Global Health World Health Organization (WHO, 2013) Davidson, Mary; Escalera, Kimberly; Goodman, Michelle; Krugman, Clarke.

Hepatitis The word hepatitis is a catch-all term that refers to any inflammation of the liver -- the irritation or swelling of liver cells from any cause (WebMD website, 2012, ‘Hepatitis’ para. 2). Hepatitis can be acute (inflammation that lasts less than six months) or chronic (inflammation that lasts more than six months) and has many different causes. It can be caused by a group of viruses known as the hepatitis viruses, including A, B, C, D, and E (WebMD website, 2012, Hepatitis, the basics 1). Viral hepatitis is among the top 10 infectious disease killers and the leading cause of liver cancer and cirrhosis. Both chronic hepatitis B and chronic hepatitis C cause approximately 80% of the world's liver cancer and have contributed to the increases in rates of liver cancer in recent decades (Perz, Armstrong, Farrington, Hutin, & Bell, 2006).

Our focus: Hepatitis B (HBV) It is estimated that 2 billion people world-wide are infected with the virus, and 650,000 people per year die from it (World Health Organization website, 2013).   The disease can be life-long, causing chronic debilitating health conditions. There is a vaccine for it, if a program or programs can be effectively utilized to immunize the population. (Center for Disease Control and Prevention, 2013)

Vulnerable Population: sub-Saharan Africa The overall hepatitis B surface antigen (HBsAg) carrier rate in the general population is 5-20%, which is amongst the highest in the world. Most infections are acquired between 6 months and 5 years of age. All children in this region are regarded as being at risk. Hepatitis B-associated hepatocellular carcinoma is probably the most common tumor affecting males in sub-Saharan Africa, with Mozambique having the highest incidence rate of 103.8 per 100,000 males (Kiire, 1990). Africa, the world's poorest continent, has the highest population growth rate. A woman in sub-Saharan Africa will give birth to an average of 5.2 children in her lifetime ("Africa hunger," 2012, p. 1). Limited access to healthcare: ‘For every 1000 people there are only 2.5 health care workers available to them. Add to that fact that this relatively small workforce is dealing with up to 25% of the world’s total disease’ ("Quality care," 2013, p. 1).

(WHO, 1980-1984) Africa ‘The only region where mortality from communicable diseases (such as viral hepatitis and HIV/AIDS) exceeds mortality from non-communicable diseases. -Viral Hepatitis: Prevention and Control, WHO report, to be released July 2013 (WHO, 2013)

History Hepatitis B was discovered in 1964 by Nobel laureate Baruch Blumberg, during his research into blood borne pathogenic disease. ("Barry Blumberg," 2011)  Its origin is unknown, but can be traced by to the late 1800s, where it was not specifically named hepatitis, but exhibited its known characteristics.  Since its discovery, Hepatitis B has been identified to be an opportunistic virus it is easily transmitted: The hepatitis B virus can be passed from mother to unborn child, and is highly contagious through bodily fluids such as blood, semen and possibly saliva. It is often spread from person to person through intravenous drug use or sexual contact (WebMD website, 2012). Symptoms of Hepatitis B include ongoing fever, nausea, vomiting, and yellow discoloration of the skin, eyes and mucous membranes (jaundice), chronic pain and fatigue (WebMD website, 2012). In its most serious form, if left untreated, hepatitis B can become a chronic infection leading to chronic liver disease and potentially increasing the risk of developing liver cancer (WebMD website, 2012).

