People carry some ailments for decades before symptoms manifest and it’s too late for treatment. Those who do get diagnosed must grapple with expensive medical costs. What then is the solution?
How do you test for a virus when you don’t know you have it?
Hepatitis B is one such. Often times, it remains undetected until it is viral, at which stage, it is often too late.
It leads to an infection of the liver that can cause both acute and chronic disease. When chronic, it attacks the liver, eventually causing scarring (cirrhosis) of the organ, liver failure, and cancer.
There are various types of hepatitis viruses including types A, B, C, D and E. Types A, B, and C are the most common. All five hepatitis viruses can cause acute disease, but the highest numbers of deaths result from liver cancer and cirrhosis that occur after decades of chronic hepatitis B or C infection.
According to the World Health Organization (WHO), an estimated 257 million people are living with the hepatitis B virus (HBV) infection, however, the rate of diagnosis is extremely low, at approximately 9% of all HBV-infected persons.
In February, Abbott Laboratories announced, “the world’s most sensitive rapid diagnostic test for the detection of hepatitis B surface antigen… This highly-sensitive, easy-to-use, rapid lateral flow test enables identification of those with the virus and facilitates linkage to care in every healthcare setting”.
This is a monumental victory for healthcare practitioners, who are working on the ground to eradicate the virus, says Dr Andrew Scheibe, a medical doctor who focuses on HIV, viral hepatitis and infectious diseases among key populations, specifically people who use narcotics.
“What’s useful about it is that it’s very easy to use and you get results in 15 minutes. Compared to the previous test, you’re able to detect more people who are infected… [as] it detects more hepatitis B surface antigen (HBsAg) in the blood… this is very useful in the field as it is a rapid test,” he says.
Scheibe is a senior technical advisor for TB and HIV Care and has research affiliations with the University of Pretoria’s Department of Family Medicine and the Urban Futures Centre at the Durban University of Technology.
The rapid diagnostic test by Abbott Laboratories is likely to empower health practitioners to fight a battle that has seemed insurmountable on the continent.
A report released by WHO states that the organization “has set baseline targets to diagnose 30% of HBV-infected individuals by 2020 and 90% by 2030. In order to reach these targets, rapid testing is imperative. Testing and diagnosis of HBV is the gateway for access to both prevention and treatment services and is a critical component of an effective response to the hepatitis epidemic”.
From an economic perspective, it is imperative that hepatitis B mortality rates be reduced because a significant number of the people who become symptomatic manifest from middle to late life.
“Those are people who should be economically active, so that has a huge economic consequence. And the treatment of people who have liver failure is very expensive,” Scheibe says.
In sub-Saharan Africa, the overall hepatitis B carrier rate in the general population is 5%-20%, which is amongst the highest in the world. Viral hepatitis is also a growing cause of mortality among people living with HIV.
“About 2.3 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” according to WHO.
There are other socio-economic factors that make the virus endemic in sub-Saharan Africa, these are dictated by lack of basic resources, as well as population density.
“A lot of the factors are linked to socio-economic and environmental factors. With hepatitis B in particular, it’s transmitted through bodily fluids, so if there aren’t good personal and public hygiene practices, that can foster an environment where these infections are spread,” Scheibe says.
“If you are in an area where there’s a high population living with an infection, it means that the likelihood of people contracting it is higher… This is a concept we call the community viral load. If, in sub-Saharan Africa, there already is a lot of hepatitis B, people will automatically be at a higher risk of contracting it, because they are more likely to come into contact with people who have the infection.”
The virus is transmitted through contact with the blood or other body fluids of an infected person.
“The virus is a hundred times more infectious than HIV. It’s one of those conditions that people can live with without knowing they are infected… a proportion of those people will go on to develop live cancer, which we have few treatments for,” Scheibe says.
In South Africa, the lack of political will to meet the goals set out by WHO has been criticized by medical practitioners who feel dealing with the virus decisively would be beneficial for all.
“I think a lot of work needs to be done to get government to put it on their political agenda, particularly, if it’s affecting people who are at high-risk, that government may not want to deal with.
