First Gentleman with Wilson Orhiunu
Email: babawill2000@gmail.com Twitter: @Babawilly
To avoid liver failure, liver cirrhosis and hepatocellular cancer, it is imperative that Hepatitis B viral infection be managed effectively. Those who do not have this infection need to be immunised if they are at risk of contracting it. Those who are carriers of this virus with the ability to spread the infection need to be educated about it and treated.
The whole Nigeria is at risk of acquiring Hepatitis B so there is an urgent need for a lifetime assurance of protection namely via mass immunisation of all babies and health workers, strict screening of would be blood donors at the blood transfusion services and safe sexual practices.
Nigeria has a Hepatitis B prevalence of 13.6% according to a 2015 study. The current population of Nigeria is 195,244,616 as of Sunday, May 20, 2018, based on the latest United Nations estimates. (Worldometer website)
That would give an approximate figure of 26.5 million sufferers of Hepatitis B. That is a huge number! If every Hepatitis B sufferer in Nigeria was to queue up in a single file next to a queue of every single person living in Australia, the Nigerian Hep B queue will be longer as Australia only has 24.9 Million people.
Emergency!!!!!!!!
Hepatitis B is very infectious, (100 times more infectious than HIV) and the situation in Nigeria is both a scandal and a national health emergency.
It is a shame when people die from preventable causes and a lot of patients do not even know they are infected with the virus and hence go about spreading it.
The virus is spread via blood contamination, shared needles, sexual activity, and traditional surgical procedures with contaminated instruments and injuries resulting in the exposure to infected blood.
Action
The disease can be completely eliminated for the next generation by having every single baby immunised against the disease. The education of the public against unsafe sexual practices and sharing instruments that may be contaminated with blood such as shaving razors, hair clippers is important.
For the current generation of Hepatitis B carriers, the picture is bleak due to the poor socioeconomic factors prevalent in Nigeria (low wages and high unemployment). There is also the problem of the cost of treatment. I spoke to a doctor in Lagos who provides screening, investigation and treatment of Hepatitis B and the costs were high.
Management in a Lagos clinic
- Screening for Hepatitis B costs N4,000. If Patient is negative they are then immunised
- The Immunisation costs N4,500 per injection and there is a course of three injections so total cost is N13,500
Total per person to screen + immunise = N21,500
Treatment for Hepatitis B
- Initial screening – N4, 500
- Cost of further detailed investigations needed if tests are positive. Tests include liver function tests, detailed hepatitis serology, viral load & fibro scan – N100,000
- For Hepatitis B positive patients with no evidence of liver damage, treatment is commenced with Pegasys- Pegylated Interferon (Roche)
Weekly injections for 48 weeks at N30,000 per Injection = N1,440,000
- If evidence of Liver damage exists commence treatment with Tenofovir costing N10,000 weekly (sometimes for life).
With Nigeria’s minimum wage currently N18,000 a month (one of the lowest in the world) and the unemployment rate being 18.8% (many sources say it is much higher), it is plain to see that if the average man would not be able to afford the treatment when faced with Hepatitis B, he finds himself just waiting to see if liver cancer or cirrhosis would develop.
There are no government-sponsored free treatments to date.
What I found most worrying is a 2000 study carried out in Lagos that found surgeons to have a Hepatitis B prevalence of 25.7% compared to the control group (non -surgical staff in the hospitals) who had a prevalence of 15%.
Surgeons operate on patients with sharp instruments that can penetrate the gloved hand. It is not rocket science. A 25% prevalence of Hepatitis B among surgeons represents a failure of the whole health system and puts patients at risk.
This study, however, did not test for Hepatitis B e- Antigen which represents high levels of infectivity if positive. No health worker should be treating patients when highly infective.
A surgeon who is Hepatitis B positive is safe to practice only if he is Hepatitis B e-Antigen negative and has a low viral count. This implies that they must be monitored by a specialist clinic.
Presence of Hepatitis B e-Antigen (HBeAg) and absence of HBe antibody (anti-HBe) usually indicates high infectivity.
With regards to health workers, it stands to reason that both nurses and doctors need to have a rigorous health screening and immunisation programme in place before they are allowed to commence clinical duties.
I spoke to a dentist in Lagos and he says there are no formal procedures in place to test members of his profession. He, however, does his own HIV and Hepatitis B tests six monthly. My medical colleagues all have pre-employment Hepatitis B screening and subsequent immunization if indicated but compliance is variable. Antibody titres are not routinely checked two months post completion of the immunisation process.
I hope to liaise with my medical colleagues in developing a programme for the immunisation of medical students in Nigeria against Hepatitis B.
The take-home message has to be that prevention is much cheaper than cure. Get tested for Hepatitis B and if negative give your liver a lifetime Assurance by never having unprotected sex.
For those in long-term monogamous relationships, it might be best to have a romantic date at the local sexual health clinic to screen for Hepatitis B, HIV, etc.
This will avoid stories that touch.
There are barriers to providing a comprehensive approach to tackle Hepatitis B in Nigeria which include:
Low investment in the health sector
Public ignorance coupled with Political apathy
Problems with the cold storage of vaccines – they become ineffective if not kept at the right temperature around the clock. Doctors have questioned the efficacy of these vaccines as they have doubts about the quality of storage that exits
Hepatitis B vaccination is free and available at health centres in Nigeria as part of the EPI- Expanded Programme of Immunisation. The percentage uptake by parents varies widely across the country
In the Akoko Edo LGA uptake in newborn babies is 78% while in Edo State, in general, it is 68%.