WHO Initiatives WHO established the Global Hepatitis Programme to address the prevention & control of viral hepatitis in 2010 Goals: To reduce the transmission of agents that cause viral hepatitis; To reduce the morbidity and mortality due to viral hepatitis through improving the care of patients with viral hepatitis; and To reduce the socio-economic impact of viral hepatitis at individual, community and population levels. (World Hepatitis Alliance, 2013)

Initiatives, cont. July 28th was established as World Hepatitis Day to increase awareness 91% of WHO member states include HBV vaccine in infant immunization programs 179 countries have introduced HBV vaccine, preventing over 1 Million deaths WHO has provided systematic approach for infection prevention in healthcare settings 2/3rds of low & middle income countries have implemented safe injection program Persons living with chronic HBV now benefitting from new treatment based on WHO guidelines

(World Health Alliance, 2012)

Impact on Healthcare Delivery Effect on Nursing Health care workers are at risk of acquiring blood-borne viral infections in high endemic regions Large numbers of hospital staff have been infected with HBV HBV is a neglected disease among healthcare workers, with a vaccination rate of 12.3% (Fritzsche, Beckner, Hemmer, Riebold, Klammt & Hufert, 2012)

Impact on Healthcare Delivery, cont. How nursing is involved in the problem The International Council of Nurses and the WHO launched a project to protect healthcare workers from needle sticks through education Teaching healthcare workers the concept of Universal Precautions to prevent exposure to blood. Instructing health care workers how to properly clean areas where a needle stick injury has occurred Eliminating the hazard- substituting injections by administering via alternative routes Establishment of an effective occupational health program that includes immunizations (Wilburn & Eijkemans, 2004)

References Africa Hunger and Poverty Facts . (n.d.). World Hunger Notes Homepage. Retrieved July 20, 2013, from http://www.worldhunger.org/articles/Learn/africa_hunger_facts.htm CDC DVH - Viral Hepatitis Populations - Asian & Pacific Islanders. (n.d.). Centers for Disease Control and Prevention. Retrieved July 23, 2013, from http://www.cdc.gov/hepatitis/populations/api.htm Campaign Material. (n.d.). Campaign Material. Retrieved July 23, 2013, from http://campaign-material.worldhepatitisalliance.org/ Chronicle of the World Health Organization. (1947). New York: World Health Organization. Fact Sheets: Hepatitis B. (n.d.). World Health Organization. Retrieved July 21, 2013, from www.who.int/mediacentre/factsheets/fs204/en/index.html Fritzsche, C., Beckner, F., Hemmer, C., Riebold, D., Klammt, S., & Hufert, F. (2012). Hepatitis b and c: Neglected diseases among health care workers in Cameroon.. Oxford Journal of Medicine, 107(3), 158-164.

References, cont. Global findings - Global Report - World Hepatitis Alliance. (n.d.). Home - Global Report - World Hepatitis Alliance. Retrieved July 23, 2013, from http://global-report.worldhepatitisalliance.org/en/global-findings.html Kiire, C. (1996). The epidemiology and prophylaxis of hepatitis b in sub- Saharan Africa: A view from tropical and subtropical Africa.. Gut, 38, S5-12. Perz, J., Armstrong, G., Farrington, L., Hutin, Y., & Bell, B. (2006). The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide.. Journal of Hepatology, 45(4), 529-538. The Economist (2011, April 30). Baruch (Barry) Blumberg, defeater of hepatitis B, died on April 5th, aged 85. The Economist . Retrieved July 20, 2013, from http://www.economist.com/node/18617858 The Quality of Health Care in Sub-Sahara Africa: How Bad is It? - The Afro Central: About African Health Care. (n.d.). The Afro Central - What You Should Know About Healthcare & Health Issues in Black Africa. Retrieved July 20, 2013, from http://www.afrocentral.net/the-quality-of-health-care-in- sub-sahara-africa.php

References, cont. WebMD - Better information. Better health.. (n.d.). WebMD - Better information. Better health.. Retrieved July 21, 2013, from http://webmd.com Wilburn, S., & Eijkemans, G. (2004). Preventing needle stick injuries among healthcare workers. Int J Occup Environ Health, 10(4), 451-456. World Health Organization. (n.d.). World Health Organization. Retrieved July 18, 2013, from www.who.int