Sahlhealth
Sahlhealth

Hepatitis in Kenya

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

KEMRI studied 389 patients with jaundice at four hospitals: Kenyatta National Hospital (Nairobi), Moi Teaching and Referral Hospital (Eldoret), New Nyanza Provincial General Hospital (Kisumu), and Coast General Hospital (Mombasa). They collected blood samples from the patients and tested them for acute and chronic hepatitis A to E viruses.

The results showed that the main cause of the disease in this group was chronic hepatitis B infection. A chronic infection is one that stays in the patient for a long time or keeps coming back. The second most common cause was acute hepatitis A. This type of infection is sudden. In this study population, they found no recent infection of hepatitis C, D, or E.

The study found that 6.3% of the total group of patients were infected with hepatitis A. Kisumu had 9.2% , the capital city , Nairobi had 6.3 % and Mombasa had 5.0%.

Previous studies have shown that by the age of 10 years, nine out of every 10 children in areas where hepatitis A is common are immune to the infection. Therefore due to this immunity, the number of adults who get the disease reduces. However, so many adults – 6.3% out of 382 could still get the hepatitis A infection.

This virus is passed on in water and food. It can remain in the environment for a long time and can survive processes such as filtration processes that are supposed to make food safe.

The finding suggests that adults should be immunized. Prevention efforts should also focus on managing the environment, water and waste.

About half (50.6%) of the patients tested had hepatitis B virus. Eldoret in Western Kenya had the highest number of cases at 92.9% of all Hepatitis B patients followed by Mombasa (81.8%), Kisumu (79.8%), and Nairobi (33.8%). Patients with chronic infections numbered 128 out of the 168.

Hepatitis B is transmitted through infected blood or other body fluids of an infected person.. It can cause liver cancer and cirrhosis, the long-term injury of the liver.

Globally, about two billion people have been infected with hepatitis B virus and about 350 million of them have the virus for life. The World Health Organisation has categorized Kenya as an endemic area.

Of all the samples collected, 3.9% were positive for Hepatitis C, when the positives were confirmed none was positive indicating exposure to the virus without active infection.

Types C and D, like B, are passed on in blood.

All specimens in the study were negative for hepatitis D virus.

The prevalence of exposure to hepatitis E virus was 8.1% this is higher than the 6.3% for hepatitis A, which was mentioned above as the second biggest cause of hepatitis and it affected more women than men. Hepatitis E is severe in women than men and in expectant mothers. it causes death among 20% of those infected.

Type E is also carried in water and food. In 2015, the World Health Organisation estimated that hepatitis E caused approximately 44 000 deaths globally – 3.3% of the deaths due to viral hepatitis.

Treatment options vary depending on which type of hepatitis you have. You can prevent some forms of hepatitis through immunizations and lifestyle precautions.

Causes of noninfectious hepatitis

Alcohol and other toxins

Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, thickening and scarring of the liver.

Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.

Autoimmune system response

In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.

Common symptoms of hepatitis

If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function.

Signs and symptoms of acute hepatitis appear quickly. They include:

  • fatigue
  • flu-like symptoms
  • dark urine
  • pale stool
  • abdominal pain
  • loss of appetite
  • unexplained weight loss
  • yellow skin and eyes, which may be signs of jaundice

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

How hepatitis is diagnosed

History and physical exam

To diagnose hepatitis, first, your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

Liver function tests

Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.

Other blood tests

If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.

Ultrasound

No alt text provided for this image

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:

  • fluid in your abdomen
  • liver damage or enlargement
  • liver tumors
  • abnormalities of your gallbladder

Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.

Liver biopsy

A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.

This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.

How hepatitis is treated

All types of hepatitis are treatable but only A and C are curable. Most people with hepatitis A or hepatitis B infection will recover on their own, with no lasting liver damage. In rare cases, people with hepatitis B will develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.

Tips to prevent hepatitis

Hygiene

Practicing good hygiene is one key way to avoid contracting hepatitis A and E. If you’re traveling to a developing country, you should avoid:

  • local water
  • ice
  • raw or undercooked shellfish and oysters
  • raw fruit and vegetables

Hepatitis B, C, and D contracted through contaminated blood can be prevented by:

  • not sharing drug needles
  • not sharing razors
  • not using someone else’s toothbrush
  • not touching spilled blood

Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection.

Vaccines

The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C. A vaccination for hepatitis E exists in China, but it isn’t available in the United States.

Complications of hepatitis

Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:

When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:

  • bleeding disorders
  • a buildup of fluid in your abdomen, known as ascites
  • increased blood pressure in portal veins that enter your liver, known as portal hypertension
  • kidney failure
  • hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function
  • hepatocellular carcinoma, which is a form of liver cancer
  • death

People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.

Sources:

  1. theconversation.com
  2. who.int
  3. healthline.com

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