The spread of viral hepatitis in Togo, where there is little awareness of the disease and most people discover by chance that they are infected, is causing concern, says the Save Africa from Hepatitis Society (ASADH), which is working with the Health Ministry to combat the disease.
No country-wide survey has yet been conducted to establish an official prevalence rate for hepatitis in Togo because the disease is not one of 10 priority diseases identified by the Togolese government, so there is no national programme against it.
However, since 2011 ASADH has been conducting ad hoc screening campaigns in Lomé, where 20 percent of the population lives.
Of the 2,242 people screened in three districts of the capital from 16 to 28 July 2012, 223 carried the hepatitis B virus, and 28 had hepatitis C, equating to prevalence rates of 9.94 and 1.25 respectively. "We recorded a [combined] prevalence rate of 15 percent in Adidogomé District,” said ASADH president Folly Anyovi.
While the prevalence rate for hepatitis C is below the 3 percent World Health Organization (WHO) threshold, hepatitis B remains higher than the 8 percent limit.
"Viral hepatitis is raging in Togo. Types B and C combined have a higher prevalence than HIV/AIDS," said Anyovi.
Hepatitis is an inflammation of the liver mainly caused by a viral infection. There are five main hepatitis viruses referred to as types A, B, C, D and E that are of greatest health concern. Types B and C are the most common cause of liver cirrhosis and cancer.
"It all started with general fatigue and headaches. I then went to the hospital where I was put on a drip. A few days later, the fatigue became more acute. I thought it was malaria until the day when, at the insistence of a friend, I did the test which turned out positive. I then realized that it was hepatitis B," said Constantin Tassankou*, 30.
"The Red Cross first detected that I had hepatitis B. I am a blood donor and that day I was stunned to learn that my blood was infected. I could not believe it and I took advantage of the ASADH campaign to have a new test, which also showed positive," Mibar Mouaka* told IRIN.
Judith Réla*, 24, learned she had hepatitis B after antenatal tests. "At first I was depressed because I had learned that hepatitis B is incurable. Midwives telling me the disease would disappear by itself did little to reassure me. Later, I saw a TV programme about the ASADH NGO… and I joined up. Now I know that a healthy diet can delay progression of the disease until money can be found for treatment."
"Senegal and Mauritania are rare examples of countries in the West African sub-region to have a national programme against hepatitis," said Anyovi, who pointed out that to treat hepatitis B in Togo currently costs 8-12 million CFA francs (US$7,985-15,973).
Targeting women, children
The 2012 ASADH screening campaign in Lomé (to mark World Hepatitis Day on 28 July) also showed a prevalence of 2.65 percent for hepatitis B in children under 15, and 6.17 percent in women, lending credence to ASADH’s strategy of providing more care to females and especially pregnant women as "prenatal screening for hepatitis prevents transmission of the virus from mother to child," said Anyovi.
His ambition is to "immunize at no charge all Togolese women and babies from birth against the disease."
According to experts, children born to infected mothers are at risk of dying from liver cancer. The Togolese Ministry of Health offers vaccinations to children against the virus - but only when they are over three months old.
In the north of the country, French NGO Tawaka screened 225 women and vaccinated 12 children born to infected mothers at Saint-Luc de Tchannandé clinic in Kara Region from January to May 2011. The proportion of women infected with hepatitis B, based on this very small sample, is about 15 percent, indicating that it could be a serious problem there.
*not a real name