By Sharon Atieno
Deaths due to viral hepatitis in Africa are becoming a bigger threat than deaths due to AIDS, malaria or tuberculosis. However, African countries are lagging behind in achieving set target for its elimination, a World health Organization (WHO) scorecard reveals.
Every day, complications of viral hepatitis-related liver disease including cirrhosis and liver cancer, claim the lives of not less than 550 people- more than 200 000 Africans annually.
WHO estimates that out of 60 million people in the WHO African region who were living with chronic hepatitis B virus infection in 2015, 4.8 million were children less than five years of age.
In addition, 10 million people in the region were infected with Hepatitis C virus, with unsafe injection practices within health facilities or communities being a major cause.
Despite this, the disease remains neglected in many African countries; the scorecard shows that only three of the 47 countries in the WHO African region are on track to eliminate viral hepatitis. These include: Mauritania, Nigeria and Cameroon.
The score card tracks progress against the Framework for Action for the Prevention, Care and Treatment of Viral Hepatitis in the African region (2016-2020). The Framework was designed to be a guide for Member States on the implementation of the Global Health Sector Strategy on Viral Hepatitis-which calls for the elimination of hepatitis by 2030 (defined as a 90 percent reduction in new cases and 65 percent reduction in deaths).
Besides the estimated burden of Hepatitis B and C in each country, the scorecard highlights the results of six indicators: national strategic plan; Hepatitis B birth dose implemented; national coverage of the third dose of pentavalent vaccine; 20 percent of people living with hepatitis B and C know their states; establishment of national treatment programmes and health ministry World Hepatitis Day.
The scorecard discloses that 28 countries have developed a national action plan for viral hepatitis; however, only 13 have published their policy document, while the rest are still in drafts.
Only 7 out of 47 countries are leading prevention efforts with national coverage of both Hepatitis B birth dose and childhood pentavalent vaccination exceeding 90 percent.
Moreover, there are huge gaps in hepatitis testing and treatment with less than eight countries providing subsidized testing and treatment for viral hepatitis. It is only Uganda and Rwanda that are on track to reach the 2020 Framework targets for testing and community awareness.
Uganda, for instance, invested USD 3 million annually in free hepatitis B screening programme since 2015, along with widespread community mobilization and awareness-raising actions. This has resulted in more than four million people being screened and more than 30 percent of the population infected with hepatitis B being made aware and can access comprehensive treatment services.
In spite of the low cost of birth dose vaccination- less than USD 0.20 per child- only 11 countries in the region are following this protocol. Cabo Verde, is one such country which has achieved 99 percent vaccination coverage at birth; coverage of the pentavalent vaccine has also been more than 90 percent over the past decade.
Speaking during the launch of the scorecard, Prof. Lesi Olufunmilayo, Viral hepatitis officer for the WHO Regional Office for Africa notes that, “hepatitis has become a disease that can be eliminated. We have the tools, technology, drugs and knowledge.”
“The Global Strategy for Viral Hepatitis shows that elimination of viral hepatitis is possible before the end of 2030,” she added.
As most of the transmissions in Africa occur before five years of age, one of the major interventions in the Strategy is prevention of hepatitis B by vaccination which has been proven to be 95 percent effective especially if given at birth or early childhood.
“Childhood transmission and mother to child transmission are key to curtailing hepatitis B virus on our continent,” said Prof. Olufunmilayo. “There is already a platform of preventing mother to child transmission of HIV and Syphilis, the inclusion of hepatitis B birth dose, turns the global response into a triple health response of Prevention of Mother to Child Transmission (PMTCT).”
In addition blood screening before transfusion and injection safety are also essential; as re-use of needles and syringes in cultural practices, health centres and persons who inject drugs , is one of the key modes of transmission.
She further notes that: “early identification is needed; political commitment to action and domestic and global investment in hepatitis care are needed.”
WHO is promoting a hepatitis response as a strategy leveraging on already existing programmes with the idea being to foster shared synergies in diagnostic models and to promote cross-programmatic efficiencies.
“We are not advocating for a standalone hepatitis programme ,” she said, “but that the hepatitis programme should be the tool that fosters collaboration and programmatic efficiencies; and that is the only way we can reach the Vision of Africa free of hepatitis B and C.”
“We are promoting a public health approach to viral hepatitis,” Prof. Olufunmilayo said.