Onesphore Nibigira, 48, discovered he was a carrier of the Hepatitis B virus at age 23, a condition he describes as a "silent monster." He stated, "It is there, it is inside you, it gnaws at you. You feel nothing. You work as usual, you do your sport as usual, as if nothing has happened, while your health inexorably declines." In Burundi, Hepatitis B and C are considered the most clinically significant viral hepatitis due to their potential progression to cirrhosis and liver cancer. Nibigira noted, "People learn they have the disease too late, often when it is already complicated." Many patients arrive at health facilities with advanced disease, precluding a curative perspective. The widespread nature of these infections and the challenges in their early detection show the urgent need for enhanced awareness and intervention strategies across the nation.
A Personal Battle with the Silent Monster
Onesphore Nibigira, 48, has lived with Hepatitis B since birth. He discovered his condition while attempting to donate blood at the Centre de transfusion sanguine, located behind the Gitega hospital, during a period of war. This discovery, made when he was 23 years old, marked a key moment in his life. Doctors initially informed him that the virus would naturally disappear within six months, an assurance that proved to be inaccurate. However, in 2015 or 2016, Dr. James Nihorimbere observed an abnormal platelet count in Mr. Nibigira, prompting further investigation. Subsequent viral load tests confirmed a very active viral load, indicating the virus was still prevalent and multiplying within his system. This critical finding led Mr. Nibigira to begin treatment in 2016. Medications for his condition are provided free of charge, requiring an annually renewed prescription for access, which helps alleviate the financial burden of long-term care for patients.
The Widespread Impact of Hepatitis B and C
Hepatitis B is often described as a 'silent monster' because the disease progresses without noticeable symptoms, according to Onesphore Nibigira. He stated, "It is there, it is inside you, it gnaws at you. You feel nothing. You work as usual, you do your sport as usual, as if nothing has happened, while your health inexorably declines." Chronic hepatitis generally remains silent, with individuals often unaware of their infection for extended periods. This characteristic contributes significantly to the challenges in early diagnosis and treatment. Nibigira noted that many people discover their illness when it is already complicated. "Les gens apprennent qu’ils ont la maladie trop tardivement, souvent lorsque c’est déjà compliqué," he added in French, emphasizing the late diagnosis.
He stated, "C’est un monstre silencieux," referring to the insidious nature of the virus. This lack of early indicators contributes to hepatitis being insufficiently known among the general population, leading to delayed medical attention. Onesphore Nibigira is regularly contacted by patients or their relatives who learn of their diagnosis at an advanced stage. The first signs of chronic hepatitis often appear only when the disease has progressed significantly, including symptoms such as pain in the right hypochondrium, intense fatigue, abdominal swelling, or lower limb edema. These advanced symptoms are often indicative of severe liver damage, such as cirrhosis or liver cancer, noting the critical importance of early screening and detection before such complications arise.
Transmission, Diagnosis, and Cost Barriers
Understanding the transmission routes of different hepatitis viruses is key for effective prevention. Hepatitis A and E are transmitted through the fecal-oral route, typically via contaminated food or water. In contrast, Hepatitis B, C, and D spread sexually, via blood, and from mother to child, showing the need for different preventive approaches. In Burundi, most health facilities can diagnose Hepatitis B and C, which are the most clinically significant viral hepatitis in the country. However, diagnosis for Hepatitis A, D, and E is limited to only a few private structures within the country, creating significant access barriers for patients suspected of carrying these less common forms. Essential tests, particularly for viral load, which measures the amount of virus in the blood and helps monitor treatment effectiveness, are costly for patients, further hindering full care. Treatment for Hepatitis C typically costs between 600,000 and 700,000 francs per month, representing a substantial financial burden. For Hepatitis B, treatment costs approximately 200,000 francs monthly when medications are available over-the-counter, although some medications are provided free of charge with a prescription.
Prevention and the Path Forward
Prevention efforts for Hepatitis A and E focus on improving hygiene, including access to clean water and proper sanitation practices, to interrupt the fecal-oral transmission route. For Hepatitis B, C, and D, strategies include avoiding unprotected sexual relations and not sharing sharp or piercing objects such as razors, needles, or toothbrushes. Additionally, screening all pregnant women for these viruses is essential to protect unborn children, as mother-to-child transmission is a significant route of infection. Vaccination against Hepatitis B is administered in a series of three injections, offering effective protection against this prevalent virus. Expanding access to these preventive measures and diagnostic services is critical to mitigating the silent threat of hepatitis in Burundi and improving public health outcomes.