Nigeria is facing a grave health crisis as only five percent of people with viral hepatitis are aware of the chronic nature of a disease that kills five million Nigerians every year.
This is even as most hospitals, especially those run by government, face severe shortage of hepatologists, gastroenterologists and pathologists who should help reverse the tide across the country, with training and recruitment increasingly ebbing.
Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. LEADERSHIPSunday gathered that in most cases, it is caused by a virus known as viral hepatitis, and the most common forms are hepatitis A, B, and C
Minister of health, Professor Isaac Adewole, disclosed that about 20 million Nigerians have hepatitis. He explained that though many people may appear healthy physically, they could be walking around without knowing they are carriers, adding that most times the disease does not manifest until it is late.
According to him, hepatitis could cause chronic liver disease, liver cancer and death without manifesting any weighty symptoms.
“Sometimes you see them vomiting, bleeding or having jaundice or becoming unconscious,” he said.
Experts have, however, blamed the high number of deaths linked to this liver disease on the relatively poor awareness about the disease among health care providers, social service providers and the general public.
According to them, the lack of awareness about the prevalence of chronic viral hepatitis in Nigeria and about the proper methods and target populations for screening and medical management of chronic hepatitis B and hepatitis C probably contribute to continuing transmission; missing of opportunities for prevention, including vaccination; missing of opportunities for early diagnosis and medical care, and poor health outcomes in infected people.
A recent research carried out by the Global Burden of Disease, a non-governmental body, indicates that despite advances made in Hepatitis C treatment and the availability of hepatitis vaccinations, deaths attributable to viral hepatitis have exceeded those caused by all other chronic infectious diseases, including HIV, malaria and tuberculosis.
LEADERSHIP Sunday gathered that while viral hepatitis remains one of the top 10 causes of deaths worldwide, most patients diagnosed with it who are unable to afford travelling abroad for treatment die while queuing to see a doctor in some government hospitals.
LEADERSHIP Sunday findings also revealed that Hepatitis A and E are transmitted by contaminated food and water and that some of the symptoms include fever, diarrhoea, abdominal pain and yellow eyes. The symptoms go on their own and do not stay in the body to cause further damage.
Hepatitis B, C and D, on the other hand, findings further showed, stay longer than six months in the body and grow into chronic forms.
President, Nigeria Medical Association (NMA), Prof. Mike Ogirima, in an exclusive interview, made the shocking revelation – that contrary to the World Health Organisation’s recommendation of one doctor to 600 patients, Nigeria has one doctor to 2,000 patients and just about 100 gastroenterologists in the whole country.
He said, “We have one doctor to 2,000 patients in Nigeria; gastroenterologists may not be more than 100. This is against WHO recommendation; how then can we get adequate (number of) hepatologists?” he asked.
The NMA president blamed inadequate manpower for the delay in securing appointment and commencement of treatment after diagnosis.
“If you have hepatitis in Abuja, for you to get a treatment, you have to queue,” he noted.
Ogirima was, however, quick to add that the situation is not restricted to Nigeria, as he explained that the referral system is even more vigorous in other countries.
“It is even better in Abuja. The referral system in the UK, if you want an elective consultation, not emergency, it takes 13 weeks; you can’t just walk in and see the specialist; you must see the family physician (first) – they are what we call the general practitioners, who will treat you and book an appointment with specialist based on the schedule for you.”
Ogirima challenged the government to rise to the challenge of addressing the pressing issue and invest more by sponsoring the training of specialists and by establishing more medical universities in the country.
“Government needs to train more, retain more and motivate more. What I mean in essence is that it has to prevent trained doctors from going out of the country; engage them as you train them by motivating them and giving them good working environment.”
However, Dr Godswill Okara, who is the director, Laboratory Services, Dr. Hassan’s Hospital & Diagnostic Centre, Abuja, holds a contrary view to Ogirima’s stance on specialist care for hepatitis sufferers.
Okara, who is also the chairman, West African Postgraduate College of Medical Laboratory Science, described gastroenterologists as physicians that specialise in conditions that affect the intestine and abdominal area.
He argued that they must not be the only doctors to treat patients with hepatitis infection, but that any physician can handle the condition except when there is a particular complication arising from the infection.
He said, “It is only when there is a particular complication arising from the infection that you refer patients to a gastroenterologist for treatment. Ordinarily, HBV infection is a chronic condition; it can also become acute when it has advanced in its progression.”
Speaking on the prevalence of the disease, Okara said, “It is quite high. According to a survey done years ago, it was speculated that about 20 million Nigerians were infected with the virus.
