What should be done to beat hepatitis - the silent epidemic

We have made immense progress in fighting communicable and non-communicable diseases throughout Africa. Of course, these diseases include those that most of us are familiar with – HIV/Aids, Tuberculosis (TB) and cancer, among other familiar offenders.

However, five variations of one virus somehow are not as openly discussed around our continent – and, indeed, our country. These are hepatitis A, B, C, D and E. The question one might ask if the topic does arise is, “Why do we need to discuss it?” The answer comes as a surprise to many – and often, too late.

Here it is: Viral hepatitis is the second leading infectious cause of death globally. This is according to the World Health Organisation (WHO) 2024 Global Hepatitis Report. Certain variations of viral hepatitis cause 1.3 million deaths per year globally. That is roughly the same as TB – one of Africa’s foremost infectious killers and one that gets far more media coverage.

I mentioned hepatitis during a conversation with several people outside of the healthcare environment, it struck me that, despite viral hepatitis affecting around 300 million people globally – which is 10 times more than HIV-infected people – so many people know little or even nothing about the disease.

Simply put, hepatitis is an inflammation of the liver. There are different variations of hepatitis, and each one is different. Depending on the strain (A, B, C, D or E), certain types of hepatitis can clear up without medical intervention. Others, however, can lead to fibrosis (scarring), cirrhosis or liver cancer if they remain undiagnosed and untreated.

Chronic Hepatitis B virus (HBV) infection causes liver cirrhosis and cancer. This is a major public health concern in Kenya. In fact, developing countries in Africa (including Kenya), account for 63 per cent of all new HBV infections worldwide. Still, according to the WHO, only 10 per cent of people infected with chronic HBV are diagnosed, out of whom only 22 per cent receive treatment.

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Hepatitis A and E are typically caused by contaminated food or water. Hepatitis B, C and D commonly occur due to contact with infected body fluids. This can happen if a patient receives contaminated blood or blood products or is subjected to invasive medical procedures using contaminated equipment – or even other contaminated equipment, such as tattoo needles. Hepatitis B transmission is often transmitted from mother to baby at birth, from family member to child or by intimate contact. Other infections or toxic substances – like alcohol and certain drugs or autoimmune diseases – can also cause hepatitis.

The varying causes, different strains and unusual mix of possible symptoms make hepatitis unpredictable. In particular, types B and C are most likely to lead to chronic disease and are the most common cause of liver cirrhosis and cancer. In some cases, symptoms are limited or don’t present at all. In others, symptoms may include jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Kenya is classified as a high hepatitis prevalence zone with high morbidity and mortality rates. Several key organisations are partnering to change this, beginning with awareness. These include Roche Diagnostics and National Aids and STIs Control Programme (NASCOP).

One of the primary challenges we face in addressing the prevalence of hepatitis in Kenya is severely limited awareness in our communities. We urgently need to address the knowledge gap in managing viral hepatitis and identify vehicles for better information sharing between healthcare providers.

I urge people to discuss the risks and test voluntarily at their nearest clinic or primary healthcare facility. Behind the scenes, in partnership with local government and private sector organisations, NASCOP and our communities are working together to prioritise awareness, access to diagnostics and treatment for hepatitis.

We have many directions to pursue in our journey towards eliminating hepatitis. Targeted messaging and accurate information are crucial for educating our communities about the risks and the importance of voluntary testing – which can be done at most primary healthcare facilities. Prioritising national vaccination programmes and access to treatment – especially in high-risk populations  – is essential.

Creating public awareness through widespread communication strategies that include local language materials, patient testimonials and media engagements is a strong focus. And policy engagement between the public and private sectors galvanises sustained funding and support for hepatitis programmes.

Hepatitis can be beaten. We have seen other countries in Africa making great strides. Egypt, for example, has effectively eliminated hepatitis C – once the third leading cause of death in the country. This resulted from significant financing from the World Bank and public-private partnerships that made screening and treatment processes more accessible, less expensive and convenient for all citizens.

Diagnostic innovations now allow healthcare facilities to streamline testing by integrating HBV, HCV (Hepatitis C), HIV, TB and HPV (Human Papillomavirus) testing. Working together, the public and private sectors have the power to co-create national diagnostics and treatment strategies based on strategic funding distribution and new finance streams.

However, our path to eliminating hepatitis begins at home, with vital conversations in our communities, among ordinary people going about their lives and healthcare professionals who can advocate for and educate about hepatitis.

We must continue appealing to policymakers to prioritise hepatitis in national health agendas, address funding gaps and address misinformation or limited awareness wherever it is present. Everyone deserves to be educated about this little-known epidemic, everyone deserves a chance to live a long, happy life, and everyone deserves to be tested, with treatment at hand when they need it.