“For example, [these are] men who have sex with men, sex-workers and people who take drugs. In many contexts, those are politically sensitive topics, but it would be very important for government to embrace,” Scheibe says.
Happy Phaleng, the MSM (men who have sex with men) Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa, says the rapid diagnostic test serves as a much-needed form of assistance for a queer community that, at times, is not prioritized because of stigma.
Phaleng, who was vaccinated as a result of a study that was taking place at work, says his hepatitis B awareness was scant prior to the vaccination. He says in some cases, people resist getting vaccinated.
“I remember when they started the study, it was quite a struggle to get people vaccinated… You look at things like PrEP (Pre-Exposure Prophylaxis), you still find people who say, ‘let me go think about it,’ even though it’s free and on-the-go.”
However, on the day he meets FORBES AFRICA, he is armed and ready with the hepatitis B and C pamphlets that are laid out in front him as he has a frank conversation about risky lifestyles.
He says there’s a certain demographic of people who are privy to information as a result of being privileged to access, he also says there are cost implications to purchasing certain news items and money is not easy to come by.
“Class plays a role. There’s a certain class of people, in this case, the medical space, who would know about medical developments. Some people don’t read, and those who do, won’t take it in because it doesn’t affect them directly,” he says.
Phaleng also frankly states that people tend to be their own worst enemies as a result of unfounded fears that prevent them from accepting help.
“We are too resistant to new things and we also have the notion that, ‘I’ve lived before without this vaccine. Why am I complicating my life with medications and vaccination?’ This ties in with the concept that, ‘what you don’t know, won’t kill you’.”
Innovations are good and well, however, studies and pilots defeat the purpose of what they are intended for as they are, at times, exploitative and not reciprocal. He alludes to the idea that citizens tend to be treated like guinea pigs by those who work on the ground on fact-gathering missions.
“In South Africa, we have had so many piloted studies and, as people, we get tired… I’ve worked with people who conduct studies can’t enter our communities and urge us to try new things and, the next thing you know, the medication no longer exists because of the outcomes of the study.”
“They just want to use our bodies to get their PhDs and launch their products.”
Scheibe, who has been working in the field of harm reduction and substance use for the past eight years, says that more people in high-risk groups may acquire the infection and they should also be vaccinated.
According to NCBI, these include, but are not limited to, people who frequently require blood or blood products; people interned in prisons; persons who inject drugs; and people with multiple sexual partners.
Duncan Tsegula, who is a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being, is a recovering drug user who used to share needles while homeless in the streets of Pretoria.
The Project, which has been running for four years, focusses on reducing the risk of harm, with particular focus on homeless (needle) drug users. Tsegula has been a leader for two years.
“Before I became a member, I was a client of the same project. They were giving out needles, to us, guys using on the street. It got to a point where people were discarding them on the street. We came up with a solution which was a needle exchange,” Tsegula says.
“If we give you 10 needles this week, we come back next week to give you more, and you return the old ones. That’s when we are sure that you are not discarding them on the streets. So far, for the past year-and-a-half, it has been working and the city council has stopped complaining.”
He confirms that he’s witnessed people sharing and repurposing needles. Some of the sharing of needles was due to desperation because homeless people are profiled and turned away from many businesses even when they are purchasing products.
“I was one of the people sharing needles. It was not easy to access a needle even if you had money because of the way you look.
“About 12 years ago, when my boss needed a needle to inject, the pharmacy refused him and he eventually broke a window. He was withdrawing and because of anger, he broke a window and was arrested.
“Our project is peer-driven and people who were there and used drugs have links with the clients, so it’s easier for them to communicate with us, but it’s not easy.
Along with the clean needles, the project provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.
They also provide alcohol swabs to prevent infection when users inject. “Some of the guys go through bins while they collect litter for recycling, they might cut themselves while doing that. The swabs are used to clean the surface area where they are going to inject,” Tsegula says.
Along with drug users, sex-workers are also profiled and are not afforded equal rights.
Phaleng says, “there are many people who take drugs for their own reasons but what we’re saying is, ‘even though you’re using for your own reasons, do it the safe way.’ Because, you can imagine if I’m injecting drugs and I still have that I’m going to – I might infect that person with a range of things.
