By ML Mazaba
Zambia National Public Health Institute, Lusaka, Zambia.
Correspondence: Mazyanga Lucy Mazaba (mazyanga.mazaba@znphi.co.zm)
Download PDF
Citation style for this article: Mazyanga ML.The epidemiology of liver disease as we celebrate world liver day. Health Press Zambia Bull. 2018;2(4); pp 1-3.
Exactly a year after the official launch of The Health Press –Zambia (THP – Z) THP-Z extends its heartiest congratulations to the World Health Organisation (WHO) on the occasion of the Organisation’s 70th Anniversary for the many meaningful successful years of its existence. Every year on 7th April the WHO takes time to create awareness on issues of international public health concern.
In the last 7 decades, the WHO has made efforts in spearheading eradication or elimination of specific diseases; Small pox is history now, others such as polio, measles, rubella, neonatal tetanus, Eliminate Lymphatic Filariasis are some among many others targeted for either eradication or elimination.
One of the founding principles of the world Health organisation is “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” The 2018 theme ““Universal health coverage (UHC): everyone, everywhere” stands on this principle. According to the WHO more than half the world’s population does not receive the essential health services they need [1].
Some key messages below
According to the organization’s Director General Dr Tedros Adhanom Ghebreyesus, WHO is committed to ensuring health for all emphasizing that ““Good health is the most precious thing anyone can have” [2].
Although the WHO Regional Director for Africa Dr Matshidiso Moeti recognizes that Access to treatment and essential services has improved in the region she reiterates the organisations commitment to supporting Member States to achieve UHC and challenges the leadership through the following clarion call:
“Today, I call on African leaders to live up to the SDG pledges they made in 2015, and to commit to concrete actions. WHO will continue to support countries to build stronger, more resilient and responsive health systems through UHC to advance #Health for All” [3].
The WHO Representative in Zambia Dr Nathan Bakyaita in the article submitted to this issue says “At country level, the role of WHO is to support the development of the health system to move towards and sustain UHC, and to monitor progress”.
According to the Honourable Minister of Health in Zambia, Honourable Dr Chitalu Chilufya, the highest level of commitment to ensuring UHC in Zambia has been shown through the action by His Excellency the President of the Republic of Zambia Mr. Edgar Chagwa Lungu in signing into law the National Health Insurance Bill.
The Honourable Minister of Health Dr Chitalu Chilufya describes it this way in a statement issued to The Health Press – Zambia “Act No. 2 of 2018 signed by President Edgar Chagwa Lungu establishes the National Health Insurance Scheme that will ensure that all Zambians have equitable access to quality health care irrespective of their status in society. This is the first time in Zambia since independence that such a progressive Bill has seen the light of day”. The Health Press – Zambia
In this issue we look at various perspectives indicating the position of Zambia in UHC issues: ‘Universal Health Coverage: A Perspective of the WHO Country Office In Zambia’, ‘The Solidarity Model: Zambia Public Health Insurance Scheme’, and a Press Statement on the National Health Insurance Scheme’. The issue has also published a review on ‘Microbial translocation and its clinical significance’ and an original article on ‘Dental Caries on Permanent Dentition in Primary School Children — Ndola, Zambia, 2017’.
The THP-Z also celebrated along, the World Liver Day which falls on 19th April. Although the 2018 theme is “Riding new waves in liver diagnosis, staging and treatment,” the editorial focuses on documenting the baseline information liver disease through a short article owing to the paucity of information titled ‘the epidemiology of liver disease as we celebrate World Live Day in 2018.’
The epidemiology of liver disease as we celebrate World Liver Day
Liver disease is a broad term for a variety of liver diseases comprising over 100 types of liver disease. The functions of the liver include the production of protein, blood clotting and metabolism of iron, cholesterol and glucose. The following may affect the functions of the liver: excessive drug use, alcohol abuse, and hepatitis A, B, C, D and E. The common signs and symptoms for liver disease include: nausea, vomiting, abdominal pain in the right upper quadrant and jaundice. Fatigue, weakness and weight loss may also occur. These signs and symptoms tend to be specific for a particular liver disease until late-stage liver disease (cirrhosis) and liver fails to function [4-6].
