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Circumcision, Tattooing, Fuel Spread Of Hepatitis

By Abiose Adelaja Adams

As the world celebrated World Hepatitis Day on July 28, the high death rate from liver cancer recorded in the country has drawn attention to viral hepatitis as a major public health concern.
According to the federal ministry of Health, over 18 million Nigerians are carriers of this virus and it keeps spreading amongst the populace due to ignorance of its symptoms, treatment and prevention. Some 80 per cent of victims are unaware that they are carriers.

And the pitiful thing about the deadly disease is caused by needless but common practiced such as circumcision, scarification for tattoos or tribal marks as well as skin and body piercing.
Further enhancing its spread is the fact that most carriers are asymptomatic (don’t show symptoms), until several decades later. Meanwhile, the liver is silently being damaged during this period.
“For a disease said to be 50-100 times more infectious than HIV, it should get even more prominence,” said professor Innocent Ujah, director general of the Nigerian Institute of Medical Research, on the occasion of World Hepatitis Day, in Lagos.
“We must have a change of attitude towards it because it is a public health
challenge ranks as the world’s eight biggest killer,” he warned.

There are two known types of hepatitis, namely Hepatitis B and hepatitis C and both are named after the B and C viruses respectively.
Evidence from the first hepatitis sentinel survey conducted in Nigeria in 2013 by Professors C.N. Obionu and B.S. C. Uzochukwu, in conjunction with the federal ministry of Health, shows that many healthy looking people carry the virus and don not know until screened. It also shows that cultural practices such as local circumcision, scarification (tribal marks), local cutting of the tonsils (belu-belu), encourage its spread.

The reason is that the procedures involve exposure to blood or body fluids or tissues, use of needles, blades or knives. And these are the avenues through which the virus is transmitted.

It is also transmitted from an infected mother to her child as well as through sexual intercourse; but, notably,  hepatitis C is mainly blood borne, not transmitted through sex.
Other ways of spread includes through delivery of a child at home, body piercing, dental procedures, sharing of sharp objects like needles, stick injury, intravenous drug usage (IDU), cupping/blood-letting, dental care outside health facilities, heredity, taking blood oaths, living with and sharing material with people who take drugs intravenously. Anyone involved in these practices is at a high risk of infection.
Globally, hepatitis B has infected two billion people, while hepatitis C has 350 million sufferers.
Charles Onyekwere, a herpetologist at the Lagos State University Teaching Hospital, LASUTH, said that the spread must be prevented so that it does not get out of hand. “Already 10 per cent of the population are chronic carriers, and most come down with liver diseases and liver cancer. We are now recording liver cancer as the second leading cause of cancer-related deaths, “Onyekwere noted.
“Chronic carriers serve as an important source of new infections; most have no signs or symptoms and an estimated two-thirds are unaware of their status,” he added.
For victims of Hepatitis, access and affordability of treatment appears to be a major challenge. In his clinical experience at LASUTH, Onyekwere said that “most patients when diagnosed can’t afford the drug, so they go untreated and later come down with cirrhosis, liver damage or cancer.”
Similarly, in her clinical experience as the head of Human Virology Laboratory, Nigeria Institute of Medical Research, Yaba, Lagos, Rosemary Audu, explained that though hepatitis B is treatable and preventable, one of the challenges is access to affordable treatment.
“Once we screen a patient and he tests positive, we tell him or her to buy the drug; then he says he can’t afford it. A drug can be as expensive as N60,000,” she said.
Audu, who is also the deputy director of Research at the institute, concluded that “the challenge with Hepatitis B is that drugs are expensive.”
Even then, she observed about the drug: “it does not cure but only slows down the progression of cirrhosis and reduces the incidence of hepatocellular carcinoma (liver cancer) and increases long time survival.”

While noting that vaccination is the only way to prevent hepatitis B, Audu also hopes that government can subsidise the cost of drugs.

“In a nutshell, healthy and normal looking adults should go for periodic screening for the purpose of early detection and accessing therapy to prevent liver damage. Vaccination of infants as well as those considered high-risk groups,” she added.
The liver is the second largest organ of the body after the skin. Its functions include clearing toxins from the body, processing food nutrients and it is also involved in regulating body metabolism.
Symptoms of hepatitis can be a sign of advanced liver disease and can last from few weeks to several months and include fever, fatigue, nausea, vomiting, loss of appetite, abdominal pain, grey coloured stool, dark urine, joint pain and jaundice.

Read more about World Hepatitis Day here