UTG Medical Students’ Association
Imagine a storm sweeping silently through our communities, a fire that burns slow and steady, and by the time you start to feel its burn, it’s already too late. This is the heartbreaking reality of hepatitis in our nation, The Gambia. Hepatitis, an inflammation of the liver, poses a significant health challenge both globally and within The Gambia. This article delves into the various types of hepatitis, their transmission methods, symptoms, and the specific impact on The Gambia, highlighting the importance of awareness and prevention.
Types of hepatitis
There are five primary hepatitis viruses, each differing in transmission routes and health implications: Hepatitis A (HAV): Transmitted primarily through ingestion of contaminated food or water, leading to acute liver inflammation.
Hepatitis B (HBV): Spread via contact with infectious body fluids, such as blood, semen, or from mother to child during childbirth. Chronic HBV can result in severe liver diseases, including cirrhosis and liver cancer.
Hepatitis C (HCV): Mainly transmitted through blood-to-blood contact, often becoming chronic and leading to serious liver complications.
Hepatitis D (HDV): Occurs only in individuals already infected with HBV, leading to more severe disease outcomes.
Hepatitis E (HEV): Typically spread through consumption of contaminated water, prevalent in areas with poor sanitation.
Global impact
Hepatitis remains a global health concern, with 354 million affected globally, and 70 million in Africa. Chronic hepatitis B and C infections are particularly alarming due to their potential to cause long-term liver damage, liver cancer, and death. Despite the availability of vaccines for hepatitis A and B, and treatments for hepatitis C, many regions continue to experience high prevalence rates due to factors like inadequate healthcare infrastructure and lack of awareness.
Hepatitis in The Gambia
The Gambia, our small nation with a population just under 3 million, is ranked 4th in countries with the highest rates of hepatitis in the world. Hepatitis, especially hepatitis B and C, presents a significant public health challenge: Prevalence: Studies indicate that HBV infection rates exceed 8% in the Gambian population, categorising it as a high-prevalence country. An estimated 10% of the Gambian population has hepatitis, meaning one in every ten Gambians is affected. More than 200,000 are estimated to live with the disease, and every household is believed to have at least one person with hepatitis.
Liver Cancer: The Gambia is ranked 4th globally for liver cancer rates, primarily due to high hepatitis B rates. HBV is the leading cause of hepatocellular carcinoma (HCC) in The Gambia. Liver cancer is the most common cause of cancer deaths among men and the third in women. Vaccination Coverage: The Gambia has made commendable progress, with HepB3 (three doses of hepatitis B vaccine) coverage reaching 88% in 2019. However, this marks a decline from previous years, highlighting the need to renew immunisation efforts. Occult Hepatitis B: Research reveals a 9.4% prevalence of occult HBV infection in the general population, rising to 18.3% among patients with advanced liver disease.
Transmission and risk factors in The Gambia
In The Gambia, HBV transmission occurs through: Perinatal transmission: From mother to child during childbirth.
Horizontal transmission: Among children through close contact, especially in settings with inadequate infection control.
Unsafe medical practices: Use of unsterilised medical equipment or transfusion of unscreened blood. Cultural practices: Traditional procedures involving skin piercing, such as circumcision or scarification, when performed with contaminated instruments.
Symptoms and complications
Many individuals with HBV remain asymptomatic until the disease progresses to a severe stage. When symptoms do occur, they may include; acute phase; fatigue, jaundice (yellowing of the skin and eyes), dark urine, abdominal pain, and nausea.
Chronic Infection: Prolonged HBV infection can lead to liver cirrhosis, liver failure, or hepatocellular carcinoma. Every week at the EFSTH, up to three deaths are recorded due to hepatitis-related complications. In a month, up to 17 deaths are reported.
Prevention and control measures
Addressing hepatitis in The Gambia requires a multifaceted approach including vaccination to Strengthen immunisation programs to achieve higher coverage rates, ensuring all infants receive the hepatitis B vaccine promptly.
Public Awareness: Educational campaigns to inform the public about transmission routes, preventive measures, and the importance of vaccination.
Safe Medical Practices: Ensuring the use of sterilised equipment in healthcare settings and promoting safe blood transfusion practices.
Screening and treatment: Implementing widespread screening to identify infected individuals and providing access to antiviral treatments to manage chronic infections.
Conclusion
Hepatitis, particularly HBV, poses a substantial health threat in The Gambia. While progress has been made in vaccination and awareness, challenges remain in achieving comprehensive control and prevention. A concerted effort involving government initiatives, community engagement, and internatsional support is crucial to reduce the burden of hepatitis and safeguard public health in The Gambia.