Persons with liver disease frequently do not present with signs and symptoms or show obvious signs of liver disease or damage unless over 75% of the liver is damaged. The common liver tests and screening include: history of alcohol abuse, liver function tests (Alanine aminotransferase – ALP, Aspartate aminotransferase – AST, Alkaline phosphatase – ALP, Gamma glutamyl transferase – GCT or Gamma GT, Bilirubin, Albumin, Prothrombin time – PT or International normalized ratio – NR), antibody or antigen tests for hepatitis A, B or C [7].
Zambia is ranked 42nd with a liver disease death rate per 100,000 of 26.02 in the world; and 22nd in Africa. Out of 47 countries in Africa, 43 are among the top 100 countries in the world with highest liver disease death rates [8]. Vaccination at birth for Hepatitis B virus has been shown to reduce the incidence of chronic liver disease [9]. Zambia initiated the Hepatitis B vaccine given through a pentavalent vaccine at week 6, 10 and 14 of age in the childhood vaccination schedule in order to prevent liver disease in the under 5 years age group. It has been estimate that full coverage of three doses of vaccine in sub-Saharan Africa is estimated to be around 67% [10]. With this low coverage, it will take a long time to have an impact on the reduction of the liver disease morbidity and mortality.
Epidemiology of liver disease
Although there is scanty information on the epidemiology of liver disease in sub-Saharan Africa, the burden of the disease in this region has increased by 57% in 20 years. No age, sex, region or race differences have been observed to be associated with chronic liver disease [11].
Conclusion
The first conference on liver disease in Africa will be held on 13-15 September 2018 in Nairobi, Kenya [12]. We hope in this conference that there will be advocacy for making a difference in finding ways to reduce the burden of liver disease in Africa. The increasing trend in morbidity and mortality rates due to liver disease will require the mobilization of resources from governments, non-governmental organizations, cooperating partners and public health experts to curtail these rates. The consoling fact is that the majorities of liver disease are preventable, treatable or even curable [13]. Access to diagnostic testing and treatment would be essential in the fight against liver disease.
References
1. WHO. URL: http://www.who.int/campaigns/world-health-day/2018/en/.
2. WHO. URL: http://www.who.int/mediacentre/news/releases/2018/who-at-70/en/.
3. Speech read at the celebration of World health Day in Zambia on 15th April 2018.
4. Wedro B. Liver disease. URL: https://www.medicinenet.com/liver_disease/article.htm#liver_disease_facts.
5. Spearman CWN. Liver disease in South Africa. CME 2005;23(8):369-70.
6. Friedman LS, Keeffe EB (eds). Handbook of liver disease.
3rd edition. Philadelphia, Elsevier Saunders, 2012.
7. British Liver Trust. Tests and screening. URL: https://www.britishlivertrust.org.uk/liver-information/tests-and-screening/.
8. World Life Expectancy. Liver disease cause of death. URL: http://www.worldlifeexpectancy.com/africa/liver-disease-cause-of-death.
9. Williams R. Global challenges in liver disease. Hepatology 2006;44(3)521-6.
10. World Health Organization Position Paper. Hepatitis B vaccines. WHO Wkly Epidemiol Rec 2009;84:405–20.
11. Spearman CW, Sonderup MW. Health disparities in liver disease in sub-Saharan Africa. Liver Int 2015;35:2063-271.
12. First Liver Conference in Africa. URL: http://regist2.virology-education.com/meetingprospectus/2018/COLDA.pdf.
13. Sarin SK, Maiwall R. Global burden of liver disease: A true burden on health sciences and economies!! URL: http://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/global-burden-of-liver-disease-a-true-burden-on-health-sciences-and-economies.