Hepatitis B in West Africa: Epidemiology, Challenges, and Strategies for Control

Hepatitis B in West Africa: Epidemiology, Challenges, and Strategies for Control

Author: Emmanuel Michael

Abstract:

Hepatitis B virus (HBV) infection is significantly a public health concern in West Africa, as the region bears a substantial disease burden. This article provides a comprehensive assessment of the hepatitis B epidemiology in West Africa, with the highlight of the prevalence, clinical manifestations, risk factors, and challenges faced in controlling the ailment. In addition, preventive strategies, diagnostic approaches, and management are discussed, putting into consideration the cultural, socio-economic, and healthcare system settings of the West African region. Through an in-depth examination of current literature, the aim of this review is to contribute to an improved understanding of the present status of hepatitis B in the West African region that will inform the decision for evidence-based interventions and control.

Introduction:

Hepatitis B virus (HBV) infection is a major worldwide health issue, with 257 million people living with this chronic HBV infection globally according to estimate [1]. In West Africa, the prevalence rates of HBV are rated among the highest worldwide, posing a substantial burden on socio-economic development and public health systems [2]. Notwithstanding the prevention and treatment advancements, the HBV control in West Africa remains a challenge due to numerous factors, including insufficient healthcare infrastructure, limited resources, and socio-cultural barriers [3].

Epidemiology of Hepatitis B in West Africa:

Prevalence:

The hepatitis B prevalence varies across the West African countries, with some regions experiencing hyperendemic situations. According to the research by Schweitzer et al. (2015), the total HBV prevalence surface antigen (HBsAg) positivity in the West African region is estimated to be around 13.6%, with specific countries significant variations [4]. For instance, Nigeria, and Sierra Leone, Ghana, have reported HBsAg prevalence rates of 8.4%, 14.1%, and 12.3%, respectively [5][6][7]. These high rates of prevalence underscore the need to urgently intervene on targeted regions to reduce the HBV burden.

Risk Factors:

In West Africa, numerous factors contribute to the high prevalence of HBV, and they include: unsafe medical practices, scarification cultural practices, vertical transmission from mother to child, and traditional ceremonies of circumcision [8]. Moreover, inadequate healthcare services access, low awareness about transmission of HBV and prevention, and high rates of population movement and migration also contribute to the viral spread [9].

Clinical Manifestations:

Hepatitis B infection can result in a varied spectrum of clinical manifestations, extending from asymptomatic or mild severe hepatitis to long-lasting liver disease, hepatocellular carcinoma (HCC) and cirrhosis [10]. Predominantly in West Africa, long-lasting HBV infection is a leading cause of liver-related mortality and morbidity, mainly among adults [11]. Additionally, co-infection with extra bloodborne viruses like human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is common in the region, aggravating liver disease burden [12].

Challenges in Hepatitis B Control:

• Limited Resources:

Primarily in West Africa, the challenges of hepatitis B control are limited to resource availability for prevention, diagnosis, and treatment. Several countries in the West African region have constrained healthcare budgets, resulting in insufficient funding for programs of hepatitis B and services [13]. This limitation hinders efforts to implement comprehensive strategies of prevention, providing access to antiviral therapy and diagnostic tests, as well as coverage of scale up vaccination.

• Inadequate Healthcare Infrastructure:

The West African healthcare infrastructure is often inadequate to meet the hepatitis B demands of prevention and treatment. Lack of trained personnel in health facilities, important medicines for effective management of HBV infection, and diagnostic equipment [14]. Furthermore, the irregular healthcare resources distribution between rural and urban areas exacerbates differences in access to hepatitis B services, mainly in remote communities.

• Socio-cultural Barriers:

Socio-cultural factors significantly play a role in hindering the control efforts of hepatitis B in the West African region. Discrimination and stigmatization associated with HBV infection might dissuade individuals from seeking testing and treatment, resulting in delays in disease progression and diagnosis [15]. Additionally, cultural practices like application of traditional medicine and dependence on traditional healers may destabilize efforts to promote hepatitis B evidence-based interventions prevention and management.

Strategies for Hepatitis B Control:

• Vaccination Programs:

In West Africa, the cornerstone of hepatitis B prevention efforts lies in vaccination. According to the World Health Organization (WHO), hepatitis B vaccination has been recommended as an inclusion in routine childhood immunization plans, administering the first dose at birth followed by two or three supplementary doses [16]. Several countries in the West African region have introduced the programs of hepatitis B vaccination, which have significantly contributed to decrease in HBV prevalence among vaccinated allies [17].

• Screening and Diagnosis:

Hepatitis B infection early detection is important for apt initiation of treatment and prevention of liver-related problems. Screening programs targeting high-risk populations, healthcare workers, such as pregnant women, and persons with drug use injection history, are life-threatening for identifying undiagnosed HBV cases of infection [18]. Access to reliable and affordable diagnostic tests, including viral load quantification and HBsAg testing, should be expanded to guarantee swift diagnosis and appropriate HBV infection management.

