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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