Nkiru Odinkemelu
If Augustine Afoma had believed that the symptom-less hepatitis virus he was diagnosed of several years ago would metamorphose into cancer and heeded his physician’s advice, he might have still been alive. As a then director with an oil & gas firm, his monthly pay was fat and life was good, with many friends and family rallying round him. However, his life took a down turn when his company insisted on a compulsory complete health check-up for every staff. It was then at that process that Afoma was diagnosed of Hepatitis B.
Afoma had never heard of such disease all his life.
His doctor took time to explain his questions and the dangers that may lie ahead, as it was symptom-less: no pain and no feeling of being ill.
Afoma never regarded the physician’s advice for further clinical analysis. He walked away, only to resurface years later. Unfortunately, it was too late. The virus had destroyed his liver. The non-symptomatic hepatitis had turned into cancer and after some effort at managing it, he died.
Hepatitis, according to experts, is the inflammation of the liver as a result of the presence of toxic substances or infections caused by a protozoan parasite or viruses. Hepatitis as a viral infection is divided into five types, namely: Hepatitis A, B, C, D and E. Depending on the type and how chronic it could be, hepatitis could range from symptomatic to symptom-less, chronic to non-chronic.
Dr. Joseph Onigbinde, Medical Director, Ropheka Medical and Dental Hospital, Alimisho Lagos, described Hepatitis simply as inflammation of the liver. He stated that liver cells are called hepatic cells; so when they are inflamed, it is called hepatitis.
The World Health Organisation (WHO) in 2015 reported that an estimated 325 million people were living with chronic hepatitis infections (HBV or HCV) worldwide; 1.34 million people died of viral hepatitis in 2015, while over 95 per cent of people with Hepatitis C could be completely cured within 2-3 months.
In Nigeria, the Federal Government, in 2017, affirmed that over 22.6 million Nigerians were living with Hepatitis, with about 30 per cent unaware of their status and not taking appropriate measures.
Speaking at a health forum, the Minister of Health, Professor Isaac Adewole, said the most common type of hepatitis among Nigerians were Hepatitis B and C, which could cause liver cirrhosis and cancer.
Adewole lamented that this transmittable infection was now common among students in secondary and tertiary institution across the country due to increasing social vices, pointing out that about 19 million and over 3.6 million Nigerians were estimated to be infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV).
A small study conducted by Dr. Onigbinde in Alimosho Local Government Area of Lagos state also aligns with the national figure. “From my own estimation in Alimosho, I was able to get 20 per cent, which was so high and if you extrapolate that in Nigerian population, it will about 30 million Nigerians carrying a time bomb,” said Onigbinde.
He argued that the high prevalence of hepatitis in Nigeria may not be unconnected with the late introduction of the vaccine into the National Programme on Immunisation in 2004, as compared to the western countries, which have had it for long.
He stressed that any one born in Nigerian before the introduction and those born in rural areas may not have gotten vaccine and is at risk of being infected, while expressing
regrets that so many Nigerians are carrying a time bomb in their system at a time a little is being done to stop the spread.
Causes
of hepatitis
Hepatitis could be caused by toxin or toxic substances such as you have in aflatoxin B, which you have in groundnuts that are not well fried. People who eat raw groundnut are more prone to getting Hepatitis. Also excessive alcohol intake could cause it, as well as other viral infections.
According to Dr. Onigbinde, who is also a New York-trained infectious disease specialist, “it can be caused by just toxic substances. There are some toxic substances that you could take that can harm the liver and lead to inflammation. Example is Aflatoxin B. This can be gotten from groundnut if not well prepared. There is also viral hepatitis from viral agent.
“We have five types of hepatitis. They are Hepatitis A, caused by Hepatitis A virus (HAV); Hepatitis B, caused by Hepatitis B virus (HBV), Hepatitis C (HCV), D (HDV) and E (HEV). For a very long time, it was only Hepatitis A and B that were common, but as research progressed, we learnt about the others.
“Hepatitis A is more of an acute infection and it is prone to family and children. It is a feco-oral infection, that is, faeces, like somebody who had hepatitis contaminating your food, contaminates it; it is usually more of food handlers’ infection. Symptoms include: yellowness of the iris, the body and skin and high temperature. This is not difficult to handle; you just need supportive therapy and the body will overcome it. There is also vaccine against hepatitis A now.
