By SAM PHIRI –
MORE than 80 per cent of adult Zambians are at risk of contracting Hepatitis B, a viral infection that attacks the liver and can kill if not detected and treated early.
The fact that not many people know about this is a source of worry for  Alipali Kumar, HIV/AIDS specialist at Adult Infectious Disease Centre at the University Teaching Hospital (UTH) in Lusaka.
“I have not seen awareness messages on television, or in newspapers, about hepatitis B but what I know is that HIV patients have some information on the disease,” Dr Kumar says. “Now this is just 13 per cent of the population.”
Worse, Dr Kumar says the mode of transmission of Hepatitis B is similar to that of the Ebola virus that has so far claimed thousands of lives, especially in West Africa.
The Hepatitis B virus that can easily be transmitted through body fluids like blood, saliva, menstruation, vaginal and seminal fluids has a relatively long life outside the body and can survive for at least seven days.
During this period, the virus has the potential to cause infection should it enter the body system of an unprotected person, by a vaccine that is.
The World Health Organisation (WHO) calls hepatitis B a life-threatening disease and life sinker known less in sub-Saharan Africa.
Known as hepatitis B surface antigen (HBsAg), the viral infection attacks the liver, causing both acute and chronic diseases that would eventually lead to an increase in the mortality rate statistics.
According to global data, the HBsAg claims more than 65,000 lives monthly with Zambia standing at 7.56 per cent prevalence.
Geographical distribution of the disease reveals that Sub–Sahara region that encompasses Zambia, records the highest statistics going up to 10 per cent of the prevalence rate globally although knowledge about this syndrome remains limited.
According to the WHO, the HBsAg vaccine that is 95 per cent efficient was only introduced in the early 80s leaving the majority of adults born before that period at risk.
For most countries in the Sub-Sahara and Zambia, the rolling out of the vaccination of infants less than six months old ageists HBsAg was only spread out as a national program less than five years ago.
Soni Subhesh, a gastroenterologist from Southern Province Choma says the Government has only managed to procure vaccines for newly born as part of its prevention program though leaving out the adults.
He says though the vaccinations for adults are also available; government has not yet put up a program to include free mandatory vaccination of adults.
Dr Subhesh however, commends Government for tackling the co-infectious disease HIV and says he has had workshops on the Hepatitis B though at a very minimal level.
Although the vaccination for adults and infants is now readily available, the major challenge remains lack of knowledge among most Zambians and the high costs involved.
“The Ministry of Health is doing a lot especially with regards to the fight against HIV/Aids virus which in most cases would core exist with the hepatitis B virus, though we recommend more workshops on hepatitis B alone ,” he said.
He says Government must be commended for the manner in which it has responded to the issue of Ebola and Aids whose prevalence rate continues to reduce, and that must be extended to Hepatitis as well.
Hepatitis B has hidden symptoms in most people during the acute infection phase though; some people may develop acute illness with visible symptoms like yellowing of the skin and eyes (jaundice) that last several weeks, dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
He says severe hepatitis can develop into acute liver failure which eventually leads to death or may develop into liver cancer.
Like HIV /Aids, hepatitis B has no cure or a specific treatment. Dr Subhesh says though the replicating of the virus can be suppressed using some named oral antiviral drugs, maintaining adequate nutritional balance including taking a lot of fluids also helps.
Some of the oral treatments that have been recommends by the WHO include Tenofovir or Entecavir, which are said to be the most potent drugs to suppress Hepatitis B virus.
According to experts and WHO, the two oral drugs have a relatively huge advantage they would rarely lead to drug resistance with few side effects.
However, in most people, the treatment does not cure hepatitis B infection, but only suppresses replication of the virus meaning that most people who start the treatment must continue for life.
Treatment using interferon injections may be considered in some people in certain high-income settings, but its use is less feasible in low-resource settings like the Sub Sahara due to its high cost.
The same could be said about the diagnosis. Counties like Zambia still have limited resources to detect the presence of HBsAg in one’s system.
The limited diagnostic centres have led to the high cost of the test making people who are prone or with visible symptoms resolve to self treatment of sugar solutions or sugar cane.
Betty Mwanza, a 21-year Lusaka resident with clear symptoms pointing towards the Hepatitis B syndrome, says she is under home made medication of curry roots, sugar cane and other wild roots used for brewing a traditional non alcoholic beverage known as Munkoyo.
“My mother had a similar problem but managed it using excessive eating of sugarcane, ‘Munkoyo’ roots and curry roots,” she says.
What Ms Mwanza does not know is what took her mother’s life at the age of 43 after exhausting all possible formulas to fight symptoms related to hepatitis B.
The question that remains unrequited is; could Betty’s mother have added to the Hepatitis B mortality statistics?
Like Ms Mwanza, many in developing counties would not get proper diagnosis in the early stage of the disease but would only do so in the  acute stages  where even the inflammation of the liver would be seen though ultrasound.
Liver cancer is said to be one of those diseases that have a rapid progression, and since treatment options are equally limited in low-income countries like Zambia, most people die within few months of diagnosis.
In developed countries, surgery, liver transplant and chemotherapy can be done to prolong life for up to a few years if liver cancer is detected.
Currently in Zambia, a hepatitis profile that includes diagnosis of hepatitis A hepatitis B and hepatitis C would cost between K1,200 to K2,000.
In instances where one is found positive of the HBsAg, doctors would request for further tests that will indicate the viral load in the patient before commencement of treatment.
This is yet another expensive test that may go up to K1,600 which currently can not be done within Zambia but in South Africa or other developed nations.
With such limitations, many Zambians who can barely afford basic medical costs and living on less than a dollar per day would be at high risk of losing lives to the virus.
The only practical way of possibly preventing the spread of the virus in developing countries like Zambia is though the child immunisation which government is fully responsible of.
If all infants can receive the HBsAg vaccine preferably within 24 hours after birth as recommended by the World health body, the war against ravaging disease would be partly won especially among the new generation.