REPORT ON VIRAL HEPATITIS AWARENESS CAMPAIGN LAUNCH UNDER THE THEME “HEPATITIS CAN’T WAIT IN SOUTH SUDAN''

Minister of Health Hon Elizabeth Delivery Her Speech During the Commemoration of the World Hepatitis Day

LIST OF ACRONYMS 

WHO:	World Health Organization
HIV:	Human immunodeficiency virus
HBV:	Hepatitis B Virus
HCV:	Hepatitis C Virus
MoH:	Ministry of Health
ARDI:	Agency for Research and Development Initiative
FoH:	Friends of Humanity
EB:	Evidence Based Medical Center
CHB:	Chronic Hepatitis B Virus
LMIC:	Low- and middle-income countries
SSA:	Sub-Saharan Africa
HCC	Hepatocellular Carcinoma

INTRODUCTION

 Friends of Humanity and Agency for Research and Development Initiative in collaboration with the National Ministry of Health and World Health Organization commemorated World Hepatitis Day with support from Shabab le shabab Health Alliance, Jerusalem Church ,Business partners including SINCO, M-Gurush & Rak media, International commercial Bank, Sonia LTD, Global Care pharmacy, Generous Pharmaceutical company, and the participation of Private Partners for Health that included Queen Medical Care, EB medical center, St. Kizito Medical Centre, Mauna Medical Centre who supported in organizing, financing and pulling of human resources to conduct the launching of the Viral hepatitis awareness and free testing during the commemoration of world hepatitis day on the 28th July 2021 and subsequent days for a period of one week (28^th July to 8^th August 2021) in Juba, South Sudan.  This campaign had drawn national and international partners including diplomatic missions especially the Embassy of the Arab Republic of Egypt represented by third secretary for political, Economic and cooperation department participated in the launching of the campaign together with the World Health Organization country representatives  and Honorable Minister of Health, Hon. Elizabeth in commemorating the world hepatitis day on the 28^th July 2021 under the theme ‘Hepatitis can not wait’ forth “South Sudan can not wait”. 

The activities were able to reach about 579,000 people with preventive messages using radio, megaphone, social media, and physical health education in primary and secondary schools as well as Churches. The team organize screening centers with counselling and testing of 667 people for Hepatitis B and C with 50 positive cases detected for Hepatitis B and one case detected positivity for Hepatitis C.

Viral hepatitis is a serious global public health problem affecting billions of people globally, and both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are rapidly spreading in the developing countries including South Sudan due to the lack of health education, poverty, illiteracy, and lack of hepatitis B vaccination. Also, there is lack of information on their prevalence among the general population. So, a population-based serological survey would be appropriate to conduct especially in Juba and other key towns to determine the prevalence and risk factors of HBV and HCV infections as well as co-infection with HIV.CONTEXT In South Sudan prioritization of viral Hepatitis is still picking-up shape with the launch of the national strategic plan and treatment guideline, yet there are still huge gaps to be addressed especially vaccines and launch of free testing to ensure population know their status to take action as viral hepatitis is the greatest silent killer all over the world. Worldwide over 2 billion persons have been exposed to HBV infection and about 400 million of the exposed are living with CHB infection with 248 million chronic carriers particularly in LMICs. WHO estimates that about 90% of HBV related deaths are associated with chronic HBV infection while less than 10% are associated with acute infection. In addition, approximately 4.5 million new HBV infections occur each year of which a quarter progresses to liver disease (WHO, 2017). In the US, China and Sub-Saharan Africa for which South Sudan is part, it is estimated that the cases of CHB are 1.4 million (USA), 93 million (China) and 65 million (Sub-Saharan Africa) (CDC, 2016). HBV carrier rate in highly endemic regions is greater than 8%, in middle endemic regions is between 2 – 8% while in low endemic regions is less than 2% (WHO, 2015). HBV kills 686,000 people every year worldwide, every 50 seconds one person dies from the complications of this vaccine preventable disease.  Overall HBV infection accounts for about 45% of cases of HCC and 30% of cirrhosis with much higher proportion in LMICs (WHO 2017). HBV is a viral pandemic and is 10 times more infectious than HIV/AIDS. The mode of spread is predominantly by percutaneous or mucosal exposure to infected blood and various body fluids such as menstrual, vaginal and seminal fluids and the virus is able to survive for up to 7 days outside the body. Perinatal transmission is the major route of transmission accounting for 90% of infection in infants and 30-50% in children between 1 – 4 years will develop chronic HBV with 21% perinatal deaths and about 25% of adults who become chronically infected during childhood die from HBV-related liver cancer or liver cirrhosis. Horizontal transmission, including household, inter-familial, and especially child-child is also important. Both sexual and oral transmission of HBV may occur, particularly in unvaccinated MSM and Heterosexual persons with multiple sex partners or contact with sex workers. Transmission of the virus may also result from accidental inoculation of minute amount of blood or fluid during medical, surgical, dental procedures or from razors and similar objects contaminated with infected blood (WHO, 2017; MoH, 2015). Acute HBV is usually a self-limiting disease marked by acute inflammation and hepatocellular necrosis, with the case fatality rate of 0.5 - 1% (WHO, 2017). The symptoms include jaundice, fatigue, nausea, abdominal pain, and loss of appetite, darkening of urine, fever, aching joints. CHB is a silent killer, there are often no symptoms even blood tests for liver enzymes may be normal. By the time symptoms appear, it is often too late for treatment to be effective. More than 90% of healthy adults who are infected with hepatitis B recover completely or get rid of the virus within 6 months, 6-10% of infected adults will develop chronic hepatitis B.  The main stay of HBV prevention is HBV vaccine conferring 90 – 100% protection in those who have attained sufficient antibody responses for 10 years and more, completed doses are in three phases, at start (0 days), one month after and six months after the first dose (MoH, 2015; Schmidt et al., 2013).

