A CRISIS IN THE MAKING! LIVER DISEASES ARE KILLING MORE SIERRA LEONEANS EVERY YEAR BUT NO ONE SEEMS TO NOTICE.

A CRISIS IN THE MAKING

www.sierraliverfoundation.org

LIVER DISEASES ARE KILLING MORE SIERRA LEONEANS EVERY YEAR BUT NO ONE SEEMS TO NOTICE.

As the largest internal organ, the liver is tied into virtually every critical process of the body. Despite its vital role in maintaining overall health, the liver is routinely ignored by the majority of Sierra Leoneans. Unfortunately dismissing the liver has dangerous consequences to quality of life and life expectancy but few understand just how high the stakes are.

There is evidence that the 11 years post-war situation in Sierra Leone is more   Addiction to drugs than pre-war situation. However, there is also another specific post-conflict problems that occur, such as the relatively large number of sexually abused victims with unwanted or abandoned children still around. The Post Ebola itself caused a great harm to many people including people whose house were quarantined, Medical workers who were not using the proper Personal Protective gears. All of these people have in one way or the other got serious problems with their Liver.

Over a period of ten to fourteen years, the death rate from liver disease has risen greatly. Those directly involved in the care of liver disease patients and blood testing for various problems has seen this tragedy play out again and again in hospitals across the country. And yet there is no sense of urgency to collect or evaluate data to measure the true scope of the disease burden nor is there a sense of urgency to deal with it. The hard Alcohol abuse made by our Asian brothers   (Indians) does cause liver disease however a lack of data and a persistent assumption and stigma linking liver disease with only alcohol have made it difficult to overcome both public and government apathy. Government should take note that the money spent on health and lives lost from the Alcohol consumption is far greater than tax being collected from the manufactured and sales of Alcohol in the country.

It is roughly estimated that 2 in Seven Sierra Leoneans, or nearly million people, has some form of liver disease. The most common forms of liver disease – viral hepatitis, fatty liver disease and liver cancer – are all on the rise which means that the increase in death rates from these diseases and their complications will continue to climb if there is no effective intervention. Some of these deaths are misinterpreted as a Black magic done to someone by another suspected person in the family or mostly women.

Liver disease does not need to be a death sentence.  Effective screening, diagnostic and treatment options MUST exist for many patients with coordinated strategies, supportive government policies and financial investments in patient care and research, liver disease will continue to strike from the shadows taking lives and exacting a high toll on the nation’s health care systems. The key findings from this Note highlight missed opportunities for prevention, gaps in care and the human impact of liver disease.

All major forms of liver disease are increasing in Sierra Leone

•      Liver disease (Hepatitis) can be difficult to diagnose because the symptoms can be vague or even non-existent until the disease is advanced.

•      It’s estimated that one in Seven Sierra Leoneans, or more than One million people, has some form of liver disease.

•      95% of deaths from liver disease are due to chronic hepatitis B and C, non-alcoholic fatty liver disease, liver cancer and alcoholic liver disease.

•      Viral hepatitis (specifically chronic hepatitis B and C) is far more common and more infectious than many other infectious diseases, including HIV, and affects more than 500 million worldwide and an estimated 600,000 in Sierra Leoneans

•      Liver failure related to hepatitis C is the leading cause of liver transplants.

•      Liver cancer is one of the few forms of cancer on the rise and liver cancer death rates related to hepatitis B are predicted to rise by 50%. The relative contribution of chronic hepatitis B and C, alcoholic liver disease and non-alcoholic fatty liver disease to the rising death rate from liver disease is unknown.

•      An estimated 10% of Sierra Leoneans, or 700,000 people, are obese. Fatty liver disease linked to obesity is the most common form of liver disease in Sierra Leone.

•      In Sierra Leone, increase in alcohol consumption by youths has increased in cirrhosis deaths in men and women.

Too many Sierra Leoneans are dying because liver disease is under-diagnosed and under-treated.

The most severe consequences of liver disease can be avoided through prevention or through early detection but we are missing opportunities to intervene.

•      Hepatitis B and C often have no symptoms until complicated by liver cancer, cirrhosis and liver failure. Despite the risk and the high prevalence, there are no widespread screening programs for either disease.

•      90% of infants who contract hepatitis B will develop life-long infection and yet only One Known Doctor offer immunization.