“In fact, we have done a survey in Dr. Hassan’s Hospital. We have an abstract and the research work we have done on it, we are presenting it at the 33rd World Congress on Medical Laboratory Science in Italy by September.”
According to him, from the study, the prevalence rate is 7.72 per cent, which translates to 13 million people living with the ailment, a figure he described as high.
“When you talk about public health, government is central and key to it. This is because when you look at the large group of people that are chronically infected, it has very adverse economic and public health consequences.
“From our study, we noticed that the age range of
20-50 has the highest prevalence rate and this is the productive workforce,” he stated.
Also speaking on the prevalence rate and possible causes, a biochemist, Blessing Chukwuemerie, disclosed that Hepatitis B and C were the most common types of hepatitis in Nigeria, and that they could cause liver damage which results in liver cancer.
She stated while the average prevalence rate of Hepatitis B virus in Nigeria is about 13 percent and Hepatitis C virus about two percent, there is no reliable data for the other types – Hepatitis A and E.
The biochemist lamented that the liver disease was given less attention and stressed that “hepatitis is four times bigger than the burden of HIV.
“People don’t present themselves early, most people rush to traditional or normal conventional paracetamol before they come to us; by then the situation is already fulminant,” he said.
A medical laboratory scientist and hepatologist at the Asokoro Hospital, who preferred anonymity, said two out of 10 tests she had conducted within the last eight months in Abuja tested positive for hepatitis, adding that Hepatitis B is the most prevalent, especially in the northern part of the country.
She stated that people who are infected with the virus become ill in the prime of their life, with those in their late 20s, early 30s, and early 40s coming down with liver diseases due to hepatitis.
She cited a 2016 report which ranked Taraba State (34 percent) and Benue State (35 percent) as having the highest burden of the disease in the northern part of the country.
She revealed that in the past 19 months, out of the 991 blood samples collected, 113 samples were found to be positive for Hepatitis B infection and 13 for Hepatitis C.
Other medical experts including those from the World Health Organisation (WHO), SOGHIN, World Hepatitis Alliance, Nigerian Institute for Medical Research (NIMR) and the Federal Ministry of Health said these needless, preventable deaths are often unreported or misclassified as deaths after a “brief illness” since Hepatitis B and C symptoms only become obvious few days or weeks to the death of the patient.
They emphasised the need to educate the population about Hepatitis B and C, especially the need to prevent infection since, unlike HIV, tuberculosis (TB) and malaria, which are backed by donor funds, hepatitis treatment is not yet subsidised and patients have to bear the cost of laboratory testing, vaccination and treatment.
The experts also noted that the infection could also be innocuous in many patients and may even be eradicated in some cases by the body’s immune system without treatment. But they insisted that the people need to be armed with the right information about this disease.
Researchers calculated that patients with Hepatitis C Virus (HCV) were 2.5 times more likely than non-HCV patients to be diagnosed with cancer, including liver cancer, and at two times higher risk of cancer when liver cancer was excluded.
According to the Centre for Disease Control and Prevention (CDC), most people become infected with HCV by sharing needles or other drug-injecting equipment.
Though less common, HCV can also be spread through having sexual contact with an infected person, sharing personal care items – such as toothbrushes and razors – that may have come into contact with the blood of an infected individual, or being born to a mother with Hepatitis C.
It is well established that infection with HCV can increase a person’s risk of liver cancer.
LEADERSHIP Sunday gathered that only hepatologist shuttles between Asokoro, Maitama and Wuse general hospitals in Abuja, the nation’s capital, hence the long queues which make sufferers wait three to four months before seeing a specialist.
A pregnant widow and mother of three (names withheld), who lost her husband recently to hepatitis, said, “My late husband tested positive to Hepatitis B when he offered to donate blood for me as is customary in Asokoro antenatal clinic.
“On realising this, he immediately opted to commence treatment in the hospital but was shocked when they gave him a three-month appointment.
“Unfortunately, my husband battled with feverish conditions, headaches and body pains for the three months he was asked to wait. We even rushed him to a private hospital where he was given the best of malaria drugs but did not feel better.
“He died at the National Hospital of liver damage caused by hepatitis infection a month to his booking at the Asokoro Hospital,” she said with tears in her eyes.
To reverse this trend, medical experts have urged the government to enunciate a workable strategy to stem the rising tide of viral hepatitis infection and to ensure that infected people are diagnosed and offered treatment in good time.
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