By Ombugadu Blessing & Yunus Dosunmu
For World Hepatitis Day 2023, the World Health Organization (WHO) focused on the theme ‘One Life, One Liver’ with focus on importance of the liver for a healthy life, and the need to expand viral hepatitis prevention, testing and treatment to optimize liver health, prevent liver disease and achieve the 2030 hepatitis elimination goals. This celebration is coming at a time when COVID-19 is no longer a global health emergency, hence the time to eliminate viral hepatitis and meet our 2030 targets is now.
Setbacks caused by the COVID-19 Pandemic
In May 2016, the World Health Assembly endorsed the Global Health Sector Strategy (GHSS) on viral hepatitis 2016-2021.The GHSS calls for the elimination of viral hepatitis as a public health threat by reducing new infections and mortality by 65% by 2030. According to the 2021 Global Progress Report (GPR), the road to elimination of viral hepatitis by 2030 requires a comprehensive public approach taken to scale. With the COVID-19 pandemic, funding gaps are expected to continue.
Programs are being held back by lack of funding and high prices of diagnostic, treatments, and vaccines especially in LMICs with a high viral hepatitis B burden. The COVID-19 pandemic therefore threatens the expansions of nascent viral hepatitis programs. Further, the 2021 GPR on HIV, Viral hepatitis and sexually transmitted diseases explains how only a fraction of people living with viral hepatitis are being diagnosed and treated. This is unfortunate because Infectious diseases and public health threats, including viral hepatitis, do not disappear during pandemics but are instead exacerbated.
The Nigerian Situation
In Africa, Nigeria is ranked as on the countries with high prevalence for HBV infections. It is estimated that about 9 in 10 Nigerians living with chronic HBV are unaware of their infection status and are left out from the global public health statistics due to a lack of resources, awareness, and political will for tackling Nigeria’s worrisome situation of hepatitis infections. For instance, the 2021 viral hepatitis scorecard by WHO highlighted that over 12 million Nigerians are carriers of chronic HBV, the commonest preventable form of hepatitis in Nigeria.
Health Literacy for One Life One Liver
In 2016, the World Hepatitis Day was themed ‘Know hepatitis – Act now’. This particular year, emphasis was laid on the importance for the public to be well informed, understand risks, get tested and demand treatment. The Centers for Disease Control and Prevention has defined personal Health literacy as ‘the extent to which individuals have the ability to find, understand, and utilize information and services to inform health-related decisions and actions for themselves and others’. However, with a person dying every 30 seconds from hepatitis related illness, one would feel perplexed on how health literacy has played a role so far towards elimination of hepatitis.
The impacts of health literacy are reduction of health disparities, potentially leading to total elimination of a disease within a population. There are 5 types of hepatitis and unlike the other types, the hepatitis C virus is regarded as a ‘silent epidemic’. If the silence on health literacy especially on hepatitis continues as it is now, then the world including Nigeria risks other types of viral hepatitis becoming ‘silent epidemics’ as well.
Youths Literacy on Hepatitis
The knowledge of youths on hepatitis is one of the cornerstones towards viral hepatitis elimination. There is need to explore learning and understanding of hepatitis by Nigerian youths. Viral hepatitis is an inflammation of the liver. This condition may resolve naturally without treatment or may become worse, progressing to cirrhosis or liver cancer. Hepatitis viruses are the most common causes of hepatitis, but other infections, toxic substances and autoimmune diseases have been attributed to causing hepatitis. Symptoms range from jaundice (yellowing of skin and eyes), dark urine, fatigue, nausea, abdominal pain and vomiting.
There are 5 main types of hepatitis viruses, namely types A, B, C, D and E. Hepatitis A virus (HAV) is contracted through consumption of contaminated water or food. The virus can be found in feces of an infected person. Although HAV can be life threatening, prevention is possible through vaccines. Hepatitis B virus (HBV) is a type of viral hepatitis transmitted through contact with infected body fluids, blood and blood products. It can also be contracted by vertical transmission (mother to child) and potential risks to healthcare workers who are involved in medical procedures and injection drug use. HBV is a vaccine–preventable disease. Hepatitis C virus (HCV) is essentially transmitted through exposure to infective blood. Sexual transmission is also possible, although less common. Sadly, there is no vaccine for HCV. Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more severe disease outcome. Hepatitis B vaccines provide protection from HDV infection. Hepatitis E virus (HEV) is commonly transmitted through consumption of contaminated water or food. HEV is epidemic in low- and middle-income countries and is increasingly recognized as an important cause of disease in high income countries. The vaccines to prevent HEV infection have been developed but are not widely available.
Youths with Disabilities and Hepatitis
Just like everyone else, youths with disabilities have one life and one liver, hence it is critical their population are not undermined. In addition, they have the rights to learn about hepatitis and take preventive actions. Disability is any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being. For any disease such as viral hepatitis, disability is a common pathway if unresolved. People with hepatitis may have severe liver damage and other clinical manifestations hindering their ability to perform daily tasks. Furthermore, people with disabilities often face myriads of challenges in form of poor access to good health, hygiene and sanitation problems, and risk of exposure to infective agents of viral hepatitis. The scenario is worse especially for persons with intellectual disability because they are high-risk group for HBV infection.
Recently, the World Health Organization announced the update of the “Consolidated Guidelines on HIV, Hepatitis and STI prevention, diagnosis, treatment and care for key populations”. Through a Guidelines Development Group, new recommendations and improved guidelines will be made to the 2016 Global Health Sector Strategy on hepatitis. It is crucial that issues of disabilities are considered and embedded in this upcoming new guideline. This will also propel the world in the race of achieving universal health coverage for all.
A call for immediate action
The good news is that hepatitis is preventable. As members of Meaningful Inclusion Pillar Team of the Nigeria Meaningful Adolescent and Engagement (MAYE) – Working Group, we join the rest of the world to celebrate this day. Everyone has One Life One Liver. First, hepatitis has robbed us of our close relatives and friends. Secondly, it is because we fear that if sustainable measures are not taken against viral Hepatitis, then we shall lose even more people in our communities and the globe at large to viral hepatitis post COVID-19. We therefore call upon all youths of Nigeria to:
- Learn more about hepatitis and increase community awareness on testing, treatment, and its prevention.
- take liver health seriously, monitor and evaluate level of youth-friendly health services in their communities.
- If you’re a victim, share your experience in order to;
- Educate others
- Get possible help
In as much as the COVID 19 pandemic has greatly affected the fight against hepatitis epidemic, we believe that if greater efforts are channeled to addressing these challenges, then we can build back better. Lastly, every Nigerian youth is a leader. Across all levels, they understand the need to possess a growth mindset and recognize the critical need to evolve and practice good health leadership to make everyone everywhere safe – leaving no one behind.
Blessing and Yunus, are members of MAYE Meaningful Inclusion Team
