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Hepatitis: Ignored killer


Patients go without drugs as billions are spent on vaccines

World Hepatitis Day was marked on July 28 under the theme, `Know hepatitis Act now’. It was designed to focus this year’s activities on increasing global awareness and strengthening prevention, diagnosis, and treatment services around the world. The increased focus could not have come at a worse time for Uganda where those infected with hepatitis are suffering without drugs and have resorted to using HIV/AIDS drugs.

“Many hospitals have vaccines only. If you need drugs, you are told to go to the referral hospitals where most times you are given ARVs (Anti-Retroviral Drugs),” says Kenneth Kabagambe who is infected.

The Commissioner Clinical Services at the Ministry of Health, Dr. Jacinto Amandua, confirmed he was aware that patients living with hepatitis are given HIV drugs because of lack of money.

“The money available was planned to initially extend vaccination to cover all parts of the country,” he told The Independent.

This financial year hepatitis has been allocated Shs10 billion. Amundua said the same Shs10 billion was allocated for procuring hepatitis drugs and vaccines and it was not adequate and the ministry had to request for additional Shs3 billion.

Additionally, he said money is released by Ministry of Finance on a quarterly basis and given to the National Medical Stores to do the procurements. The money released in the first three quarters of the 2015/16 financial year which ended in June was for vaccination and that of the Fourth Quarter was for Anti-retroviral drugs.

He added that the National Drug Authority has approved a single drug – Tenofivir which is manufactured locally to be used by hepatitis patients. He says it is not yet available on the market.

While 1.4 million Ugandans live with HIV, about 3.5 million are infected with hepatitis and 30% (more than a million) are chronically ill and require treatment.

The 2005 HIV sero survey which included screening for hepatitis B showed the disease to be more prevalent in the Karamoja region with 23.9%, Northern Uganda (20.7%), West Nile (18.5%), and Western Region (10.0%); and the lowest infection rates were in Central Region (6%) and South­ -Western (3.8%).

Areas with highest prevalence were considered first in the four phased vaccination exercise. First, they considered 30 districts of West Nile, Acholi, Lango and Karamoja sub regions. Also, last year, the government made it compulsory for children and health workers to be vaccinated. The vaccine is given in three intervals. The second is given a month after the initial one and then the final one after six months.

Hepatitis which is treated by antiviral medication spreads through blood and other body fluids and attacks the liver.  Experts say it kills faster than HIV.  In fact, Amandua said, the disease is 10 times more deadly than HIV and Uganda is one of the countries with the highest prevalence in the world.

In 2010 the World Health Assembly (WHA) recognised viral hepatitis as a global public health problem and urged governments to take actions to prevent, diagnose, and treat it. Five years later, the World Health Organization (WHO) came up with a first ever set of guidelines for treatment.

Statistics from WHO indicate 240 million people suffer from the disease and an estimated 780,000 succumb every year. Most of these deaths are registered in developing countries where awareness is still lacking. Some people only get to know a thing about the disease when they test positive for it. Many do not show any symptoms until when they are diagnosed with liver cancer which is the most advanced stage of the disease. At this point, it is too late for them.

Amandua says, however, some get symptoms like yellowing of the skin, discomfort on the right side of the belly, dark urine, and fatigue.

Amandua says just as HIV, the risk of acquiring the disease increases when one has unprotected sex with a person with the disease or with multiple partners. Residents and staff of correctional facilities and group homes, those with multiple sex partners, health workers, and emergency personnel, those who share sharp instruments and men who have sex with men are at a higher risk.

He encourages people to use condoms and also conduct routine testing because people with chronic infections may feel fine for a long time, even as the virus is causing damage and by the time symptoms appear the liver damage may be advanced.  Amandua says everyone needs to be tested.

Hepatitis B becomes chronic when it lasts more than six months without treatment. Although infections can persist in adults, most chronic cases occur in children.

Amandua said they have programmes focused on prevention of mother to child transmission of the disease since many contract the disease at birth.  Those newly infected are referred to as acute cases.

Blood tests can tell doctors whether the infection is acute or chronic and whether the virus is actively multiplying. Additional important tests to consider after testing positive, according to Amandua, include the liver function which is meant to determine whether it’s functioning normally, the hepatitis antigen; which shows whether one has a dormant or active virus, and the viral load which determines the amount of virus in the blood.

He however clarified that the disease does not spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B.



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