By Johnstone Kpilaakaa
Dr Peter Yawe lost his 20-year-old cousin to liver cancer caused by chronic Hepatitis B Virus (HBV) infection in 2015. Four years later, during his days as a medical student at the University of Jos, he started a radio program.
Through the weekly radio program on ICE 96.1 FM, Jos, listeners got information on the relevance of hepatitis screening, lifestyle modification, dieting, and exercising. “The program— One Liver, offers opportunities for youths—who are the major listeners of the program—to actively participate in question-and-answer sessions led by invited medical experts,” says Dr. Yawe. The program was instantly widely accepted, reaching over 20,000 listeners weekly, in Jos North & South and parts of Bauchi and Kaduna.
Statistically, about 290,000 people die from Hepatitis C virus, HCV-related complications, annually, making it one of the world’s most prevalent infectious diseases. Despite the high number of people suffering and dying from the disease, only 21% know their HCV status.
In Nigeria, an estimated 20 million people are chronically infected with HCV and other strains of hepatitis like Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis D virus (HDV) and hepatitis E virus (HEV), according to the World Health Organization (WHO). According to the WHO, patients with chronic hepatitis infection have an increased risk of progressive liver damage and scarring, liver disease, liver cancer and even death. Although it can be prevented through vaccination, there is no cure. However, there are available medications to reduce the viral load and slow the progression of liver cancer.
For residents in local Jos communities, the One Liver radio program created much needed awareness about liver health. “Since I started listening to the show, I have been more aware of the dangers of hepatitis and I became more intentional about my lifestyle,” Olalekan Okelola, a listener of the One Liver radio programme told Social Voices. Mr Okelola would later get his first dose of the hepatitis vaccine through one of the outdoor campaigns and medical outreaches organized by Healthy Livercare Initiative (HLI).
As the radio show grew in reach and impact, HLI was initiated with a major objective of providing support and information through outdoor campaigns and medical outreaches in student communities and rural areas. The first medical outreach was in June 2019, at NTA TV College, Jos. Since then HLI has held other outreaches at Plateau State Polytechnic, Jos, University of Jos and Saint Loius College, Jos. As well as other suburban communities like Lamingo in Jos North local government.
“At Lamingo, we screened 128 people for both Hepatitis B and C. The positive-tested patients were referred to the Jos University Teaching Hospital for expert management, while the negative-tested patients for Hepatitis B were referred for vaccination at the epidemiology unit of the Ministry of Health, Jos branch,” Yawe stated. “We have a follow-up team that ensures these individuals get to these institutions”.
To commemorate the 2022 World Hepatitis Day, HLI says it screened and vaccinated about 1000 residents of Kabong, a suburban community in Jos North local government. One of the beneficiaries of the outreach said it was ‘impactful’.
“Several residents came out and they all expressed willingness to learn and improve on their behaviours,” Chief Nyam Gwom, a community leader in Kabong told Social Voices. “As an older person and a leader in the community, I was really enlightened. Following the outreach, I am more intentional about educating my subjects on the relevance of testing and healthy living,” he said.
Since the HLI commenced its outreaches, it became evident that cultural practices like scarification, female genital mutilation, male circumcision, and uvulectomy are a barrier to the fight against hepatitis.
“In some of the rural communities, we have reached, the indigenous people engage in some deeply rooted activities of cultural and social importance to them, activities such as ingestion of locally brewed alcohol; “burukutu”, sharing of sharp objects for tribal marks, in turn, propagate the spread of hepatitis and another liver-related disease,” Dr Yawe said. “Educating these people about the harms of their activities without disregarding their culture poses a major challenge.”
Since its a sub-urban community, Kabong has fewer of these practices. However, Chief Gwom believes that continued engagement with local policymakers will curtail these practices. “It is ignorance that makes us do some of these things. We are in a modern world, with more insights into various issues. If more of this advocacy is done in our communities, especially with local policymakers like community leaders and religious leaders, it will help to fight these harmful practices,” he said.
After recording success with its radio program and its outreaches, the medical outreaches had to ground to a halt as the pandemic hit. One Liver stopped airing because the management and production staff of the radio station who are mostly members of the Non-Academic Staff Union of Universities and Allied Educational Institutions (NASU) were asked to work from home.
With no access to communities, HLI developed an android mobile application, “LIKITA”, to provide relevant information about hepatitis and other liver diseases. The LIKITA application was designed to enable users locate medical experts and hospitals within their communities in Plateau State, the application also provides telemedicine services where these individuals can also call or chat via the app.
However, the adoption of LIKITA was very slow and is still dragging So far, it has recorded 100+ downloads since its launch on Google Playstore. Dr. Yawe attributes this to poor internet and smart penetration in rural communities where most of their activities are targeted. A LIKITA user, Chinedu Okejeme said “the app is quite innovative but needs a few upgrades”.
When Social Voices visited the app in December 2022, the live chat option was unavailable but the contacts of Dr. Yawe and another HLI volunteer, Dr. Simon Ogenyi were on the “contact us” page. Also, 11 Jos-based hospitals were listed on the database. The “medical information” page—which provides educative content about Hepatitis and other related issues—was also active.
Despite setbacks, HLI, has continually deployed behaviour change communication (BCC) as a response to eliminating Hepatitis. According to Niniola Williams, Managing Director at Dr. Ameyo Stella Adadevoh Health Trust (DRASA Health Trust), “behaviour change communication (BCC) is a core pillar in the fight against infectious diseases. Tackling public health challenges hinges on improving knowledge, attitude and practices such that people take charge of the role they play in improving their health and the health of those around them.”
“For hepatitis, there are sociocultural factors that could exacerbate the disease so BCC is a way to meet people where they are, understand what these unique societal factors are and design changes that involve these communities and align with their specific needs. Thus, the promotion of healthy behaviours through BCC cannot be overemphasized,” she added.
“Eliminating hepatitis in Nigeria by 2030”
In July 2022, the Federal Ministry of Health developed a National Strategic Framework for eliminating viral hepatitis in the country by 2030. This is an adoption of the Global Health Sector Strategy for Viral Hepatitis approved by the WHO member states during the 75th World Health Assembly in May 2022.
“The core pillars identified for attaining the 2030 target include infant vaccination, prevention of mother-to-child intervention, blood and injection safety, harm reduction, diagnosis, and treatment,” Nigeria’s Minister of Health, Dr. Osagie Ehanire, stated during the unveiling of the framework. “The need to create massive public awareness cannot be overemphasised. Together with this, we need to build the capacity of health care providers, expand access to diagnosis and treatment and improve community engagement as well as political leadership at all levels.”
Although the Nigerian government has not disclosed how much it has budgeted to eliminate this virus, it has described inadequate funding as a “major challenge in the drive to eliminate viral hepatitis”. According to a 2020 report by The Hepatitis B Foundation, “Nigeria, with its vast mineral, natural resources, and human capital, has what it takes to eliminate viral hepatitis by 2030. But it lacks the strong political will and financial commitment by governments at all levels to finance an elimination strategy.”
A 2019 study published by the Lancet Global Health states that over $58.7 billion is needed to eliminate viral hepatitis as a public health threat in 67 low-and middle-income countries—including Nigeria—by 2030. This means that each country needs about $876 million for national intervention, this will reduce new infections by 90% and mortality rate by 65%, the report added.
Mrs Williams believes that the government can leverage BCC to achieve its 2030 target she said “the government cannot do it alone. BCC requires engagement with other stakeholders such as multidisciplinary experts and nonprofit organizations like DRASA Health Trust. To fight against infectious diseases—including hepatitis—collaborations and partnerships are essential at the national and sub-national levels.”
This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.