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Hepatitis B: Common, deadly but receives low attention in Nigeria

KHADEEJAH was in her final year at Al-Hikmah University, Ilorin, Kwara State in 2015, when she had fever and cough. She went for a routine checkup at the hospital where she was initially diagnosed with typhoid fever, but after subjecting her to further tests, she was confirmed to be hepatitis B positive.

Disturbed with the doctor’s report, she called her parents on phone to break the news to them with the hope to find succour.

But her parents became even more troubled for it is possible they also were infected with the disease. Though not genetic, Hepatitis B is a liver disease that can be caused by inherited conditions. The disease can be transmitted among family members.  But when her parents took tests to ascertain their status; no one was positive.

The disease could also be spread when someone comes in contact with blood from a person who has the disease. Hepatitis B (HBV) is 50 to 100 times easier to transmit sexually than HIV, studies have shown.

“I became worried because I have neither had a blood transfusion before nor had I undergone any surgical operation,” she said.

Her mother also was curious as to how she could possibly get the infection. Suspecting that  her mother was suggesting she could have got it from having a sexual intercourse, she told the old woman with emphasis: “I haven’t known any man, I had never had any intercourse with any man.”

That was three years ago.

The 23-year-old Khadeejah, now married with two children, has come to term with her medical condition.

The ICIR reporter saw her last week at the consultation Room Two at the University of Abuja Teaching Hospital at Gwagwalada, Abuja, when she came for her usual medical checkup with a gastroenterologist (the specialist that treat hepatitis B patients).

She told The ICIR about the stigma and frustration she went through in the past years as a person living with hepatitis B. Just like HIV/AIDS, hepatitis B is infectious. And everyone who knows Khadeejah has being diagnosed with the disease has tried to avoid her, including her blood sister.

When I travelled to my sister’s house,  the usual reception has changed. 

‘Please don’t go near my children because I’ve not immunised all of them!’” she recalled her sister telling her during the visit.

“That was the first time I experienced stigmatisation from a family member,” she said.  The situation made her hate coming closer to children. “I don’t even touch them, and I don’t even want them to come close to me,” she said.

Khadeejah seems to have overcome her hypersensitivity after having children of her own. At the hospital where she was seen waiting for the doctor, her baby was burrowing head in her bosom. Then the baby became restless over what the mother could not understand, Khadeejah, noticing that, transfers the baby to the father who is waiting outside the consultation room.

The World Health Organisation described hepatitis B as a potentially life-threatening liver infection caused by the hepatitis B virus.

The disease attacks the liver, especially when it is chronic, and can be contacted through the blood or other body fluids of an infected person.

Ojonugwa Ameh, a consultant gastroenterologist at University of Abuja Teaching Hospital said that the disease, though a silent killer, is more deadly than HIV infection.  When it reaches the chronic stage, it affects the liver, leading to cancer of the liver and liver failure. So, when a patient is tested positive, there is a need to check if it is an acute or a chronic one.

The acute, Ameh explained, can be cured within six months of infection, as the body defence system builds up to eradicate the virus. After six months, there is no cure but a treatment which suppresses the virus from damaging the liver. The major part of the treatment is for patients to use their antiviral medication as prescribed –usually one pill per day.

The gastroenterologist said the symptoms include general body pains, stomach pains and malaria fever at an initial stage. Other symptoms are swollen of the stomach, legs and hands; vomiting;  stooling blood, and jaundice (the yellowish of the eyes), which shows when the kidney has been affected.

 Uzo Okwuasaba, a Senior Registrar, Gastroenterology Unit of Internal Medicine Department at National Hospital Abuja told The ICIR that the most common means of contacting the infection in Nigeria is through a mother-to-child contact which he called horizontal contact. This he said happened when a mother with the viral infection is not aware of her status and transfers the disease at birth.

Okwuasaba also said children under five years are more vulnerable to the viral infection, especially those who did not have immunisation, because these children could easily put a lot of dirty things in their mouth.

“The lifestyle of most of Nigeria’s babies is such that they play around, picking things easily into their mouth, and the children’s immune system is not always high,” he said.

In addition, Ameh said the infection could be transmitted through infected blood.  Other means are sharing of sharp objects like razors, clippers and using of unsterilised instruments for any procedures that go with the cutting of the body.

“People that cut their nails from the local nail cutters are at risk. The sterilisation of their instrument might not be very ideal, and hepatitis B is a tenacious virus that can survive on instrument and surfaces for a very long period,”  Ameh said.

The disease can also be contacted through sexual intercourse, and there are reported incidences whereby people contact the virus through saliva, but this is not common, Ameh said.

The high burden and awareness in Nigeria

The WHO  estimated that 11.2 per cent of Nigeria’s population is hepatitis B positive. The figure indicates that 20 million Nigerians are living with the viral infection.  And this represents that one in nine Nigerians has the disease.

Isaac Adewole, the minister of health, said during the 2017 World Hepatitis Day expressed determination of Nigeria to eliminate hepatitis B infection by 2021. The minister said it is achievable because the country already provides HBV vaccination as part of the national immunisation schedule for children and adults.

In addition, the country screens for HBV and hepatitis C virus (HCV) in all donated blood for transfusion and has a policy for injection safety.

However,  the screening and vaccination coverage among adults remains unsatisfactorily low in Nigeria due to a lack of awareness among the general populace, according to WHO.

Ameh confirmed that the level of awareness about hepatitis B is poor in Nigeria. “I see some professors who are ignorant of hepatitis B, he said. “If the elites can be ignorant of hepatitis B, what can we say about those in the villages.”

He added that the awareness of the hepatitis B screening is not adequate.  Most people do not know their status. Only when they come very sick, and most times at that stage, the damage has been done.

Similarly, the NHA doctor said there are lots of people with hepatitis B in Nigeria who do not know their status. This is because the only way they can know is by screening.

“We need as many screening centres, especially at the primary health care centres so that people can be tested and know their status early before liver diseases set in,” said Okwuasaba. He said hepatitis B has not received as much awareness like HIV, where it gets so many counselling and testing centres.

Checking through the Federal Ministry of Health budget between 2015 to 2017, a sum of 42.7 million was budgeted for test kits for hepatitis B and other transmissible diseases, but none of this allocation goes to the awareness campaign. The particular budget on test kits has been named for the three years as procurement and supply of transfusion-transmissible infections (TTIs) test kits and reagents for HIV, hepatitis B and C and syphilis for 500,00 blood samples.

However, the 2018 budget has included N90 million for campaign and screening of hepatitis B in three states in Nigeria. Out of this N90 million,  N30 million was budgeted for HIV, hepatitis, malaria, and Lassa fever awareness campaign in selected senior secondary schools in Kubwa, Abuja. Another N30 million for the screening and awareness campaign for HIV/AIDS, hepatitis and breast cancer in Zaki-Biam Ukum local government area in Benue State.

The last N30 million was budgeted for the screening and vaccination for hepatitis B at Aniocha and Oshimili federal constituency in Delta State.

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