10 October 2017

Ethiopia: Sustaining HBV Intervention Success Stories

Viral hepatitis result in a potentially life-threatening inflammation of the liver, which is characterized by complications of liver disease. Specifically, hepatitis B (HBV) and C (HCV) viruses alone cause chronic viral hepatitis which is a major global health problem responsible for 57_per cent of liver cirrhosis and 75_per cent of primary liver cancer cases, respectively.

A 2013 WHO report indicates that more than 240 and 150 million populations were affected by chronic liver disease due to HBV and HCV respectively. Africa has been the second largest number of chronic HBV reports next to Asia. A recent report still estimates that about 2.2 billion people globally have evidence of past or present infection with the viruses. And about 500 million of these are chronically infected- a figure more than ten times those affected by HIV and AIDS.

Besides, chronic viral hepatitis takes the lives of around 1.3 million people from chronic liver disease and hepatocellular carcinoma (HCC) per annum. It is then evident that the death toll from viral hepatitis is fairly analogous with the 1.5 million deaths from HIV and AIDS and 1.2 million deaths from either tuberculosis or malaria annually.

WHO also reported that unlike HIV, which primarily occurred in low-income countries, 58 percent of hepatitis deaths occurred in upper-middle-income countries and high-income countries. For example, in absolute numbers, East Asia and south Asia have the greatest number of hepatitis deaths with 52 per cent of the total number of deaths.

Notwithstanding its high prevalence and highly infectious nature as well as significant burdens of disease including huge rate of mortality and morbidity worldwide, viral hepatitis has not been given the attention it deserves by the international community.

In Ethiopia, several investigations on the prevalence and magnitude of HBV indicate that there is an average of 2.3 per cent decline annually. According to data from HealthGrove, the annual mortality rate per 100,000 people from hepatitis B in Ethiopia has decreased by 52.8% since 1990. This is due to successful interventions against hepatitis B virus (HBV).

According to Consultant internist and gastroenterologist hepathologist, assistant Prof. of Medicine, Addis Ababa University and Director of Endoscopy Center at Black Lion Hospital Dr. Amir Sultan told The Ethiopian Herald that Ethiopia has been adopting and employing a WHO recommended Global intervention approach to prevent transmission.

The expansion of the healthcare system particularly in rural areas for delivery, antenatal care and pregnancy services has had a huge impact on the prevention effort.

In addition, Ministry of Health organized a national task force and developed strategic documents and treatment guidelines following the global move and determinations. Although there is an important number of infection among the total population, the intervention through promoting the universal precaution resulted in success.

Dr. Amir explains that the enduring viral hepatitis in Ethiopia are caused by virus hepatitis B and C, with estimated prevalence of about eight and one percent of the entire population respectively. The nature of the virus significantly contributed to the prevalence. The high infection rate is due to the fact that Hepatitis B virus is almost hundred times more infectious and stronger than HIV.

The overall mode of transmission mirrors that of HIV. Nevertheless, a number of studies by different universities including those from Addis Ababa University traced that the commonest mode of transmission in Ethiopia is through early horizontal transmission (among children aged 1 to 5 years as they engage in household activities), followed by sexual transmission. This pattern of transmission is different from that in most parts of the world. In Asia, the commonest way is from mother to child during birth, where as in the west it is intravenous drug use and sexual intercourse.

Realizing the commonest ways of infection, the government focused on minimizing the acquisition of the virus in addition to offering available treatments to those patients who developed the complication. This basically targets children who are vulnerable to the infection. The new generation therefore is not going to be infected for there is already a vaccine for hepatitis B. There is also a vaccine available for certain selected group of the society, particularly those who are highly risked in handling sharp materials. The professor hence is very hopeful about the future of HBV. "I'm therefore quite confident in that the impact is going to be massive in the near future. Because the practice is in congruent with the global Expanded Program of Immunization ."

Those nations that employed the same intervention have attained success. An outstanding illustration can be Taiwan. It received international recognition in significantly reducing HBV infection and liver cancer complications over 20 years. Ethiopia in the same way started the trend before five years, so it would not see more HBV infection. Because children who were born in health care system accessible areas of Ethiopia over the past 5 to 7 years already received the vaccine for hepatitis B infection. There is also a better access to the vaccine for healthcare workers.

Government has also placed emphasis on preventing HCV. The Ministry of Health together with the Ethiopian Gastroenterology Association has been working harder to make the drug available in Ethiopia at 99 per cent discount. And the manufacturing company, Gilead Sciences now provides Ethiopia the drug at 1 percent cost of the original price which is about 84,000 US dollar per personal dose.

The overall attainment so far can be deemed rewarding. However, it would be prudent to sustain the efforts for lasting resolutions. Therefore, being on post HIV era and taking into consideration the magnitude and seriousness of the problem, prevention and control of viral hepatitis need a high degree of attention similar to HIV and AIDS, tuberculosis and malaria.

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