कसको शिक्षा कस्तो शिक्षा

 

 Hepatitis B Diseases Burden and Services Provision and Future Roadmaps in Nepal

Keshab Rijal ¹

¹ Fellowship of KoICA SP, MPH, Global Health Security Program, Yonsei University, Seoul, South Korea

Background

Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. However, the number of deaths due to viral hepatitis is increasing over time, while mortality caused by tuberculosis and HIV is declining. Most viral hepatitis deaths in 2015 were due to chronic liver disease and primary liver cancer. An early win in the global response to viral hepatitis was achieved through the effective scaling up of the hepatitis B vaccine in 2015, global coverage with the three doses of hepatitis B vaccine in infancy reached 84%. This has substantially reduced HBV transmission in the first five years of life, as reflected by the reduction in HBV prevalence among children to 1.3%. Access to affordable hepatitis testing is limited. Few people with viral hepatitis have been diagnosed and reported.

Purpose:

The purpose of this equity analysis is to identify the inequality of disease burden and service access and provide policy recommendations for redesigning services towards HPB control.

 

Methods:

Principally this is secondary review and analysis. Key references searched were free online available related published articles in Google search. The recent disease burden in Nepal, annual report of the department of health services and WHO recent publications also analyzed. The current status of hepatitis B infection and services available for control and treatment measures are discussed.

Findings and Discussion:
Nepal, Bangladesh, Bhutan, and Thailand have become the first countries in WHO South East Asia Region to achieve Hepatitis B control, after childhood immunization data that showed consistently over 90% coverage with Hepatitis B vaccine doses provided during infancy for past many years.

Studies conducted among five-year-old children in these countries corroborated the high immunization rates, and that Hepatitis B prevalence in these four countries among children was less than one per cent.
Considering the low prevalence setting at the national level, the hepatitis B vaccination is not administered at birth by the National Immunization Program.
A study among mothers and under 5 years of children has revealed the high PR of HPB infection among the indigenous ethnic groups in the upper mountain region of Nepal; 17 % mothers and 48% of children who are living with HPB positive mothers.

 

Recommendations:

At the birth dose of HPB vaccine administration under routine immunization is highly recommended. Targeted prevention, control and treatment services to specific high PR group community and the high-risk group is of serious concern. So the specific intervention to address this problem is urgently and importantly recommended and it should be scaled up in a gradual manner to cut the chain of infection and achieve the target of elimination. Further study and analysis of high PR of HPB in high Himalayans people is of great scope of work. Cross risk at the urban area including the homo/ hetero unsafe sexual practices and injectable drug users should be mapped and plan specifically.

 

Keywords:

Hepatitis B, Prevalence, Control, Coverage, Risk factors