Hepatitis B is not necessarily a death sentence

Monday July 15 2019

A nurse taking blood samples from one of the

A nurse taking blood samples from one of the locals who turned up for Hepatitis B screening at Arua Hospital recently. Tests that can help diagnose hepatitis B or its complications. PHOTOs BY CLEMENT ALUMA 


Last year, 17-year-old Christine Birungi was sent home from school after she tested positive for Hepatitis B. The school administration required that she returns home to seek treatment.
During that time, government was undertaking a countrywide screening and vaccination exercise, which also involved schools. Birungi’s elder sister Brenda Nyamaizi says the test results caused panic among a number of family members who believed that the disease was incurable and Birungi would die.
Others accused Birungi of engaging in premarital sex since they believed she had contracted the disease through unprotected sex.
Nyamaizi says she immediately had to part with Shs240,000 for Birungi to conduct other tests recommended by the doctors.
“But we were amazed because further tests indicated that the virus was still at an acute stage which would clear within six months and did not require her to get any treatment,” Nyamaize states.
Although they are yet to conduct confirmatory tests that the virus has cleared, Nyamaizi says they still cannot believe the Senior Four student will heal from the disease they had always thought was incurable once tests were positive.

What it is
According to the World Health Organisation (WHO), viral hepatitis B is an inflammation of the liver caused by a viral infection which attacks the liver and can cause both acute and chronic disease.
It is a major global health problem. It is estimated that about 780,000 people die each year due to consequences of hepatitis B such as liver cirrhosis and liver cancer.

WHO also indicates that the virus is highly contagious and is transmitted through contact with the blood or other body fluids of an infected person and can survive outside the body for at least seven days.

Dr Jackson Amone, the commissioner of clinical health in the Ministry of Health, says viral Hepatitis can be transmitted from a mother to their new born child, sexually or through pricking oneself with something infected with the virus.
Transfusion of blood infected with Hepatitis B, he says, is also another way through which the viral disease is transmitted.
“And maybe when children are playing and one has the disease, it can be spread to others through saliva. Sometimes when you go to a barber, the disease can also be transmitted through unsterlirised machines used to cut hair,” Dr Amone says.

When to treat
Dr Amone says it is not a must that every time someone tests positive that have to be put on treatment. He says in some cases, like Birungi’s such a person should be subjected to other tests to evaluate the stage at which the virus has advanced.
“Usually the patient presents with Hepatitis in an acute phase which may subside after six months although it may become chronic,” he says.

Signs and symptoms
The signs and symptoms of Hepatitis B, he says, may seem like those of malaria such as fever, joint pains, mild headache and yellowing of the eyes. However, the signs usually occur in its advanced stages although one may not know that they have Hepatitis B.
“It continues developing and after five months, it becomes chronic and at this stage it becomes difficult to manage. The patient starts presenting with deep yellowing of the eyes, swollen abdomen, and legs,” Dr Amone says.
Therefore, patients are advised to be screened for Hepatitis B so as to vaccinate if they test negative and start treatment if one tests positive.
When the ministry realised that the prevalence was high, a vaccine was introduced in 2002 and started vaccinating the children on a routine basis.
Dr Vincent Karuhanga, a general practitioner at Friends Polyclinic, says the disease is mainly acquired through sexual intercourse or from a mother to child during child birth.
“After one has got the infection, it is called acute Hepatitis infection and usually does not need drug treatment because in more than 90 per cent of cases in a healthy adult, the infection will clear within six months failure of which the infection becomes chronic and requires treatment,” he says.
However, Dr Karuhanga says up to 90 per cent of infants getting hepatitis B end up getting chronic Hepatitis B requiring that within 12 hours of birth, babies whose mother has Hepatitis B should be immunised and given Hepatitis B Immuno-Globin (antibodies).
Dr Diana Atwine, the permanent secretary Ministry of Health, in a recent interview cautioned health workers against rushing to put patients on treatment because sometimes, Hepatitis particles found in the blood sample need to be re-examined to confirm a diagnosis.
“Some of the people might have particles of the virus in their body when they actually defeated the virus,” Dr Atwine said.
“To determine whether there are many particles of the virus in the body, another test is carried out on viral load to quantify the amount of the virus in the body. If the amount is a lot, then one starts treatment. If the liver is damaged, enzymes start going on top of the liver, then one starts on medication as well,” she added.


Prevalence per region
According to the Ministry of Health, a survey conducted in 2005 indicated a 10.3 per cent prevalence rate. This was repeated in 2016/17 and it had reduced to 4.1 per cent distributed in the country.
Statistics indicate that the Northern region has the highest prevalence compared to the South at 4.3 per cent. East has lower, central about 1.8 per cent and south west the lowest about 0.3 per cent.
“We are not very sure about the difference in prevalence but we assume the difference could be related to culture such as tattooing because once you have Hepatitis you can easily transmit it,” Dr Jackson Amone, the commissioner of clinical health in the Ministry of Health, says.