Of the five strains of hepatitis, B and C have been described as global public health threats and the world's most common causes of liver infection.
At a corner of a crowded female hospital ward, Mabel Dauda groaned loudly in pain from where she lay.
Nurses dressed in white and blue uniforms moved around the ward, pushing along with them trollies containing medications and other items, as they attended to the patients.
Ms Dauda, who appeared to be mid-30, had been diagnosed with liver disease. According to the medical official on duty, the disease had reached the end stage. The patient was surrounded by family members who were crying as they hoped and prayed for a miracle. But that did not happen.
Ms Dauda died right where she lay in a corner of the ward. The end came for her sooner than anticipated.
"If only her case was presented earlier. The infection had already caused serious damage to her liver before she was brought in," the doctor assigned to Ms Dauda murmured as he stepped away from the ward.
The scenario was in 2016 at the Ekiti State University Teaching Hospital (EKSUTH) in Ado Ekiti, the state capital, where this reporter was also on admission at the time.
Although the doctor did not exactly mention the cause of Ms Dauda's death, some of her wailing relations had mumbled the word "hepatitis," after the doctor confided in them.
Hepatitis, a viral infection, is known as a major cause of liver disease, which leads to death if not promptly and properly managed.
A consultant gastroenterologist at the Lagos University Teaching Hospital, Emuobor Odeghe, said hepatitis B, one of the five strains of hepatitis virus, can infect the liver and cause liver damage, calling it the commonest cause of chronic liver disease and its complications in Nigeria.
Mrs Odeghe said hepatitis is an inflammation of the liver that can be self-limiting or can progress to cirrhosis or liver cancer.
The World Health Organisation (WHO) said approximately 296 million people were living with chronic hepatitis B in 2019, and that 1.5 million new infections are recorded each year.
The global health body also disclosed that hepatitis B resulted in an estimated 820,000 deaths in 2019, mostly from cirrhosis and primary liver cancer, also known as hepatocellular carcinoma.
Nigeria is one of the most affected countries. With an estimated population of over 200 million people, the country has a hepatitis B prevalence rate of 8.1 per cent and hepatitis C of 1.1 per cent, according to the 2018 Nigeria AIDS Indicator and Impact Survey (NAIIS) report.
The malignant nature of hepatitis may have informed the decision to set aside a day every year to raise awareness about the viral infection and share knowledge on how to halt its danger.
WHD 2023
World Hepatitis Day (WHD) is marked on 28 July every year to raise awareness about the global burden of viral hepatitis and to influence real change.
The theme for the 2023 WHD, "We are not waiting' is a call to accelerate elimination efforts of viral hepatitis now and the urgent need for testing and treatment for the people who need it.
More about hepatitis
According to Mrs Odeghe, the consultant gastroenterologist, hepatitis viruses are the most common cause of hepatitis in the world. She listed its five types including hepatitis A, B, C, D, and E.
Although all five strains are of great concern, because of the burden of illnesses and deaths they cause and the potential for outbreaks and epidemic spread, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are said to be the most common cause of long-term liver damage and cancer, accounting for about 90 per cent of deaths from viral hepatitis.
Mrs Odeghe said while hepatitis A and E are caused by ingestion of contaminated food or water, B, C, and D usually occur as a result of contact with infected body fluids.
"Hepatitis B virus can be transmitted through contact with infected body fluids such as from mother to child, one child to another child through skin cuts or infections that get in contact with infected blood during play, sharing of sharps and personal items; unsafe sexual practices; using unsterilised instruments for surgeries and other medical procedures; unsafe blood and blood product transfusion and needle stick injuries sustained by health care workers," she said.
A consultant paediatrician, infectious diseases, at Barau Dikko Teaching Hospital, Kaduna State, Shuaibu Musa, also reiterated that hepatitis B and C virus are transmitted through direct contact with infected blood or certain bodily fluids.
Mr Musa said hepatitis is a silent epidemic because most people do not have symptoms when they are newly infected or chronically infected, hence they unknowingly spread the virus to others.
He said most patients with hepatitis B and C remain asymptomatic until the liver is significantly damaged. "Some symptoms of the viral infection include loss of appetite, stomach pain, dark-coloured urine, nausea, yellowish eyes or skin, and vomiting."
Global health threat
Of the five strains of hepatitis, B, and C have been described as global public health threats and the world's most common causes of liver infection.
According to WHO, approximately 296 million people were living with chronic hepatitis B in 2019, and 1.5 million new infections each year. The health body also disclosed that hepatitis B resulted in an estimated 820,000 deaths in 2019, mostly from cirrhosis and primary liver cancer, also known as hepatocellular carcinoma.
Data also reveals that about two billion people globally have been infected with the hepatitis B virus (one out of three people).
In Africa, more than 90 million people are living with hepatitis, representing 26 per cent of the global total.
A medical doctor at the Federal Medical Centre (FMC), Gusau, Zamfara State, Bashir Gusau, said hepatitis B has become a global threat that requires urgent attention.
Mr Gusau said people are not presenting for hepatitis tests as often as they should, hence the continuous spread of the virus.
"There are many persons living with hepatitis for long and they are ignorant of their health status. This infection has become an epidemic that must be tackled quickly to prevent more deaths," he said.
Meanwhile, in Nigeria, the NAIIS survey - a national household-based survey that assessed the prevalence of HIV and related health indicators including the national prevalence of two additional blood-borne viruses of HBV and HCV - gave an estimated number of about 19 million Nigerians living with Hepatitis B and or C.
Nigeria's former health minister, Osagie Ehanire, also said that hepatitis is under-reported, under-diagnosed, and under-treated in the country.
Late case presentation
Although there is no cure for hepatitis B, health experts say cases can be well managed if presented early.
