Hepatitis: A Ghana situation review
Contributed by Theobald Owusu-Ansah, President, Hepatitis Foundation of Ghana
All countries in the African Region consider viral hepatitis an urgent public health issue. The burden of viral hepatitis is believed to be one of the highest in this part of the world. Hepatitis A, B, C and E are the types mostly found in the region. Given the differences in the geographic distribution, transmission, diagnosis and treatment of viral hepatitis infections, national policies and control strategies are required.
Global Health Sector Strategy on Viral Hepatitis
There is the first global health sector strategy on viral hepatitis, a strategy that contributes to the achievement of the 2030 agenda for sustainable development. It covers the first six years of the post- 2015 health agenda, 2016–2021, building on the prevention and control of viral hepatitis infection: framework for global action and on two resolutions on viral hepatitis adopted by the World Health Assembly in 2010 and in 2014.
The strategy addresses all five hepatitis viruses, with a particular focus on hepatitis B and C, owing to the relative public health burden they represent. It describes the contribution of the health sector to combating viral hepatitis, towards its elimination as a public health threat and also promotes synergies between viral hepatitis and other health issues, and aligns the hepatitis response with other global health and development strategies, plans and targets.
It positions the response to viral hepatitis within the context of universal health coverage – an overarching health target of the 2030 agenda for sustainable development.
Ghana belongs to the areas where the prevalence of chronic hepatitis B virus (HBV) infection is high (≥8%) and that of hepatitis C virus is also high (5-10%). There is thus a high burden of infection with resulting high prevalence of chronic liver disease and liver cancer (hepatocellular carcinoma). In Ghana, HBV is considered to be of significant public health importance and a disease that requires greater attention.
National hepatitis B prevalence is estimated at 11%. This is an estimate arrived at using prevalence among blood donors and pregnant women. Approximately, 4million out of 28million have hepatitis B in Ghana. The country lacks the resources to educate, immunize and screen people for hepatitis, and often there are no medical centers or drugs available to treat those infected. In a cruel twist of fate, many people find out about their hepatitis B when they attempt to donate blood
The national prevalence of HBV as determined by HBsAg seropositivity was 11 %. HBV prevalence among voluntary blood donors (VBDs), replacement blood donors (RBDs) and pregnant women were 10.8, 12.7 and 13.1 % respectively. HBV infection prevalence was highest among studies published within the period 1995–2002 (17.3 %), followed by those published within 2003–2009 (14.7 %) and the lowest prevalence rate being recorded across studies published in the period 2010–2015 (10.2 %). Although there are records on hepatitis B, they normally underestimate the number of those who have been infected by the disease. Some people have the disease but have not been diagnosed. People get infected daily but we are generally unaware of the trend of the spread of the disease.
Regional prevalence was determined as follows:
Ashanti 13.1%, Greater Accra 10.6%, Eastern 13.6%, Upper West 21%, Northern 13.1%, Central 11.5% Brong-Ahafo 13.7%
Higher prevalence of HBV infection was attained for rural (13.3 %) compared to urban settings (12.2 %). Across the country, highest HBV infection prevalence rates were recorded in persons within the age group 16–39 years.
This situation, compounded by the lack of disease awareness, lack of health infrastructure, lack of access to screening and vaccinations, traditional cultural practices and beliefs, peer and social pressures, lack of adequate information and alternative services to them and historical cultural practices and poverty and lack of political will.
Informed by the global goals and targets, countries must develop as soon as possible, practicable ambitious national policies and strategies for 2020 and beyond, taking into consideration the country context, including the nature and dynamics of the country’s viral hepatitis epidemics, populations affected, structure and capacity of the health care and community systems, and resources that can be mobilized towards achieving the 2020 & 2030 global targets.
Nearly 4 million Ghanaians live with hepatitis B or C. Most are unaware of their infection, leaving them at risk for advanced liver disease. Hepatitis B and hepatitis C are the leading causes of liver cancer in Ghana. Liver cancer is one of the few cancers on the rise, and one of the deadliest. The epidemics of hepatitis B and C have surpassed that of HIV/AIDS and annually kill more people than all 60 reportable infectious diseases combined.
Indeed, we would acknowledge the contributions and efforts of government over the past few years which led to the formulation of the national policy on viral hepatitis. However, the nation’s opioid crisis continues to fuel the rapid spread of both viruses. In addition to these challenges, the National Hepatitis Policy concludes in no uncertain terms that Ghana can eliminate hepatitis B and C as a public health threat by 2030, averting nearly 90,000 deaths, and putting us on the path to achieve one of the greatest public health victories in our lifetime.
What is needed now is a strategic political will, collaborations with all the various stakeholders and financial investments, especially, in sub-Saharan Africa. This would require a strong central leadership role.
The Hepatitis Foundation of Ghana's contributions over the past few years include;
- Collaborations with the Ghana Health Services/Ministry of Health in the establishment of the National Viral Hepatitis Surveillance and Control Programme and also the first substantive programme manager was appointed in 2012.
- Active participation in the development and the launching of the National Policy on Viral Hepatitis in 2014.
- Active participation in the development of National Treatment Hepatitis Guidelines
- Commemoration of the World Hepatitis Day every year, training of community nurses, health professionals, hepatitis patients.
- Providing free screening and vaccinations to the general public, supportive care and prompt referral of hepatitis patients to seek better treatments.
We will continue to strengthen and expand our advocacy and awareness campaigns with all the stakeholders involved.
We also pledge our support and contributions in the area of the development of an "active" policy backed by political willingness, resource mobilization and capacity building. These are keys to successful disease elimination.
We sincerely believe that, only a rigorous and strategic national response to hepatitis B and C can make the 'Eliminate Hepatitis' a reality. "We are in the era of elimination,” Gottfried Hirnschall, MD, MPH, director of department of HIV and Global Hepatitis Program, WHO, said during a press conference. “The hepatitis train has left the station. We still have a long way to go. We have to push forward and push forward dynamically. And we have to do it together.”
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