Health

HEPATITIS: A disease that is still a taboo

By Samuel Lukanga

Sendi as we always called him, now a father of six had a painful experience with viral hepatitis, an inflammation of the liver caused by a virus, which can be fatal.

During a routine blood donation, he was diagnosed with the hepatitis C virus. He had no symptoms, hence his surprise to learn his serological status. “I was distraught, panicked, and surprised when I heard the result. I remained silent. I was scared,” he recalls.

Relatively unknown to the general public, viral hepatitis is a serious public health issue in Uganda, as in many other countries.
According to the World Health Organization (WHO), there are five types of viral hepatitis: A, B, C, D and E. However, types B and C are considered the most dangerous. In Uganda, these two types of viral hepatitis combined have killed as many people, if not more, than HIV/AIDS or malaria, a situation mainly due to a lack of awareness among the population.

Like Sendi, many Ugandans are unaware of the behaviors and situations that lead to the transmission of viral hepatitis. According to data from both the National Development Plan III and Uganda Bureau of Statistics, 1.2 million Ugandans have hepatitis A, B, or C, which means that one in seven citizens live with the disease without knowing it.

Apart from hepatitis B, which the public generally knows can be transmitted through unprotected sex, the modes of transmission of the other types are relatively unknown.

“The modes of transmission differ depending on the type of virus,” says Dr. Felix Kawooya, an associate hepato-gastroenterologist with ministry of health. “For the two viruses of greatest concern, type B and C, which are likely to lead to chronic diseases and complications, there is a significant risk of vertical transmission from mother to child. Besides, there is what we call horizontal transmission, which may occur in different circumstances: within a family or a community through close contact between people with skin injuries, during unprotected sexual intercourse – which is why we call hepatitis a sexually transmitted infection (STI), or through contact with infected blood, either in hospitals during medical procedures (transfusion, surgery, hemodialysis sessions, acupuncture, dental care), or via skin break-ins caused by non-medical procedures (tattoos, piercings, unmedicated circumcisions, scarifications, etc.)” he added.

When he learnt he had contracted the virus, Sendi was overcome with shame. He had to undergo several months of treatment. Ten years later, he considers himself lucky to have had access to an effective treatment that stabilized his viral load. Unfortunately, many are not as fortunate as he was in recovering their health.

Hepatitis is usually an asymptomatic disease that can progress silently before a diagnosis is made. In addition, the fear and the taboos associated with it often cause the person to deny it, which, in turn, can lead to a late diagnosis and the progression of the inflammation towards a more serious disease, such as liver cancer.

Sendi knows this situation. Within two years, he lost two close members of his family to viral hepatitis.

“It happened in 2016. Faced with the utterly deteriorating health of my older brother, I decided to take him to the hospital for tests. The test revealed a dual infection with hepatitis B and C. The symptoms he had were a bloated stomach, yellow eyes and pain. No treatment was possible in Semuto, Nakaseke because there was no hepatologist. So, we had to travel 60 km to get to Matuga, the neighboring town. Unfortunately, it was already too late, and my brother passed away a few days later, after having been to several hospitals and seen several traditional therapists.” Sendi narrated.

When his older brother, who was 59 years old, died, Sendi endured a double penalty. He went through grief, and also had to take care of 19 children – his brother’s 12 children and his own seven children. As if the ordeal was not hard enough, two years later he lost his younger sister, who also had hepatitis C. Sendi recalls painfully, bruised by the cruelty of the hardships he went through.

Indeed, viral hepatitis is a disease that not only causes grief, but also can represent a very important socio-economic burden for many families.

“Without early diagnosis, the treatment of viral hepatitis can be extremely costly, especially in the advanced phase of cirrhosis or liver cancer,” says Dr. Felix says, pointing out the financial challenges families face when they have to bear the cost of hepatitis treatment.

Despite the significant challenges, considerable progress has been made by our government through the health ministry, particularly in the area of patient care.
Currently, the drugs used for hepatitis B do not cure patients, but rather aim to stop viral replication in order to reduce the risk of cirrhosis and liver cancer. However, there is a very effective vaccine to prevent hepatitis B.

From the Permanent Secretary of our health ministry, Dr. Diana Atwine, hepatitis is considered a priority disease and is integrated in the National Health Development Plan. It is also among the diseases keenly monitored by the National Council to Combat HIV/AIDS, Tuberculosis, Malaria, Hepatitis, Sexually Transmitted Infections and Epidemics.

Due to lack of information, a large proportion of the population in the country is unaware of the risk situations that can cause them to contract the hepatitis virus. Similarly, for fear of stigma and discrimination, many Ugandans do not have their symptoms diagnosed, and these, in some cases, eventually reveal a viral hepatitis that is unfortunately too advanced to be treated.

Like this year’s World Hepatitis Day yet to be commemorated in Kazo District on 28th of August, whose theme is “Hepatitis can’t wait”, provides an opportunity for our government to raise awareness on hepatitis as a serious health threat and to promote measures to combat it.

Let us not forget that a person dies every 30 seconds of viral hepatitis, a situation is likely to worsen due to this COVID-like crisis. Accelerated investment in hepatitis prevention and care is urgently needed to eliminate the disease by 2030.

For God and My Country, Uganda!

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The writer is a social development enthusiast from Nakaseke District. Tel: 0785717379 / Email: lukangasamuel55@gmail.com



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