Everyone should be tested for hepatitis B virus — Ojo

President of the Society for Gastroenterology and Hepatology in Nigeria, Dr. Segun Ojo, speaks with MOTUNRAYO JOEL on the need for more specialists and funding to combat the spread of diseases that affect liver and bladder systems among Nigerians

What is the latest research in gastroenterology and hepatology?

Gastroenterology and hepatology is a rather wide branch of medicine, which covers diseases of the entire gastrointestinal or the gut, the liver and gall bladder systems. There is so much work going on in all these areas at all times but we can only speak on a few progress made in the field.

Gastroenterology, as a discipline, is an emerging one in Nigeria. There are still very few specialists in this area when compared to the population of the country, thus when patients are referred to see gastroenterologists, some may have to travel long distances to see them. The laboratory diagnosis of GIT diseases is also problematic. There is a dearth of appropriate technical knowhow as well as necessary equipments needed to aid diagnoses in many of our hospital laboratories.

Viral hepatitis, an inflammatory disease of the liver caused by the  hepatitis B virus (HBV), should be considered as being topical because it is of a peculiar importance, being a very common disease among Nigerians.

Does this field of medicine enjoy adequate attention from the government in Nigeria?

Gastroenterology, like other branches of medicine, has for long been under-funded in Nigeria. In recent years, much attention has been focused on the control and management of HIV/AIDS with resultant neglect of other diseases including gastroenterological problems and especially, viral hepatitis.

Hepatitis C has seen major advancement in recent years, what is the latest development?

In Nigeria, I believe we should focus our attention on the hepatitis B virus rather than hepatitis C, which is much less prevalent. Regarding the treatment of viral hepatitis due to HBV, the public ought to know some basic facts. First and foremost that everyone needs to be screened for the infection- it affects a large number of people and the infection usually remains symptomatic until the late stages, which may be liver failure or liver cancer. Secondly, the disease should only be treated by experts known as Hepatologists, rather than by doctors who are not trained in the field. The best treatment environment is in a teaching hospital where the relevant diagnostic laboratory tests are available.

What is the biggest health-care challenge facing Nigeria today?

The biggest challenge facing Nigerians today is the lack of readily available and affordable health care facilities. Many Nigerians living in the rural areas do not have access to modern health care facilities. In the urban areas, most of the well equipped medical centres are private institutions and beyond the financial capabilities of middle and low income earners. The lack of adequate health insurance cover for Nigerians is also a hindrance to receiving necessary health care.

There seems to be a rising case of patients with severe liver disease, what is the cause?

As mentioned above, in Nigeria, the most common cause of liver disease is viral hepatitis particularly the hepatitis B virus infection. HBV is transmitted through the use of unsterilised needles, blood transfusion and sharing of sharp objects. It may also be transmitted via sexual intercourse and the placental route. HBV infection is preventable because there is an available vaccine for it. This vaccine has been included in the National Programme on Immunisation in Nigeria. However, we still have a lot of young people presently in the hospitals with liver disease due to HBV infection.

Apparently there is a general lack of awareness about this virus and the availability of the vaccine. Other causes of liver disease include chronic alcoholism, which is common in industrialised countries, and the indiscriminate use of both over the counter and prescription medications. The use of herbal concoctions has also recently emerged as an important cause of chronic liver disease in Nigeria.

Does Nigeria have a national transplantation centre? If no, is there a need having one?

Nigeria, as far as we know, does not have a national transplantation centre. The need for this cannot be over-emphasised. Many Nigerians have chronic kidney and liver diseases that could benefit from organ transplantation. A few hospitals in Nigeria have attempted kidney transplantation with mixed results. Obviously, there is still need for a government policy on transplantation services.

Experts have said gastroenterology problem and abdominal pain remain one of the most common reasons patients visit hospitals, is this true?

Symptoms referable to the gastrointestinal tract definitely rank high amongst the list of complaints patients bring to the hospital, probably because problems of the GIT are almost impossible to ignore and could be rapidly life threatening. In Nigeria, common ailments include diarrhoeal and peptic ulcer diseases. Abdominal pain is a general term and could be caused by any organ malfunction or disease in the abdomen. Some of the intra-abdominal organs are not part of the alimentary system. Thus, a patient who goes to the hospital with abdominal pain has to be thoroughly evaluated to determine the source of the problem.

As head of the gastroenterology and hepatology department in Nigeria, what are the most common challenges doctors are facing?

The most common challenge faced by trainee doctors is the lack of adequate exposure to current diagnostic tools and management strategies. Many of the diagnostic facilities and treatment protocols available in Nigeria are dated. The trainee doctor also faces a problem of not seeing enough patients as many of them do not have access or attend the tertiary health centres.

What provisions does the government make for public health care?

Health care in Nigeria is a three tier system; the primary health care institutions, secondary institutions and the tertiary institutions. The primary institutions are managed by the local government offices and are supposed to provide adequate first level health care to individuals in both rural and urban areas. However, most of these centres are inadequately supervised and therefore do not cater for the patient quota expected of them. The tertiary centres are at the pinnacle and include the teaching hospitals. While the government has tried in recent times to equip these hospitals adequately, most of them still fall below the expected standard. The government has put in place the National Health Insurance Scheme to aid access to quality healthcare. However the coverage of this scheme is still quite narrow and thus is still not available to the larger part of the populace.

PUNCH