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Hepatitis B, the silent epidemic that causes liver cirrhosis, cancer, kills

A patient (Left) is vaccinated against Hepatitis B in Soroti (FILE PHOTO)

KAMPALA – When Ms Lillian Nasije’s daughter of two years developed abdominal pain, lost appetite, got a fever on and off and developed a yellowish skin with whites on her eyes, the villagers asserted that she had been bewitched or cursed by gods.

Ms Nasige says she took her baby to a witch doctor who gave her a concoction of herbs but that the herbs never worked.

She explained that the health of the child kept deteriorating and that she had to seek another local doctor who told her that the child had been bewitched by a neighbour and required two goats to save the girl.

“I did not have the two goats, so I decided to seek medical advice from medical personnel who told me to seek treatment from a hospital. I did that and the doctor told me that my child was suffering from Hepatitis B,” said Ms Nasige.

Ms Nasige is not alone, there are many people in the villages who believe in witchcraft and never think that hepatitis B can affect anybody whether child or adult.

Dr Jackson Omone, commissioner clinical services at the ministry of health says that the child could have got infected during birth or the mother could have passed on the disease to the child.

Dr Omone describes hepatitis as an inflammatory condition of the liver and that the condition can be self-limiting or can progress to liver fibrosis (scarring), cirrhosis or liver cancer.

He added that the disease is caused by a viral infection though there could be other causes of hepatitis adding that for instance, a condition described as autoimmune Hepatitis results from medications, drugs, toxins, and alcohol.

Dr Omone who was 19 February speaking to the Doc-talk show on NBS Television hosted by Dr Darious Owachi said Hepatitis B virus can spread to the baby during childbirth.

“This can happen during vaginal delivery or a c-section and that when babies become infected with Hepatitis B, they have a 90% chance of developing a lifelong, chronic infection.

He explained that Nasige’s baby could have been infected by Hepatitis B during birth and that many babies get Hepatitis B from their mothers during birth “it should not be mistaken for witchcraft but should be taken to the hospital for treatment,” added Dr Omone.

He said despite its high prevalence, there are a few misconceptions about the prevalence, spread and outcome of Hepatitis B Virus [HBV], which infects and kills more people than even HIV/Aids.

The World Health Organisation (WHO) estimates that 240 million people are infected with HBV and 170 million with hepatitis C (HCV) and that globally, 36.9 million people were living with HIV in 2017.

WHO describes HBV as a ‘silent epidemic’ because nine out of 10 infected persons remain unaware of their condition for years.

Dr Omone added that acute Hepatitis B is a newly acquired infection and individuals affected by the infection notice symptoms between one and four months after exposure to the virus and that this can be treated or the body can fight it.

“Chronic hepatitis B lasts longer than six months and is usually an infection that has to be dealt with in the longer-term,” said Dr Omone.

Prevalence.

Unlike measles, flu or meningitis, whose outbreaks cause deaths within days, those infected with HBV rarely show signs and end up without appropriate treatment.

One in four HBV patients will die of liver cancer or failure after many years.

Statistics from the Ministry of Health show that Uganda is one of the countries with a high number of people affected by Hepatitis B.

The statistics reveal that about 3.5 million (10% of the population) are living with chronic hepatitis B infection and that the highest infection rates are in Karamoja (23.9%), northern Uganda (20.7%), West Nile (18.5%) and western region (10.0%).

Dr Ramya Raghavan, Consultant Internal Medicine, Columbia Asia Hospital Whitefield says globally, hepatitis is killing nearly 1.4 million people annually, and that worldwide, nearly 300 million people living with viral Hepatitis unaware. “It also causes two in every three liver cancer deaths,” he adds

Transmission

Dr Omone said Hepatitis B is highly infectious and is spread from mother to child during birth, during transfusion with infected blood and blood products, during dialysis, sexual intercourse with multiple partners, sharing syringes among injectable drug users and during prolonged close contact with infected people.

“The hepatitis B virus is a blood-borne virus. It is transmitted from person to person via blood or fluids contaminated with blood,” Dr Omone said.

Unlike HIV, HBV can survive for seven days outside the body, making dried blood and secretions a serious health threat.

Dr Andrew Kasoro, a paediatrician at Mbale regional hospital says then attacks the liver, resulting in acute and chronic disease- the acute phase is often asymptomatic and, unless one is infected as an infant, few adults progress to the chronic state.

“The risk of developing chronic HBV infection decreases with age and only five percent of adults who get an acute infection will be at risk of developing liver cirrhosis and cancer,” added Dr Kasoro.

He said, by comparison, infected infants and children under five have a 90 and 30 percent chance of developing chronic disease, respectively
Symptoms

The common symptoms include liver pain, jaundice, dark urine, pale-coloured stool, appetite loss, feeling tired, nausea and itching all over the body.

Diagnosis

Hepatitis B infection is diagnosed based on the above symptoms and blood tests, which indicate abnormal liver function.

According to Dr Kasoro, a blood test is used for diagnosis, and other tests like liver ultrasound and the less common liver biopsy may be carried out to assess the degree of liver involvement.

He explained that the initial infection after exposure is acute, with either complete recovery, or progression to chronic disease and that when symptoms develop in acute hepatitis B, management includes rest, adequate hydration and proper nutrition.

Avoidance of other factors like alcohol, which may make the liver inflammation worse, is also advised

Treatment.

According to Dr Omone, acute Hepatitis B usually does not require medical treatment. But if symptoms like vomiting and diarrhoea persist, more fluids and electrolytes have to be given to the patient.

Experts say there is no medicine to prevent acute Hepatitis B from becoming chronic but that if the symptoms last for a long period of time, consult a gastroenterologist.

Prevention

  • Razor, toothbrush, fingernail clippers, should not be shared if they have blood on them.
  • Think about health risks if you are planning to get a tattoo or body piercing. You can become infected if sterilized needles and equipment and disposable gloves are not used.
  • Practice safe sex. Latex condoms have to be used when multiple partners are involved to prevent HBV transmission.
  • If you inject drugs, don’t share needles or other equipment.

NO CURE

Medical experts talked to indicate that there is no specific treatment or cure for acute hepatitis B, and most adults do not progress to chronic disease.

However, many children who were infected from birth or who are below the age of five do. Chronic hepatitis B is diagnosed by the persistence of certain blood markers for six or more months after initial infection.

Dr Owachi urged the public to identify those who would benefit from vaccination and those who require medication to halt the progression to liver cirrhosis and cancer and called for increased coverage of screening is necessary to save our people from Hepatitis B.

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