“Sex-work is work. Everybody has the right to health. They also deserve to be treated fairly and access medication.
“A healthy society is a very productive society. If we get to a point where we succeed in preventing illness rather than treating them, will save large amounts of money,” Phaleng says.
Scheibe echoes his sentiments.
“We must understand that we need to move away from criminalization because that has very negative public health consequences which, in turn, have very negative financial implications.”
For his work with hepatitis, he’s the light at the end of the tunnel, but he is cautiously optimistic.
“It’s important to be optimistic that progress can happen, should happen and is already happening. It’s very clear that we have the tools, and we know what needs to be done.
Scheibe says very little will change, “unless there is a recognition that policies that criminalize sex work and drug use, or are discriminating on women, are re-evaluated. There needs to be a lot of focus in addressing those, or we will never be able to eliminate hepatitis or HIV.”
Tasty Vegan Options: Consumed By Healthy Eating
The restaurant market still hungers for healthy options. This entrepreneur is feeding that need, serving earth-conscious customers and gym junkies.
Her desperation for a healthy meal fueled the fire for business.
Leigh Klapthor, 31, couldn’t find enough eateries that sold healthy food that was not bland, so decided to start her own.
“It is no fun to go out with friends and you are always the girl with the green salad,” she says.
“I wanted to find a way where being healthy is not such a chore and I also wanted for it to be affordable.”
Klapthor, who dropped out of a course in marketing communications at the University of Johannesburg, ditched a job in corporate marketing to pursue her passion for food.
In 2017, she started Sprout Café at the Stoneridge Centre in Edenvale in Johannesburg with a loan she received from her husband’s business and money that was given to them as a wedding gift.
“Everybody underestimates what everything will end up costing [when starting a new business]. In my mind, I thought R150,000 ($10,588) would work. I thought I would get my shop fitting and everything done and in the first month we would be able to pay salaries with the money we make,” says Klapthor.
But she soon realized the unforeseen challenges faced by many entrepreneurs. She had to eventually pump in a capital of R350,000 ($24,706) to start the venture.
“So I had a couple of life lessons at the beginning. I had to end up using our savings but I didn’t mind having to do that because I trusted and believed in the vision.”
But though she did, the banks did not because they often declined all her loan applications.
“I think there are so many young black and enthusiastic individuals that have brilliant ideas and vision but the investment capital is not there. Though I do not have the capital as well to assist them, I would say keep going because the vision is greater,” Klapthor says.
Sprout Café offers health food, light meals, vegan food, and vegetarian and ketogenic diet food.
With her corporate marketing skills, she advertised her food on social media and gained a lot of traction.
“I want to create food on Instagram and people are like, ‘oh my God, I want to eat that’ and when they come into the store, it is the same deliverable they receive,” she says.
Sprout Café turns over R3 million ($211,677) annually and has 10 employees.
After only two years of business, she has recently opened a second branch in the heart of the busy Moove Motion Fitness Club in Sunninghill in Johannesburg.
“There are people that are on specific diets and there is no one that is giving these people food. There is no one that is saying, vegan people want to be healthy too. They are making a conscious decision to preserve the environment and preserve their health and they are making these decisions but there is no one that is there to accommodate them.”
Klapthor says that the world is moving towards a plant-based lifestyle and she believes that many have recently caught on to that idea recently.
Trend translator Bronwyn Williams of Flux Trends, reiterates Klapthor’s views on how the world is adopting healthier habits. She believes that Generation Z is choosing good, clean fun the most.
“Yes, South Africa is not exempt from the global movement towards more locally-sourced and earth-friendly products and packaging,” Williams says.
However, Williams believes that because 64.2% of the South African population still lives in poverty, clean and organic food still remains costly for the majority of people.
“That said, unfortunately, earth-friendly consumer options remain a luxury that only the upper middle class can really afford to support and enjoy… certified organic, eco-friendly products tend to cost far more—up to 40% more than ‘regular’ packaged produce, it would be disingenuous to say that what the market wants is locally-sourced, earth-first produce when the majority of South Africans are struggling just to put any food on the table,” Williams says.
