Dar es Salaam. A few years after her two family members died from liver cancer, Hawa Simba was early this year also diagnosed with Hepatitis B — an inflammatory condition of the liver.
That was a huge blow for the 28-year-old resident of Tabora, who is now admitted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam. She is camped at the specialist hospital since two weeks ago.
The life ahead won’t be easy. She faces the silent, lifelong battle that thousands of Tanzanians are fighting.
Hepatitis B is not the kind of disease that you would ordinarily hear people talking about in public. That, nonetheless, doesn’t make it any less significant.
It’s killing almost as many people globally as HIV and TB, according to the World Health Organisation (WHO). And like many African nations, Tanzania has an arguably high prevalence rate of chronic hepatitis B.
As of 2007, the official rate stood at between 5.7 and 7 per cent, according to figures the Health ministry released during the World Hepatitis Forum in 2017. The actual burden is probably not known.
Experts say the majority of infected people, including healthcare workers are unaware of their status. And independent researchers suggest the prevalence rate could be around, if not more than, 8 per cent.
This year alone at the ORCI where Hawa is seeking treatment, at least 6,438 showed up for screening between January and June this year.
Dr Julius Mwaiselage, the institute’s executive director, told The Citizen on Sunday that 3.4 per cent of these people tested positive.
“Some individuals have no symptoms at all; others experience only the initial infection symptoms, but others remain chronically infected as the virus continues to attack the liver over time without being detected,” Dr Mwaiselage said.
He was speaking prior to World Hepatitis Day – observed every year on July 28. The theme for 2019 is ‘Invest in eliminating hepatitis’.
It clearly highlights the urgency with which the country needs to address the disease.
Across the globe, campaigners want people to know that they can still live a full, dignified life with Hepatitis B. But the most important thing is prevention, especially vaccination in newborns. For adults, testing, linking to care, education and treatment as needed are crucial – as there is no cure, treatment is often lifelong.
But screening and treatment are among the major challenges people like Hawa are facing in Tanzania – where the vaccine and related costs are beyond the reach of many.
Hawa is eligible for treatment at the ORCI. But she still has to foot the bill that comes with having to stay several hundreds of kilometers away from home. She can’t get the same service in her region.
“My entire family is extremely saddened and shocked – and though they are supporting me financially, we cannot afford to the costs,” says Hawa.
It was the high cost of treatment that forced her back home without a solution when she first came to the commercial capital seeking help after experiencing persistent abdominal swelling and pain accompanied by fatigue – the early signs of hepatitis B.
She had gone to Muhimbili National Hospital (MNH) – the country’s main referral hospital – where the doctors told her she had a tumor in her stomach.
“I could not be treated because I did not have the money they asked for; so I went back to Tabora,” she says.
Six months later – in June – Hawa had saved a little. She came back to the MNH for another diagnosis. This time, they told her she had an enlarged liver — a common warning sign of acute hepatitis B.
From MNH – where officials say 1,700 hepatitis B patients are currently receiving treatment – Hawa was referred to the ORCI for more specialised liver screening.
WHO recognises the cost of treatment as one of the major stumbling blocks to eliminating viral hepatitis. Vaccines and medicines exist, but they are not yet reaching everyone in need.
In Tanzania, the government’s national strategic plan for control of viral hepatitis (2017-2021) targets to eliminate the disease by 2030.
But major hurdles remain.
Only a few public health institutions are currently offering screening and vaccination services for both adults and babies.
The lack of national data on the burden is another major challenge Tanzania faces. This has a negative impact on response.
However, the government says it has taken some successful steps to scale up hepatitis services. The Health ministry said early this year that more than 20 million Tanzanians have been vaccinated to date – since the introduction of hepatitis B vaccine to under five children in 2002.
Funding will be key to addressing such challenges, WHO noted in a statement released this week.
The global health body called on countries to take advantage of recent reductions in the costs of diagnosing and treating viral hepatitis and scale up investments in disease elimination.
A new study by WHO, published today in Lancet Global Health, has found that investing $6 billion per year in eliminating hepatitis in 67 low- and middle-income countries would avert 4.5 million premature deaths by 2030, and more than 26 million deaths beyond that target date.
A total of $58.7 billion is needed to eliminate viral hepatitis as a public health threat in these 67 countries by 2030.
This means reducing new hepatitis infections by 90 per cent and deaths by 65 per cent.
“Today 80 per cent of people living with hepatitis can’t get the services they need to prevent, test for and treat the disease,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.
“On World Hepatitis Day, we’re calling for bold political leadership, with investments to match.”