“Hepatitis B may be acute or chronic but rarely do people have the acute that gives symptom, and even if it is going to give symptoms, they will sometimes be non-specific; it could just be haemorrhagia, headache or feverish feelings that one can attribute to any other disease, like malaria or typhoid and after some time, it will be silent and begin to work underground.”
Onigbinde
said Hepatitis B was more dangerous, “in the sense that it can get into the system surreptitiously and you may not even know that you have it. It may not give any symptoms and if at all it does, it could be non-specific. You may just have muscle pains, headache, and you may think it is malaria and it later become quiet.
“Most of the time, the body handles 75 per cent of the cases; so it goes away, but some 25 per cent of the cases becomes chronic. So if someone tests positive to Hepatitis B today and after six months he is still positive, then he becomes a chronic carrier and it would remain in the system and the person carrying it would not even know that something harmful is in the system and it begins to attack and destroy the liver cells in some cases.”
Reports have it that 80 per cent of cancers of the liver are due to chronic infections of Hepatitis B and C combined, which explains why Onigbinde calls the hepatitis infection a time bomb.
He said: “It is time bomb because it is in the system and can destroy the liver. The liver is the second most important organ of the body after the brain and everything you take goes through it and it detoxifies it. If it malfunctions, because of destruction done to it due to hepatitis, you have liver problem, cancer or liver cirrhosis and death can follow.”
In Nigeria, experts lament that much attention has not been paid to the fight against the HBV, even though it is seen to be deadlier than liver failure and more infectious than Human Immunodeficiency Virus (HIV).
Just like HIV, the Hepatitis B virus could be transmitted through blood and unlike HIV, through body fluid. This makes it more infectious than HIV.
According to the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), HBV is 50 to 100 times more infectious than HIV and it is estimated that over two billion people are infected worldwide and approximately one million deaths occur annually from HBV related illnesses.
The Federal Government has said that efforts were being accelerated to ensure that every Nigerian was protected against the hepatitis virus.
The health minister said the federal government had put in place modalities to confront the spread of the viral disease through prompt establishment of the viral Hepatitis Control Programme in 2013 and development of the first edition of the national policy for the control of Viral Hepatitis in Nigeria.
He stressed that the five years national strategic plan from 2016 to 2020 for the control of viral hepatitis in Nigeria was set to achieve elimination of the disease through awareness, diagnosis and interventions.
Transmission
Each year, approximately two million people contract hepatitis from unsafe injections. Five per cent of the injections are for procedures like blood transfusions and injectable contraceptives. Another five per cent is for immunisation, while the remaining 90 per cent are to administer medicines.
Expatiating on this, Onigbinde said the HBV could be transmitted usually from sexual intercourse, intravenous drug use, during hair cut and occasionally from brushes. It could also be transmitted through tattoos and deep kisses. Some have argued that it could also be transmitted through sweat although this is still controversial.
There is still mother-to-child transmission of Hepatitis B, which goes to say that just like HIV, you can have the mother who is positive transmitting it to the child through childbirth.
Prevention
To prevent hepatitis, SOGHIN enjoined everyone to pay attention to the key preventive messages, such as knowing the risks, which include unsafe blood, unsafe injections and sharing of sharps objects.
The group urged the populace to always demand safe injections through use of disposable syringes. They also warned against getting tattoos, body piercing and circumcision with poorly sterilised instruments, against transfusion of unscreened blood and other blood products, and against casual and unprotected sexual intercourse.
Treatment
Hepatitis is not in any way a death sentence. Treatment for any hepatitis infection depends on the type and severity. The step an individual is expected to take in the invent of discovering he might be infected with the virus is to visit an infectious disease specialist, who will, in turn, carry out some clinical observation to discover if the infection is passive or active.
Dr. Onigbinde said: “When an individual finds out he has Hepatitis B, he needs to see his physician. This must be somebody who is an expert in the field, an infectious disease specialist who will carry out what we call quality test. It is not just enough to know that somebody is infected but is this infection active or passive? If it is passive and if after six months the person is still positive, we will need to monitor that person; but if it is active, then we need to introduce anti-retroviral drug that can handle it.
“Hepatitis A and E are curable, while Hepatitis B is treatable; but you need to do regular check-up to determine your status and they are not very expensive.”
For a child who got the disease from the mother, the specialist said there is hemoglobin that could be given to a child within 22 hours after the child is born. However, before the physician administers the drug, he must first carry out a test to ensure the child has it, before giving the treatment.