By Alusine Sesay
How Hepatitis E virus infiltrates cells. Photo: www.bing.com
Approximately 13.8% (about 1.1 million people) of the population of Sierra Leone live with chronic Hepatitis B Virus (HBV), while hepatitis C also affects many and requires urgent attention, the Ministry of Health said in a statement marking World Hepatitis Day on July 28.
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer, according to the World Health Organization (WHO).
Though the statement of the Ministry of Health did not provide details about the characteristics of the affected population, a new study, ‘Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997–2022: A Systematic Review and Meta-Analysis’, which was published in the American Journal of Tropical Medicine and Hygiene shows that the pooled prevalence of chronic HBV infection was 13.0% in Sierra Leone. During the study period, the HBV prevalence rates were as follows: 17.9% before 2015, 13.3% during 2015–2019, and 10.7% during 2020–2022.
The use of the 2020–2022 HBV prevalence estimates corresponded to 870,000 cases of chronic HBV infection (uncertainty interval, 610,000–1,213,000), or approximately one in nine people, according to the study.
The study shows that the highest HBV seroprevalence estimates were among adolescents aged 10–17 years, Ebola survivors 36.8%, people living with HIV 15.9%, and those in the Northern Province 19.0% and Southern Province 19.7%.
The research indicates that there are significant knowledge gaps regarding the prevalence of viral hepatitis B and C in Sierra Leone, despite the high burden reported in a few studies. There are limited programmatic interventions on the control and prevention of viral hepatitis in the country, according to the study.
Even though the impact of hepatitis extends beyond health, affecting the socio-economic fabric of our society, limited access to testing and healthcare services results in many people being unaware of their hepatitis status, leading to late diagnoses and poorer health outcomes, according to health authorities.
The Health Ministry said, “Our healthcare infrastructure faces immense challenges in providing adequate services for prevention, diagnosis, and treatment of hepatitis. Increased funding, improved healthcare facilities, and trained healthcare professionals are critical to effectively addressing this growing epidemic.”
“Despite these challenges, there is hope. With the support of international partners, government commitment through the Ministry of Health, and community efforts, we are making strides towards better prevention and treatment,” the Ministry said. “Vaccination programs for hepatitis B, awareness campaigns, and improved access to testing and antiviral therapies are key components of our strategy to combat hepatitis.”
The Ministry of Health said this year’s theme, “Hepatitis Can’t Wait,” reminds them that they must act now to prevent and control the disease. “Early detection and treatment are crucial. We call upon all citizens to get informed, get tested, and seek treatment,” it said in the statement.
“In Sierra Leone, the fight against hepatitis is critical as we strive to reduce the burden of this disease and improve public health.”
The health authorities said vaccination against hepatitis B and practicing safe sharp measures could prevent the spread of the disease. Community leaders, healthcare workers, the media, civil society organizations and policymakers must work together to raise awareness and mobilize resources to fight hepatitis.
“Although we face challenges in organizing large-scale events due to funding constraints, the Ministry of Health remains committed to combating hepatitis. We will continue to engage the public through radio, television, and social media, providing vital information and resources.”
The Ministry of Health said, “On this World Hepatitis Day, let us unite in our efforts to eliminate hepatitis by 2030.
Hepatitis viruses
Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.
Hepatitis B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Acute infection may occur with limited or no symptoms or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain, according to the WHO.
Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Globally, an estimated 328 million people were living with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, with one million deaths attributable to the sequelae of these infections. Africa and the Western Pacific are the main regions affected by the epidemic of HBV, with an estimated prevalence of 6.1% and 6.2%, respectively.
Country Profile
Sierra Leone is a country in West Africa with an estimated population of 8.14 million and a gross domestic product per capita of 516 U.S. dollars in 2021.
The country has faced a brutal civil war (1990–2001) and significant public health challenges, and the West Africa Ebola epidemic (2014–2016), which have aligned to contribute to a fragile healthcare system. In 2016, there were an estimated 1.4 doctors, nurses, and midwives per 10,000 of the population, one of the lowest anywhere in the world.The latest Sierra Leone Demographic Health Survey (2019) reported an infant mortality rate of 75 per 1,000 live births, maternal mortality of 717 deaths per 100,000 live births, and adult mortality rate of 5.14 per 1,000. Despite these health indicators, the health expenditure per capita has remained low (i.e., 8.75% of the gross national product in 2020), and over 60% of healthcare costs are financed by end users via out-of-pocket payments.