[YAOUNDE] The authors of the WHO Hepatitis Report 2024 emphasize that a country like Egypt has demonstrated that it is possible to move towards the elimination of viral hepatitis with political and financial commitment, effective implementation of the national strategy, and local production of medicines.
The North African country has diagnosed 87% of people living with hepatitis C and provided curative treatment to 93% of them, surpassing the WHO’s gold-level targets of diagnosing at least 80% of patients and providing treatment to at least 70% of those diagnosed.
“Such achievements can be within reach of other countries too and it is still possible to reach the WHO elimination target by 2030, if rapid action is taken now,” the experts say.
“We must systematically vaccinate newborns at birth, systematically screen pregnant women during prenatal consultations, and treat patients infected with the virus if possible without waiting for them to develop cirrhosis.”
Folly Anyovi, ASADH
The report therefore prescribes actions such as screening, treatment, prevention, and the mobilization of innovative financing from all sources.
Added to this is community engagement (involving affected populations and civil society in the response to viral hepatitis) and the continuation of viral hepatitis research programs to improve diagnostics and work towards finding a cure for hepatitis B.
Folly Anyovi, a specialist in virology and molecular genetics and founder of the Association Sauvons l’Afrique des héritiers (ASADH), specifies that to truly overcome hepatitis B and C, it is necessary to “systematically vaccinate newborns at birth, systematically screen pregnant women in prenatal consultations, and, if possible, treat patients infected with the virus without waiting for them to develop cirrhosis.”
The interested party adds that it is also necessary to introduce into routine, systematic screening for hepatitis delta, to reduce or subsidize the cost of treatment for hepatitis C in Africa and to raise awareness, screen and vaccinate the most vulnerable groups.
Indeed, coverage of hepatitis prevention, diagnosis and treatment interventions in the WHO African region remains very low, and lower than the global average, say experts from the organization.
According to the recent report covering the year 2022, the number of deaths caused by viral hepatitis in Africa is estimated at 307,000 deaths, including 272,000 deaths related to hepatitis B and 35,000 to hepatitis C.
Globally, the estimated number of deaths from viral hepatitis has increased from 1.1 million in 2019 to 1.3 million in 2022, of which 83% are from hepatitis B and 17% from hepatitis C. Every day, hepatitis B or C kills 3,500 people worldwide.
Prevalence
The prevalence of chronic viral hepatitis B in the general African population is estimated at 5.8% and hepatitis C at 0.7%; while total hepatitis B infections are 64.7 million people (all ages) compared to 7.8 million for hepatitis C.
Africa accounts for 63% of new hepatitis B infections, or 771,000, compared to 172,000 new hepatitis C infections.
“Less than 5% of people with hepatitis B in the region have been diagnosed, and only 5% of them have received treatment,” says Françoise Renaud of the Department of Global HIV, Hepatitis and STI Programmes at WHO and co-author of the report.
The region, she continued, “also has the lowest coverage of the birth dose of vaccine, at 18% compared to the global coverage of 45%,” recalling in passing that viral hepatitis is a “major” public health issue.
According to this expert interviewed by SciDev.Net, services are rather available in specialized health care facilities, and not in primary health care. “Only a third of the countries surveyed by WHO provide free services for viral hepatitis,” she adds.
The report said countries such as Nigeria (15.7 million infections) and Ethiopia (8.4 million) are among those accounting for two-thirds of the global disease burden of hepatitis B and C, the deadliest strains of the virus.
Propagation factors
According to Daniel Low-Beer, a senior epidemiologist at WHO, the increase in deaths from viral hepatitis, particularly hepatitis B, can be attributed to a variety of factors, including low coverage of diagnosis and treatment, and the aging of the population cohort with hepatitis B infection.
The latter also blames the disruptions caused by COVID-19, which have slowed the scaling up of access to treatment in many low- and middle-income countries.
For Ndioura Diallo, hepato-gastroenterologist and president of the NGO SOS Hépatites Guinée, all the factors, particularly psychological and socio-economic, favoring the spread of viral hepatitis are present in sub-Saharan Africa.
“There is the ignorance of the sick, the lack of hygiene (food and environment). But above all the poverty of the sick. They cannot make the diagnosis and pay for the medication. I was able to conduct a small survey. According to the results obtained, out of 100 people with hepatitis, only 35 people were able to make the diagnosis and pay for the medication,” he argues.
The WHO report also indicates that of the 64.7 million hepatitis B infections recorded in Africa in 2022, only 2.7 million have been diagnosed and only 150,000 have received treatment by the end of 2022. This represents a diagnostic coverage rate of 4.2% and 0.2% treatment coverage among people with hepatitis B by the end of 2022.
As for hepatitis C, one million people have been diagnosed out of 8 million cases of infection and 200,000 people have received treatment by the end of 2022. This represents a coverage rate of 13% for diagnosis and 3% for treatment.
