The high prevalence of hepatitis among Ghanaian children

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The high prevalence of hepatitis among Ghanaian children Powered By Docstoc
					MPH Capstone Project
     Evelyn Aboagye
     May 10th , 2010
PROBLEM DEFINITION

 Hepatitis B (Hep B) viral infection is a vaccine
 preventable illness that still affects 2 billion
 people worldwide

 Viral transmission occurs through exposure to
 blood/blood products and other body fluids

 Vertical (mother to child) or horizontal (child
 to child) transmission
PROBLEM DEFINTION
 The hepatitis B virus (HBV) affects the liver resulting in
  acute disease that most people can recover from.

 However, infection can also lead to chronic liver disease
  including cirrhosis and liver cancer.

 Chronic Hep B infection is an identified risk factor for the
  development of liver cirrhosis and liver cancer.

 An estimated 350 million people have chronic infection

 25% of adults deaths are related to chronic infection.
PROBLEM DEFNITION

 In highly endemic Hep B areas, acquisition of
 infection is usually in infancy and childhood.

 Childhood acquisition impacts development of
 chronic infection and its sequelae

 90% of babies infected perinatally will develop
 chronic infection

 30 to 50% of children under 5 years who acquire
 the infection will develop chronic infection
MAGNITUDE OF THE PROBLEM
 40% of Ghana’s population is below 15 years of age.


 Overall prevalence of Hep B in Ghanaian children is 21%
  (10- 37%)

 Doubles from < 5 years to > 12 years


 1 in 3 children between 5 and 15 years already have
  serological evidence of infection

 6%-16% seroprevalence with pregnant women


 8.3% Maternofetal transmission
MAGNITUDE OF THE PROBLEM

 HBV is the primary viral cause of morbidity
  and mortality associated with liver disease
  in Ghana

 70% of diagnosed cases are between 20 to
  49 years

 40% were HBsAg positive.
KEY DETERMINANTS

 Lack of awareness of Hep B infection and its
 sequelae
  - Lack of data on knowledge and attitudes
  - Recent media talk

 Sociocultural norms
  - Sharing of personal items
  - Cultural practices such as tribal marks
KEY DETERMINANTS

 Geographical location
 - Rural vs urban

 Lack of comprehensive national policy
 - EPI program allows immunization of babies at 6, 10 and
 14 weeks of age using pentavalent vaccine
 - No program for children born before vaccine introduction
 and babies
 - No maternal screening

 Vaccine costs
  - Pentavalent + monovalent vaccines brings additional costs
PREVENTION/INTERVENTION STRATEGIES
 Universal Infant immunization
  - Recommended by WHO for countries with Hep B
 prevalence > 8% including newborns

  - Ghana introduced hep B immunization in 2002 in the
 Expanded Program of Immunization (EPI)

  - Pentavalent vaccine (Diptheria, pertussis, tetanus, H.flu
 and Hep B)

 - Given at 6, 10 and 14 weeks

 - No provisions were made for newborns and children born
 before vaccine introduction
PREVENTION/INTERVENTION STRATEGIES
 Maternal testing and immunization of at risk
 babies with Hep B vaccine and HBIG
 administration
  - Not part of current maternal health services

  - Some developed countries

  - Hep B vaccine and HBIG unavailable and not covered
 under National Health Insurance Scheme

 Public information and Education
  - Some discussion in civil society and media but limited

  - Does not guarantee behavior and cultural change
RECOMMENDATION

 Comprehensive immunization policy including
 provision of monovalent hep B vaccines in EPI

 Newborn, childhood and adolescent immunization
 using existing cold chain services

 Retraining health personnel in timely vaccine
 administration

 Hep B immunization should be covered as part of
 preventive services in NHIS
RECOMMENDATION

 Key stake holders support – parents, health
 care workers, schools, government of Ghana
 and its immunization partners

 Child welfare clinics, home visits, primary and
 high school entry points to identify those in
 need of immunization
CONCLUSION

 To reduce the current prevalence of Hep B among
Ghanaian children and interrupt viral transmission
 in the long term, there is the need for provision of
  monovalent Hep B vaccines to all newborns and
    unimmunized children with key stakeholder
                      support.
Thank You