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Health ministers explain why hepatitis B prevalence is high

The death on November 8 of Ruhaama MP William Beijukye brought new political attention to hepatitis B, the deadly viral disease, which killed him.

On Monday last week, the state minster for Primary Health Care, Sarah Opendi Achieng, said the lack of information by health workers and a budget shortfall were to blame for the increase in cases of hepatitis B in the country.

According to Opendi, unlike HIV/Aids, which has adequate resources from partners to support counseling, testing and treatment, it is a challenge for hepatitis B.

“We have a challenge because for hepatitis B, it is difficult to do individual counseling, testing and of course provide the vaccine. We are constrained with the resources and the health workers are not ready to provide all their time to every individual person that comes and is tested positive,” Opendi told The Observer.

Her revelations came on the coat-tails of the death of Beijukye, from hepatitis B.

A-Plus Funeral Management handlers assisted by Uganda police carry former Ruhaama MP William Beijukye Zinkuratire’s body

At a special parliamentary sitting convened for MPs to pay tribute to their colleague, Veterans Affairs minister Bright Rwamirama blamed the hepatitis B disease on the refugee influx in the country, while other legislators expressed concern over the damage it is causing like shattering families and marriages due to inadequate counseling and guidance of the victims.

INFORMATION

Opendi said: “There has been a problem in that some of the health workers did not have adequate information regarding hepatitis B. This has been a challenge but we have sent out teams to sensitise, educate and provide them with all the necessary information and guidance they need to give to the patients.”

While appearing before the parliamentary committee on Health in August 2016, ministry of Health officials led by Minister Jane Ruth Aceng noted that Uganda is highly endemic for hepatitis B virus (HBV), with 52 percent lifetime exposure at 3.5 million, accounting for 10 percent of the population living with chronic hepatitis B (CHB).

At the time, the highest infection rates were recorded in Karamoja (23.9%), northern Uganda (20.7%), West Nile region (10%), central region with 6 percent, and southwestern 3.8%.

Hepatitis B infection is a life-threatening disease caused by a virus. It attacks the liver and causes damage and inflammation.

The virus is passed from person to person through exchange of bodily fluids (including sweat), blood, unprotected sex, contaminated skin-piercing instruments or from an infected mother to her baby at birth.

The state minister for Housing, Dr Chris Baryomunsi, who is also a public health expert, says there are scars which form on the liver of an infected person and that in adults, up to 90 per cent of those who get infected recover from it, but 10 per cent of the cases usually progress to chronic hepatitis B where symptoms do occur.

In children, majority progress into the chronic phase with just 10 per cent recovering from the acute phase. Within the meagre resources allocated to health care, Opendi reveals that interventions have been made in high-prevalence districts in Acholi and Lango, followed by Karamoja, Teso and West Nile. Next is Busoga.

About Shs 200 billion is needed to cover the whole country for sensitisation of health workers and the masses, testing and treatment.

Opendi, however, said the other challenge is that health workers have no morale and are not willing to spend a lot of their time attending to hepatitis B patients.

“We are finding challenges in the districts where we are operating in that even where we have taken the vaccines, the health workers are not willing to provide the vaccines throughout the week,” she said.

“They have been allocating one day in a week and for limited numbers. They can say maybe 20 patients and that is it, and that is why you see that the vaccines are not utilised at the rate we actually expected them to be utilised,” she added.

Vaccination for children against this lethal condition was introduced in Uganda since 2002, meaning children who are 15 years and below have been protected through the routine immunisation.

Baryomunsi says when one tests positive, hepatitis B infection cannot be treated. Some relief can be provided to patients using antiviral drugs Tenofovir and Entecavir which suppress the infection so that it does not progress to active disease state.

SUPPRESS IT

According to Baryomunsi, a number of people who get infected go through a cycle as happens with other viral infections and then the disease just disappears on its own. But once it has progressed into an active disease when signs and symptoms can be seen in the patient, then it cannot be cured but you can only suppress it using the antiretroviral drugs.

“The late MP [Beijukye] had the manifestations of symptoms after the election. That means he could have contracted it earlier but it was in the latent phase for a long time because the incubation period can extend from 30 to 180 days and then you go into what we call acute phase which lasts for about six months,” Baryomunsi said.

“You will have the illness but you are not showing the visible symptoms, it is only when it crosses to the chronic type when you develop the symptoms that you start seeing features of the disease. So, he could have contracted it much earlier but it took time to manifest and it was unfortunate that by the time the diagnosis was made, a lot of damage had been done on his body even when he got specialised treatment here in Uganda and in India,” he said.  

“It was too late to save him because it had progressed into cancer of the liver which spread to other parts of the body including the lungs and this caused collapse of his lungs, leading to his death,” he added.

Baryomunsi says unlike in measles where after immunisation one can still suffer from it, the hepatitis B vaccine is extremely potent to the extent that it gives one protection to over 95 per cent and rarely does it occur after one has been immunised, except maybe when a person’s immunity gets compromised.

namuloki16@gmail.com

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