Why Hepatitis B is a silent killer disease in West Nile

Mr Samuel Ladu, a 24-year-old refugee, who fled from South Sudan in 2014 to Uganda, thought it was the end of his life after he received his test results indicating that he was Hepatitis B positive.
The Senior Six student of Alhaji Bezza Secondary School, who is currently on Hepatitis B medication, said he felt helpless at first.
“When I tested positive in July 2018, I was stressed and I thought that was the end of my life. I didn’t perform well in class for some time,” Mr Ladu said in an interview at the weekend.

He is a refugee in Ayilo II Refugee Settlement, Adjumani District, who fled to Uganda due to the unrest in South Sudan. Mr Ladu, an orphan, lives with his elder brother.
He wondered how he was infected with Hepatitis B since he was not involved in risky behaviours that could expose him to contracting the disease.
He was enrolled on medication in 2021, after undergoing all the necessary tests to ascertain the level of the viral load.
“The health workers counselled me until I accepted my situation. Now I am on medication, I take one tablet a day, and they normally give me for three months,” Mr Ladu added.

He observed that access to the vaccine and testing services is not available to many refugees.
According to the World Health Organisation, Hepatitis B is a potentially life-threatening live infection caused by the Hepatitis B Virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.
In the West Nile Sub-region, of the population targeted to get vaccinated, 88 percent got the first dose of Hepatitis B vaccination, 60 percent got the second dose, and only 36 percent completed the last dose.

Clients who tested positive and enrolled in care for the Financial Year 2021-2022 in the West Nile Sub-region, 896 tested positive but only 415 managed to enrol in care and treatment.
As a result of low uptake of the Hepatitis B vaccination, Adjumani District launched a programme for Covid-19 and Hepatitis B vaccination among the population in the refugee and host communities within the district. The assistant district health officer, Mr Henry Lulu, says the vaccination success rate among the refugee population during the 2022 mass vaccination exercise was very slow.
Mr Lulu added that out of the 273,380 targeted population for Covid-19 vaccination in Adjumani District, 158,592 (58 percent) were vaccinated while for the refugee population, only 24 percent of the refugees were vaccinated.

“Last financial year, 253 people died in the district and 45 died of Hepatitis B accounting for 14.8 percent,” Mr Lulu said.
In 2018, during recruitment exercise for Local Defence Units, more than 90 of the recruits who were screened tested positive of Hepatitis B. The head of the recruitment, Col Ronald Bigirwa, said: “This is an indication that a bigger number of the population is infected. In Yumbe District, I discussed with the leadership to encourage vaccination.”

National status
A progress report of July 2022 by the Ministry of Health indicates that Uganda introduced the mass adolescent and adult testing and vaccination campaign against Hepatitis B in the Financial Year 2015/2016.
The ministry aimed at reaching people aged 14 years and above, targeting the population of 17,130,883. This represented 49 percent in a phased approach over the past seven years. Currently, the implementation is taking place in 61 districts.
According to the Ministry of Health, in the first phase, the target was to reach out to 5,109,280 while in the second phase, the target was to reach 4,389,156 people and, in the third phase to reach out to 7.6 million people.

Out of the 17m targeted population, 5,436,896 were people tested, representing 33.6 percent. A total of 5,107,490 representing 94 percent tested negative, and 329,406 6 percent of the tested population were confirmed positive.
In the seven years, 77 percent of the population got the first dose of the vaccination, 51 percent got the second dose and only 30 percent managed to complete the 3rd dose.

The fight
Adjumani District secured funding from UN Women to the tune of Shs132 million, targeting 100,000 refugees and host communities as the disease burden of Covid-19 and Hepatitis B is anticipated to rest on women who are the guardians of children and most families.
The district health office has designated 37 Hepatitis B screening centres, covering all the sub-counties and all the health facilities in the district and the exercise has been programmed to last six days.

Similarly in Terego, the district chairperson, Mr Wilfred Saka, said the district, which is hosting 171,179 refugees and more than 233,300 nationals, last month during random sampling, 27 samples were collected and taken to Zombo Industrial Hub and three people tested positive for Hepatitis B.
“These were just randomly picked and they did not present any sign. This means there are so many other people who are infected and have not been noticed. We must develop robust and mass testing to involve refugees and nationals so that appropriate approaches can be taken by the government,” he said.

In Yumbe District, Mr Zubairi Ojo, the acting district health officer, said the prevalence was 8 percent between 2020/2021 and dropped to 6.2 percent in 2021/2022, as a result of the interventions together with the Ministry of Health.
From 2020 to 2022, according to the acting district health officer, of 13,000 people who were tested in Yumbe, 67 people tested positive and all were enrolled in care and treatment.
Although the number of refugees vaccinated and tested is unclear, the district has embarked on mass tests and vaccination that includes refugees.

Mr Ojo added that from 2020 to 2022, at least 14,000 people got vaccinated in the Yumbe District and 4,000 of the people vaccinated were refugees from the Bidibidi Refugee Settlement.
The district lost 80 to Hepatitis B between 2020 and 2022, the deaths, according to the acting district health officer, are attributed to late diagnoses and poor health-seeking behaviours, and negative myths associating the disease with witchcraft.
The uptake of the vaccination is still low among refugee adults and even among the host communities because of their attitudes towards the diseases.

Why low up take
The political and health teams said there is low uptake due to limited advocacy and mobilization in communities, misconceptions, myths, and anxiety about the disease.
Limited implementing partner involvement at the district level, knowledge gap- health workers. Stockouts and unavailability of basic laboratory tests at the health facilities, lead to high levels of loss to follow-up of those who test positive.
High dropout rates for those who start vaccination. Hepatitis B testing for pregnancy has been included in the new ANC guidelines and has not been fully disseminated.

Key facts by WHO
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
    The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp instruments.
    WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year.
    In 2019, hepatitis B resulted in an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).
    Hepatitis B can be prevented by vaccines that are safe, available and effective.