Lack of public education hurting the fight against hepatitis

Low awareness has slowed the uptake of hepatitis testing in Kenya, posing a significant challenge to the country's healthcare system and putting millions of Kenyans at risk of dying from cirrhosis and liver cancer.

According to the National AIDS and STI Control Program, nine out of 10 people living with hepatitis in Kenya are unaware of their status despite an infection rate of more than five per cent. 

The World Health Organization (WHO) 2024 Global Hepatitis Report states that hepatitis is the second leading infectious cause of death globally, with 1.3 million deaths per year.

Taofik Oloruko-Oba, country manager in Kenya and head of the East Africa Network at Roche Diagnostics, defines hepatitis as an inflammation of the liver presenting in different variations of A, B, C, D and E.

“Hepatitis is often caused by a viral infection, but it can also be triggered by autoimmune hepatitis, medications, drugs, toxins and alcohol. Autoimmune hepatitis occurs when the body produces antibodies against liver tissue,” said Mr Oloruko-Oba.

The Ministry of Health reports that hepatitis in Kenya is disproportionately distributed across counties and populations, estimating that over 1.9 million people are infected with hepatitis B (HBV), and C (HCV) viruses, with a majority of 1.6 million having HBV.

Mr Oloruko-Oba stressed that hepatitis, especially the B variant, is poorly understood and is responsible for the deaths of millions of Kenyans, mainly due to lack of public education and intervention.

He noted that chronic HBV is the most dangerous variant of hepatitis, leading to cirrhosis and potentially cancer. Kenya accounts for 63 per cent of all new HBV infections worldwide. However, the WHO reports that only 10 per cent of people with chronic HBV are diagnosed and only 22 per cent of them receive treatment.

"The high hepatitis cases are due to lack of awareness and knowledge of symptoms, which underscores the need to implement public health interventions and strategic policies to control and eventually eliminate the disease," said Mr Oloruko-Oba.

He stressed that early detection of hepatitis is crucial to improving patient outcomes and that time is always of the essence in treatment.

"We are currently facing a major challenge in Kenya with regard to the high prevalence of hepatitis, which is the very limited awareness in our communities. We need to take immediate action to bridge the knowledge gap in the management of viral hepatitis and find better ways for healthcare providers to share information," said Mr Oloruko-Oba.

WHO has already launched a global strategy to combat hepatitis B and C infections. The strategy aims to reduce new cases of viral infection by 90 per cent and hepatitis-related deaths by 65 per cent by 2030. The strategy also aims to ensure that 80 per cent of viral hepatitis infections are treated.

According to the strategy, eliminating hepatitis B requires collaboration on five core interventions, including hepatitis B vaccination, prevention of mother-to-child transmission, blood and injection safety, harm reduction services for people who inject drugs, and increased testing and treatment.  To achieve these goals, it is important to promote and expand HBV vaccination to other populations.

"Vaccination provides seroprotection rates approaching 95 per cent in healthy adults after completion of the three-dose course, but falls to 87 per cent in those who receive only two doses, highlighting the importance of completing the three-dose course," said WHO.

Kenyan guidelines state that everyone should be screened for HCV at least once. However, in situations where routine screening is not feasible, priority for HCV screening should be given to blood donors, haemodialysis patients, health care workers, intravenous drug users, persons with high-risk behaviours, immunocompromised patients, persons with pre-existing liver disease and persons living with HIV. 

Screening generally involves serological testing of asymptomatic individuals not known to be at increased risk of exposure to HBV. Testing involves serological testing of individuals with symptoms or those at increased risk of exposure to HBV. 

Regarding vaccination, the Ministry of Health recommends that the hepatitis B vaccine be administered in two to three initial doses one month apart, followed by a booster dose at six months or later. Completion of the entire series is necessary for full protection. Vaccination at birth is recommended for all children born to mothers with hepatitis B. 

Similarly, the Kenya Expanded Programme on Immunisation includes HBV vaccination as part of a universal immunisation strategy for all infants. The vaccine is also selectively administered to individuals considered to be at high risk. 

A WHO study found that an estimated 4.5 million premature deaths could be averted by 2030 in low- and middle-income countries through vaccination, diagnostic tests, drugs and educational campaigns. 

Despite the availability of an effective vaccine, HBV remains a major public health problem in Kenya. 

Describing it as a silent killer, Mr Oloruko-Oba explained that HBV is 100 per cent more infectious than HIV. “With no specific cure, managing the symptoms of HBV will reduce the risk of long-term health effects and prevent transmission.

"Depending on the strain, some types of hepatitis can be cured without medical intervention. Others, however, can lead to fibrosis, cirrhosis or liver cancer if left undiagnosed and untreated," he said.

Despite the high burden of hepatitis in the country, there has been no systematic review and meta-analysis to estimate the disease burden, leading to neglect and delayed treatment.

In addition, the high cost of hepatitis B testing and vaccines is a major factor contributing to high mortality rates. Many hepatitis services are paid for out-of-pocket, which has a significant financial and psychological impact on patients, families and the healthcare system, leading to increased healthcare costs.

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