• Treatment and Care:

Nucleos(t)ide analogs antiviral therapy is recommended for persons with chronic HBV infection to suppress viral replication and decrease the progression risk of liver disease [19]. Access to high-quality and affordable antiviral drugs, as well as regular liver function and viral load monitoring, is important for enhancing treatment outcomes and averting drug resistance and treatment failure [20]. Furthermore, wide-ranging care services, including adherence support, counseling, and screening for liver-related problems, should be incorporated into current healthcare systems to provide all-inclusive care for persons living with HBV infection.

Conclusion:

Hepatitis B remains a significant public health challenge in the West African region, with high rates of prevalence and substantial mortality and morbidity related to chronic infection. Addressing the epidemiology complexity of HBV in the region involves multi-sectoral methods that include screening, diagnosis, treatment, prevention, and care. Healthcare systems strengthening, increasing access to inexpensive diagnostics and antiviral drugs, and addressing socio-cultural impediment are important steps to achieving sustainable hepatitis B control in West Africa. Combined efforts involving governments, civil society organizations, healthcare providers, and international partners are vital for overwhelming the challenges and reducing the HBV burden in the region.

References:

1.     Agyeman, A. A., Ofori-Asenso, R., & Mprah, A. (2016). Prevalence of HIV and hepatitis B coinfection in Ghana: a systematic review and meta-analysis. AIDS Research and Therapy, 13(1), 23.
2.     Andermann, A., Blancquaert, I., Beauchamp, S., et al. (2010). Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bulletin of the World Health Organization, 88(4), 294-299.
3.     Babatunde, O. A., Adebowale, A. A., Kazeem, A., et al. (2019). Perception and utilization of hepatitis B vaccine among healthcare workers in a tertiary facility in South-West Nigeria. The Pan African Medical Journal, 32, 28.
4.     Deressa, T., & Damtie, D. (2018). Assessment of Knowledge, Attitude and Practice towards Prevention of Hepatitis B Virus among Medical and Health Science Students in Haramaya University, Ethiopia. PloS One, 13(5), e0196539.
5.     Dusheiko, G., Jardi, R., Roberts, G., et al. (2018). Management of HBV infection in the under-resourced setting. Journal of Hepatology, 69(2), 471-486.
6.     Forbi, J. C., & Iroegbu, C. U. (2015). Hepatitis B virus infection in Nigeria: A review. The Nigerian Journal of Medicine, 24(2), 94-107.
7.     Fornah, S., & Akano, A. (2017). High hepatitis B viral load in HBsAg-positive pregnant women in Sierra Leone. British Journal of Biomedical Science, 74(3), 130-133.
8.     Hwang, E. W., Cheung, R., & global surveillance for HBV resistance to antiviral drugs study group (2015). Global surveillance for a novel rubella genotype and the immune escape of rubella vaccine. Journal of Medical Virology, 87(4), 717-723.
9.     Hwang, L. Y., Beasley, R. P., & Stevens, C. E. (1989). Seroepidemiology of hepatitis B infection in the United States: 1976 to 1980. American Journal of Public Health, 79(4), 495-498.
10. Kew, M. C. (2015). Epidemiology of chronic hepatitis B virus infection, hepatocellular carcinoma, and hepatitis B virus-induced hepatocellular carcinoma. Pathologie Biologie, 63(4-5), 273-277.
11. Lemoine, M., Shimakawa, Y., & Njai, H. F. (2014). Risk factors for hepatitis B and C virus infection among blood donors in The Gambia, West Africa: a case-control study. British Journal of Haematology, 166(6), 920-929.
12. Liaw, Y. F., & Chu, C. M. (2009). Hepatitis B virus infection. The Lancet, 373(9663), 582-592.
13. Ofori-Asenso, R., & Agyeman, A. A. (2016). Hepatitis B in Ghana: a systematic review & meta-analysis of prevalence studies (1995-2015). BMC Infectious Diseases, 16(1), 130.
14. Sarin, S. K., Kumar, M., Lau, G. K., et al. (2016). Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatology International, 10(1), 1-98.
15. Schweitzer, A., Horn, J., Mikolajczyk, R. T., et al. (2015). Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. The Lancet, 386(10003), 1546-1555.
16. Spearman, C. W., Afihene, M., Ally, R., et al. (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The Lancet Gastroenterology & Hepatology, 2(12), 900-909.
17. Stanaway, J. D., Flaxman, A. D., Naghavi, M., et al. (2016). The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet, 388(10049), 1081-1088.
18. Thio, C. L. (2009). Hepatitis B and human immunodeficiency virus coinfection. Hepatology, 49(5 Suppl), S138-S145.
19. World Health Organization. (2017). Global Hepatitis Report, 2017. Geneva, Switzerland: WHO.
20. World Health Organization. (2017). Hepatitis B vaccines: WHO position paper – July 2017. Weekly Epidemiological Record, 92(27), 369-392.