•      Less than 10% of hepatitis B patients and less than 25% of hepatitis C patients have been treated in neighboring Countries like Senegal and Ghana with high cost, restrictive reimbursement policies, lack of health care resources and poor understanding amongst patients and primary health care providers.

•      In Sierra Leone, the most potent drug therapies for hepatitis B are not available for reimbursement.

•      Liver cancer is the leading cause of death of hepatitis B patients and a major cause of death for patients with other chronic liver diseases. Although liver cancer can be successfully detected and treated if caught early, there are no government screening recommendations for at-risk patients.

•      Government agencies spend 5 to 10 times more on research into diseases that affect significantly fewer people than hepatitis B or C. HIV/AIDS, TB, Cancer, and other diseases have free treatment and centers but not for any Liver related Diseases.

Treating liver disease is costly but ignoring it will cost even more in lives and resources.

•      Liver transplants cost more than $100,000 per person including hospital costs and immunosuppressive drugs.  Treating hepatitis B may cost $1,000-$2,000 per year for 10-20 years while a course of treatment for hepatitis C may be $5,000-$7,000.

We need to do more to fight liver disease...and we need to do it now.

Unlike other major diseases, there has been no national strategy put in place for a public health response to liver disease.  Without a coordinated effort involving investment and resources for prevention, screening, treatment, patient care and research, thousands of Sierra Leoneans will die needlessly. The Sierra Liver Foundation, in partnership with liver experts from across the country, is sounding the alarm and recommending short-term and long-term solutions to help defuse this ticking time bomb. We urge federal and provincial/territorial governments and health agencies to make liver disease a priority and to act to protect the health and well-being of Sierra Leoneans of all ages.

Key recommendations:

1.    Urgently Support the Sierra Liver Foundation to raise the Awareness the  of Liver health countrywide

2.    Ministry of health and Sanitation, in conjunction with other health care givers, must establish a national liver disease strategy.

3.    Encourage family physicians to incorporate liver enzyme (ALT) screening into all annual physicals.

4.    Conduct a national seroprevalence survey with oversampling in high-risk communities to determine the prevalence of hepatitis B and C in Canada and identify the communities with the greatest need for resources.

5.    Bring in More sophisticated devices for liver health testing.

6.     Increase treatment capacity by:

a. Establishing in-patient units and out-patient clinics staffed with trained physicians and nurses to care for liver disease patients in major urban and regional hospitals in each province.

b.  Setting up provincial funding resources for nurse practitioners specializing in liver disease.

c. Recruiting family physicians to treat patients as part of hepatitis treatment groups.

7.    Mandate standardized provincial/territorial reporting procedures for acute and chronic hepatitis B and C with information being collected and collated by the Public Health Agency of Sierra Leone and make it available to Sierra Liver Foundation.

8.    Implement universal neonatal hepatitis B immunization with a  catch-up program for provinces switching from an adolescent  vaccination program. Harmonize hepatitis B immunization  programs between provinces for high-risk adults.

9.    Simplify and improve coding for liver disease procedures and deaths.

10. Establish liver cancer (HCC) screening programs for all at-risk patients with outcome tracking and quality assurance protocols. 

11. Enhance resources (equipment and personnel) at existing regional cancer centres to facilitate multidisciplinary care of liver cancer.

12. Improve access to treatment for hepatitis B and C patients by establishing less restrictive reimbursement policies based on the most up-to-date approaches to the management of these diseases and not strictly on cost of treatment. Eliminate reimbursement restrictions based on ALT level and presence of cirrhosis. 

13. Establish research programs for hepatitis B and C that examine innovative ways to deliver care.

The Sierra Liver Foundation commissioned this report to show — for the first time – the true scope of liver disease in this country. Using information from various sources including government, academic and institutional databases and individual treating physicians, our experts collected facts and figures and extrapolated data on the most prevalent forms of liver disease. By publishing this report, we are issuing  a call to action to federal and provincial governments to address this serious health issue for the sake of all Sierra Leoneans

About the Sierra Liver Foundation

The Sierra Liver Foundation (SiLiFo) is the first organization in Sierra Leone devoted to providing support for research and education into the causes, diagnoses, prevention and treatment of all liver disease. Through our chapters across the country, the SiLiFo strives to promote liver health, improve public awareness and understanding of liver disease, raise funds for research and provide support to individuals affected by liver disease.

Liver Disease in Sierra Leone: The Silent Killer  ‘ A Crisis in the Making’ was prepared by Edward Jeffrey Boima

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