Finding the “Missing Millions”

World Hepatitis Day

According to the WHO report, 325 million people across the world are living with Hepatitis B and C whereas 300 million people are living with viral hepatitis oblivious of the condition. Hepatitis is defined as the inflammation of the liver caused by a virus. Other infections, toxic substances, and autoimmune disease can also result in hepatitis.  Viral types A, B, C, D, and E are of much concern because of the morbidity and mortality burden they cause and the potential for outbreaks and epidemic spread.

Hepatitis A and E are caused by the ingestion of contaminated food and water whereas B, C and D are as a result of contact with infected body fluid.  Hepatitis viruses B and C are responsible for chronic disease in hundreds of millions of people.  Moreover, they account for 96% of all hepatitis mortality.

The liver is the largest internal organ that aids in food digestion, energy storage, and detoxification.  It is the target site for the virus.  Exposure to the virus for more than 6 months can result in chronic infection and place the individual at risk of cirrhosis or liver cancer (the second leading cause of death).

Both acute and chronic hepatitis result in significant morbidity and mortality in Sub-Saharan Africa.  Acute infection may occur asymptomatically or may have symptoms such as jaundice, dark urine, extreme fatigue, nausea, vomiting, fever, diarrhea, and abdominal pain.  To manage the condition, symptoms need to be understood by the general population.

According to the Kenyan Guideline for the Treatment of Chronic Hepatitis B and C viral infections, it is documented that the Hepatitis B virus is 100 times more infectious than HIV and 30 times more infectious than the Hepatitis C virus.  This supports the Global Disease Burden of Disease study of 2016 which stated that deaths caused by viral hepatitis surpassed all chronic infectious diseases including HIV/AIDS, malaria and TB. 

Locally, attention has been shifted to HIV/AIDS and malaria prevention and this has contributed to the slow fight against hepatitis.  Kenya is considered a high prevalence area for the Hepatitis B virus with >8% prevalence as per WHO.  It is further estimated that 1 million people have Chronic Hepatitis B with less than 50,000 being children at the age of 5 years.

The Kenyan government is slowly progressing in the fight against hepatitis. Measures include: routine screening, screening of donor blood for Hepatitis B and C viruses, compulsory immunization for infants, developing national guidelines on prevention and management, vaccination of health workers against Hepatitis A and B, and providing sterile needles and syringes.

Challenges include: medication is expensive, inability to determine the efficacy of the compulsory immunization and unlike HIV/AIDS, there is hardly any attention in the prevention of mother to child transmission.

Hepatitis can be managed through medication as well as nutrition.  Nutritional management involves a diet that minimizes stress to the liver.  The diet involves plenty of fruits and vegetables, whole-grains, lean protein, and portable water.  Additionally, one should practice safe sex and avoid cigarette and drug abuse.

The elimination of viral hepatitis by 2030 is the end game.  This translates to the primary mandate of winning the fight against hepatitis. Winning the war utterly lies in public awareness.  The government should, therefore, partner with other institutions to ensure information is available for all to find the ‘missing millions.’

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