, and regional government hospitals are required to be involved in viral hepatitis case reporting scheme. Such a disease surveillance scheme would help in predicting, observing, and minimizing any harm caused by outbreak, epidemic and pandemic situations.

 Ensuring those already infected with viral hepatitis have timely access to testing, care, and effective and affordable treatments to delay development of disease and prevent disability and eventual mortality

For example, early diagnosis provides the best opportunity for effective medical support. It also allows those infected to take steps to prevent transmission of the disease to others, for example by adopting safe sex practices. Further, it allows lifestyle changes to be made to protect the liver from additional harm, specifically, by eliminating alcohol and certain drugs that are toxic to the liver.

Mr. President, we can't afford to ignore problem any longer. We should figure out a plan to tackle it once and for all. Now is the time to get started. Please don't get me wrong, we won't be able to change things overnight but we can begin to take the steps to prevent the spread of viral hepatitis in Ghana. A Chinese proverb says, “A journey of a thousand miles begins with a single step. It is time for Ghana governments to take a serious look at viral hepatitis: how to prevent it spread, and how to provide affordable treatment for those living with viral hepatitis.

Hepatitis is Treatable, Preventable!
Know it, confront it, Get Tested!
Spread the Word but not the Virus.
From: Mr. Theobald Owusu-Ansah
Regional Board Member for Africa, World Hepatitis Alliance

President and Founder, Theobald Hepatitis B Foundation

Email: [email protected]
Tel: +233-20-8269214 / +233-247-093893