FINDINGS

Table 1: Location for the campaigns and free testing for HBV & HCV

Place Test was Conducted		Test Results		Total
Negative	Positive HBV	Positive HCV
Midan Jamus (Munuki)	87	16	1	104
Public Health Lab	50	1	0	51
Munuki Play ground	14	4	0	18
St. Kizito Parish	101	9	0	110
St. James Chapel	64	6	0	70
Gushen ECSS	118	8	0	126
Lologo One	135	7	0	142
Lologo two	46	0	0	46
Total	615	51	1	667

Table 2 Age distribution among participants who voluntarily tested for HBV & HCV and the results

Age Group of Patient			Test Res	ults	Total
Negative	Positive HBV	Positive HCV
10 - 20	Count	123	8	0	131
% Within Age Group of Participants	93.9%	6.1%	0.0%	100.0%
21 - 30	Count	179	20	0	199
% Within Age Group of Participants	89.9%	10.1%	0.0%	100.0%
31 - 40	Count	171	16	0	187
% Within Age Group of Participants	91.4%	8.6%	0.0%	100.0%
41 - 50	Count	84a	5a	1b	90
% Within Age Group of Participants	93.3%	5.6%	1.1%	100.0%
51 and above	Count	58	2	0	60
% Within Age Group of Participants	96.7%	3.3%	0.0%	100.0%
Total	Count	615	51	1	667
% Within Age Group of Participants	92.2%	7.6%	0.1%	100.0%

The table above indicates the 667 persons who were voluntarily counselled, tested and offered their results for the both Hepatitis B and C. with Hepatitis B prevalence standing 7.6% as compared to the WHO 2015 report on HBV carrier rate among endemic regions of 8% and HCV of 0.4%. 54%(359/667) of the number tested were male of which 10%(36/259) are positive for Hepatitis B 

Table 3: Sex distribution among participants who voluntarily tested for HBV & HCV and the results

Age group of Patient	Test Results	Number of people	Total
Male	Female
10 - 20	Negative	60	63	123
Positive HBV	5	3	8
Total	65	66	131
21 - 30	Negative	103	76	179
Positive HBV	17	3	20
Total	120	79	199
31 - 40	Negative	95	76	171
Positive HBV	11	5	16
Total	106	81	187
41 - 50	Negative	39	45	84
Positive HBV	2	3	5
Positive HCV	1	0	1
Total	42	48	90
51 and above	Negative	25	33	58
Positive HBV	1	1	2
Total	26	34	60
Total	Negative	322	293	615
Positive HBV	36	15	51
Positive HCV	1	0	1