Eliminating Hepatitis: Nigeria’s Lesser Known Silent Killer

Roberto Taboada and Danjuma Adda

According to the World Health Organization (WHO) Global Hepatitis Report, Nigeria is among the top 10 countries that shoulder one-third of the global hepatitis burden. Every day, 3,500 people globally die from hepatitis B and C infections and the WHO African Region accounts for 63 per cent of new hepatitis B infections. 

According to WHO estimates, Nigeria has more than 20 million people living with hepatitis B, C or both; yet more than 80 per cent of the people who have the disease do not know their status.

This paints a striking and disturbing picture of an epidemic that has somehow flown under the radar – a severe health problem that has surpassed the combined mortality of HIV, TB and malaria. 

This silent killer cannot be ignored anymore. However, the statistics beg the obvious question: Why has hepatitis not received more coverage?

What is Viral Hepatitis? Hepatitis is an inflammation of the liver. There are several variations of hepatitis, and each one is different. Depending on the strain (A, B, C, D or E), certain types of hepatitis can clear up on their own. However, certain strains can lead to fibrosis (scarring), cirrhosis or liver cancer if they remain undiagnosed and untreated.

According to the WHO, “Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child and also by sexual contact.”

 Hepatitis in Nigeria

To gain some insight into the actual state of hepatitis in Nigeria, I spoke to Dr Danjuma Adda. Dr Adda is a practising medical professional and public health expert whose personal experience with hepatitis B poignantly illustrates the physical, emotional and social challenges faced by people affected by this silent epidemic. In 2004, Adda contracted hepatitis B in a hospital setting while working on comorbidity clinical diagnostics on patient samples. Six months after his diagnosis, he was struck by the fact that, despite the availability of post-exposure prophylaxis for HIV, he was offered none for Hepatitis B. To clarify, after possible exposure to the hepatitis B virus, hepatitis B post-exposure prophylaxis (PEP) can be used to decrease the chance of getting hepatitis B.

For Dr Adda, this stark reality highlighted a critical gap in healthcare practices at the time. Additionally, the diagnosis came with the daunting task of disclosing his status to his future wife in a community that was, at best, ill-informed about the causes and effects of hepatitis. He also faced extreme anxiety about his future as a healthcare professional. Thankfully for Dr Adda and his wife, mutual courage and support prevailed. A year after the Doctor disclosed his status, his wife was vaccinated, and the couple continue to weather the burden together to this day while Dr Adda is treated, along with their five children.

In 2007, Dr Adda was dealt another tragic blow when his mother succumbed to liver cancer as a result of hepatitis C infection. 

Having been diagnosed years before, treatment had not been administered by the healthcare professional responsible for delivering the diagnosis. 

In fact, his assessment, according to Dr Adda, was that there was no cause for concern, as “everybody has hepatitis”. As a public health expert, Dr Adda experienced firsthand the lack of awareness about viral hepatitis – not only among local communities but even among healthcare professionals. 

His experiences prompted him to establish a charity to drive better access to diagnosis, care and education for patients and healthcare practitioners. Dr Adda has since served as a World Hepatitis Alliance (WHA) Executive Board Member for Africa (2014-2016) and the first African WHA President. The doctor’s dedicated advocacy and hard work are invaluable. However, he cannot win the fight alone.   

Eliminating the Silent Killer

Taking control of the hepatitis epidemic in Nigeria and the rest of Africa calls for cooperation from the public and private sectors, local communities and funding organisations. The lack of continuous medical education among healthcare professionals – particularly in addressing diagnosis – compounds the problem in Nigeria. According to accounts from Dr Adda, many doctors and nurses still rely on outdated knowledge from medical school, unaware of current guidelines and treatments for hepatitis. The shortfall among healthcare providers reveals a significant gap in knowledge dissemination. This is why updated guidelines from organisations like WHO and EASL (The European Association for the Study of the Liver) often do not reach the frontline, leaving many healthcare workers ill-equipped to manage and advise on hepatitis effectively.

To address these challenges, community-based awareness programmes and testing initiatives are crucial. Media platforms like radio and television may significantly increase public knowledge about viral hepatitis. NGOs and local health organisations also have a vital role to play in driving awareness and encouraging voluntary testing – especially in underserved communities. Additionally, in partnership with private sector stakeholders, healthcare providers and the public, the Nigerian government should have more open discussions about taking coordinated action against viral hepatitis. 

Practically, this would require innovative approaches to funding, streamlined diagnostics laboratory infrastructure and prioritising access to testing and care for all Nigerian patients, even in the most remote communities. Continuous medical education for healthcare professionals must be prioritised to ensure the patients’ first and most important contact points are up-to-date with the latest guidelines and treatments. Addressing hepatitis as a public health priority is essential to reducing the alarming mortality and morbidity rates in Nigeria. By enhancing awareness, creating robust education initiatives and collaborating to improve healthcare infrastructure, we can move closer to achieving WHO’s 2030 targets of diagnosing 90 per cent of individuals with hepatitis and treating 80 per cent of those diagnosed. 

As individuals, each of us has a role to play. And Dr. Adda’s inspiring journey proves that a single voice can make a significant impact. Imagine if we added just a few million more voices to remind our communities that everyone deserves to get tested for a better chance at life, and where treatment is needed, everyone deserves access to lifesaving care.

* Mr. Taboada is the Network Lead, Anglo West Africa at Roche Diagnostics and Dr. Adda is Public Health Expert & ex-President, the World Hepatitis Alliance