Ghana must up its game to win the race against hepatitis

A woman is examined at a hepatitis ward in Uganda. Reuters/James Akena

Viral hepatitis remains a massive challenge in Africa where around 100 million people are estimated to have either hepatitis C or B infection. The prevalence of hepatitis viruses in Africa is more than four times the 23 million infected across resource-rich nations.

And of the almost 1.4 million people who die from complications related to these infections each year, the majority are in resource constrained areas like Africa.

To tackle this problem, the World Health Organisation has set an ambitious target to eliminate viral hepatitis in Africa by 2030.

As part of the plan in the next five years the organisation aspires to reduce chronic hepatitis B and C infection by one third and reduce hepatitis associated deaths by 10% on the continent.

For countries in the region the next 14 years will be a race against time to action these commitments. But for Africa to be successful, countries need to overcome three main hurdles. Firstly, they must develop stronger data systems to understand the burden of the diseases. Secondly, they must plan to prevent the spread of these infections. And thirdly, they need to roll out effective treatment programmes.

In our research which highlights Ghana’s high viral hepatitis burden, we found that countries can have challenges in all three areas. New and extraordinary measures are needed on the continent if the 2030 goal is to become a reality.

Inconsistent figures

Data is one of the main challenges. Most countries in Africa do not have strong data systems to efficiently track temporal changes in disease burdens. As a result reliable national estimates are often lacking or outdated. What this means, for instance with viral hepatitis, is that the burden could be significantly higher than previously thought or reported.

Ghana is a case in point. According to Ghana’s Health Service, there are 2.5 million people in the country who live with viral hepatitis.

But our research estimated the prevalence of chronic hepatitis B infection in Ghana to be 12.3%. This means that there could be as many as 3 million Ghanaians living with hepatitis B alone if recent population estimates are used. The level of hepatitis B infection in the country is far higher than the global prevalence of 3.61% and the reported prevalence in the African region of of 8.83%.

Our analysis also showed that pregnant women and Ghanaians aged 16 to 39 face the highest levels of infection. And among HIV patients in Ghana, we estimated that almost one in seven people suffer from chronic hepatitis B infection while 3% of Ghana’s population also suffer from chronic hepatitis C infection.

Our hepatitis C prevalence figure is far higher than the previously reported estimate of 1.7%. Our preliminary assessments also indicate that around 1 in 8 Ghanaians show evidence of past hepatitis E infection (unpublished data).

The socio-economic implications of a high viral hepatitis burden in Ghana while not thoroughly documented could be far reaching. Two of every three pregnant women in Ghana who develop sudden and severe hepatitis E infection are likely to die.

And research also suggests that chronic hepatitis B infection is implicated in over 40% of liver cirrhosis cases in Ghana. Additionally, one in 14 liver cirrhosis patients in in the country has being found to be chronically infected with hepatitis C.

The challenge is that cost of treating the complications such as liver cirrhosis and cancer which arise from chronic viral hepatitis could run into thousands of dollars. Many Ghanaians cannot afford such treatment and this could significantly deplete national health resources even if it were to be publicly funded.

The economic consequences due to loss of life and absenteeism from work could all come at a significant cost to a country still struggling to address its economic problems. These all support economic arguments for intensified prevention efforts to curb the spread of viral hepatitis in the country.

Lapses in control

Historically, efforts to control viral hepatitis in Ghana have been too slow and inconsistent. Several practises are hampering effective control of these infectious diseases.

A vaccine for hepatitis B has been available for more than three decades. It has been shown to be safe and 95% effective in preventing infection and chronic disease developing.

Administering the vaccine is an integral part of the Ghanaian government’s viral hepatitis policy, which was launched in 2015. While children born after 2003 are routinely screened and vaccinated against hepatitis B as part of the Expanded Programme on Immunisation, no publicly funded population-wide vaccination is currently offered outside the programme. Even pregnant women and HIV patients among whom infection risks remain very high are excluded.

In addition, Hepatitis B immunoglobulin G and vaccines for babies born to mothers with hepatitis B has not been covered under the country’s National Health Insurance Scheme. As a result this has to be financed out-of-pocket.

Ghana’s blood policy also mandates that donated blood is screened for blood-borne infections. This focuses mainly on HIV 1 and 2, syphilis, hepatitis B and hepatitis C but neglects other important viral hepatitis such as hepatitis E. This is despite growing evidence which shows possible hepatitis E transmission through blood transfusion, especially in endemic regions like Africa.

In addition, hepatitis C screening for high risk groups such as injection drug users is not done. And comprehensive harm-reduction services including offering sterile injecting equipment is not standard.

The way forward

The major gaps in hepatitis prevention and care services need to be addressed to tackle these viruses.

But in addition, programmes that help people understand how these viruses are transmitted is a necessity. Many Ghanaians do not know how these diseases are transmitted and there are still a lot of misconceptions.

Both the government and public health institutions should engage in extensive efforts to address unhealthy population practices and low living standards that contribute to spread of these infectious diseases.

The World Health Organisation has set a good path. The Ghanaian government, health professionals and all non-state actors must now rally together and intensify efforts towards bringing the burden of viral hepatitis under control.

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