Mrs Odeghe, the consultant gastroenterologist, said early detection and treatment of hepatitis B will reduce the risk of complications including liver cirrhosis and cancer.
She explained that late case presentation has led many manageable cases to deaths, one of which was that of Ms Dauda.
"Being hepatitis B positive is not a death sentence. Anyone who is positive should immediately see his/her doctor for further evaluation because there is an effective and safe treatment for it," she said.
Salma Abdulrasheed, a resident of Masaka in Nasarrawa State, said she is currently undergoing treatment for hepatitis B at the National Hospital, Abuja.
Ms Abdulrasheed said although she presented to the hospital at the chronic stage of the infection, the doctor said her condition can still be managed as hepatitis B has no cure.
Mr Musa, the infectious diseases consultant, said hepatitis B becomes chronic if it lasts more than six weeks in the human body, noting that 25 per cent of chronic hepatitis B infections progress to liver cancer.
"For people who are chronically infected but don't have any symptoms, their liver is still being silently damaged which can develop into serious liver disease," he said.
Sadly, most patients with hepatitis B and C infections are asymptomatic and can remain so until the liver is significantly damaged. According to WHO, only about 10.5 per cent and 19 per cent of patients with chronic HBV and HCV are aware of their status.
The case of Daniel Benjamin is not different from that of Ms Abdulrasheed. Mr Benjamin said he never experienced any symptoms associated with hepatitis B until he became very ill and was rushed to the hospital.
"In all honesty, I didn't observe any unusual symptoms with my body, I was 100 per cent fine until one morning I suddenly fell ill and was rushed to Garki Hospital," he said.
Preventable but not curable
Unlike its counterparts, hepatitis B has no cure but can be managed effectively.
Mr Musa explained that the treatment options available for hepatitis B infection include focusing on controlling the viral replication, reducing liver damage, and preventing the progression of the disease.
"For acute hepatitis B, supportive care is often sufficient. But chronic hepatitis B requires long-term management using drugs that can kill the virus which is prescribed to slow down the replication of the virus and reduce the liver damage," he said.
He noted that these drugs can help control the infection, improve liver function, and lower the risk of complications.
Mr Musa, however, said the killer infection can be prevented with the use of approved vaccines which he said are highly effective and recommended for everyone especially those at high risk.
He said the vaccines provide long-lasting protection against the virus as some studies show that immunity will persist for at least 20 years.
"Some studies also indicate that complete doses last for a lifetime and also the duration of immunity can vary between individuals because of certain factors like the age the vaccine was administered, the dosage received, the individual's immune response, and other underlying health issues of the individual," he said.
Recommended doses, vaccines availability, accessibility
Rukayya Muhammad, a nurse at the Specialist Hospital, Sokoto, said a full course of hepatitis B vaccine is given in three doses and it offers lifelong protection for some people.
Ms Muhammad said the recommended dose of vaccine for a child is at zero, one, and six months and for adults, zero, one, and two months.
She, however, said recommended doses vary based on countries and vaccine type.
Investigations carried out by our reporter show that the costs of hepatitis B vaccines and tests vary based on location, health facility, and the nurse and or medical practitioner on duty.
At Asokoro District Hospital, Abuja, a dose of the vaccine costs N2,000. Three doses are required for an adult to achieve full immunity against the virus, making a total of N6,000. A patient is also required to first undergo a hepatitis B test for N2,000. If negative, the patient can proceed with vaccination.
At Wuse District Hospital, Abuja, a dose of the vaccine costs N3,000 and the test is N2,000, according to one of the nurses. When the reporter approached another nurse for confirmation, she said one dose cost N2500.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
At the National Hospital, Abuja, a dose is N4,200 while the test to confirm the patient's status is N4,000.
Emmanuel Ishaku, a resident of Kabala Doki, in Kaduna North LGA of Kaduna State told PREMIUM TIMES that he received the vaccine free of charge at the primary health centre in his community.
Mr Ishaku, however, said he paid N500 to carry out the hepatitis B test.
Vaccines not free for adult
The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Faisal Shuaib, said the Hepatitis B vaccine is given under the Expanded Programme on Immunisation (EPI) schedule in Nigeria.
Mr Shuaib in his response to an FOI sent to the agency said Hepatitis B vaccine is among the childhood vaccines given to infants to prevent the viral disease and that it is readily available for children in all public and private health facilities providing routine immunisation services across the country.
He, however, said the vaccine is not readily accessible for adults because the EPI policy is yet to include it as a routine vaccine for adults.
"Apart from the fact that the focus of routine immunisation is essential to ensure all children get all the antigens, it is also required that adults get tested for hepatitis disease before they take the vaccine," he said.
"Once an adult tests positive for hepatitis, taking the vaccine is no more necessary."
Mr Shuaib said adults are able to access the vaccine through arrangements by private health facilities and some NGOs who make special requests to the agency.
He noted that there are already ongoing efforts by the Nigerian government to make the vaccine more available and accessible for adults.
To increase vaccine uptake, Mrs Odeghe, the consultant gastroenterologist, said the government must ensure vaccine availability and make it affordable for average Nigerians.
She said the full course of vaccine costs at least N5,000 in major parts of the country, a cost that many people cannot afford.
Increased awareness, screening
Mr Musa, the infectious diseases consultant, reiterated the need for increased awareness, especially for those in rural communities where many people are ignorant of such diseases.
He said regular screening will also ensure more cases are captured and placed on treatment before the infection gets to the chronic stage.
"Hepatitis B cases are still on the increase due to ignorance and lack of awareness and that is because a lot of people don't know the causes and ways to prevent the infections. They are unaware of the very potent vaccines against hepatitis B," he said.
Ms Abdulrasheed and Mr Benjamin, currently managing the infection, said they were not aware of the vaccines until they were diagnosed.