Though Klapthor knows more people are opening healthy-eating establishments because they see that it is a trend, she believes that they need to be in touch with the reality of an ordinary person’s life and consider the cost implications.
“You can’t charge someone R150 ($10.59) for a Beyond Meat burger and expect her to come back tomorrow for the same burger. People are tight with their money and they work hard for it, they do not want to let go, for instance, of R500 ($35.29) in three days,” Klapthor says.
“We want to provide a healthy lifestyle, something that is consistent and that people can live through, and not just a treat-themselves-to at the end of the month. Every day, you should be able to eat a Sprout meal without having to feel any kind of guilt and shame.”
Obviously, it is a concept that has worked and keeps her business healthy as well.
Young women in Soweto, South Africa, say healthy living is hard. Here’s why
Data from South Africa has shown that over two thirds of young women are overweight and obese. This predisposes them to non-communicable diseases such as diabetes and hypertension. Most women are not exercising enough, and consumption of processed and calorie-dense foods and high amounts of sugar is common.
It was this knowledge that sparked the establishment of the Health Life Trajectories Initiative. It’s being run in South Africa, India, China and Canada and aims to provide interventions that can help young women stay healthy before, during and after pregnancy.
In South Africa, this randomised controlled trial will provide one-on-one support as well as peer group sessions to over 6000 young women. The idea is provide them with information, and to help them set and maintain goals for healthier lifestyles.
Researchers from the Medical Research Council and Wits University’s Developmental Pathways for Health Research Unit are running the South African arm of the study. We wanted to start by better understanding our target population – that is, young women aged between 18 and 24 living in Soweto.
Soweto is a large, densely populated urban township which comprises one third of Johannesburg’s population. Soweto is becoming rapidly urbanised, but the majority of people are still very poor and struggle to provide food for their families.
We conducted a series of focus group discussions and in depth interviews to unravel health behaviours, barriers and facilitators to wellbeing and health with young women from Soweto who had not yet had a child. We also asked them about what sorts of interventions they’d prefer to support and guide them.
The women offered important insights that showed it’s not enough to simply promote healthy eating and exercise without considering the very real environmental and structural constraints present in South Africa.
Barriers to healthy choices
The 29 participants spoke about many different facets of health. These included happiness and mental wellbeing, faith, social support, body image, and lifestyle behaviours.
They identified many barriers to healthy eating, among them the cost of and access to healthy food options. Some women also said they had little access to exercise facilities such as gyms and were afraid to exercise on the streets because they feared being assaulted or harassed. One woman said:
No, I don’t feel safe because we have drug addicts, traffic, women trafficking: it’s not safe for us to walk in the streets.
The women we interviewed painted a picture of an environment in which healthy behaviours are difficult to implement or sustain. One said:
Small businesses that are opening up in my community and they all sell fries, literally they just all sell fries…
Women told us that cheap and unhealthy fast foods are on every street corner: “bunny chow” – hollowed out bread stuffed with curry – vetkoek (a fried dough bread stuffed with different fillings) and fried chips are affordable and available within a few steps of most houses. As a result, women did not want to go out of their way to purchase healthier, more expensive foods.
Our interviewees also didn’t feel able to demand that healthier food be bought for their homes, because many were not contributing financially and were therefore not in a position to control food purchases. Women reported being financially dependant on relatives and male partners.
They also said that opportunities for physical activity were neither provided nor prioritised for women in Soweto. Some women said that a lack of facilities made it difficult for them to participate in any exercise, as they did not have access to gyms or fields to exercise.
Other women told us that there were gyms, sports grounds, parks, and even free aerobics classes at community halls in their area. However these facilities often get vandalised quickly, and can no longer be used. More importantly, they didn’t feel safe enough to exercise on the streets, perhaps by jogging or running. They also felt unsafe walking around in leggings or tights. Women were fearful of human trafficking, sexual assault, and violence – very real issues in this community.
Crucially, our research found that young women did not see obesity as a sufficient reason to change their behaviour. But they said they would be motivated to exercise and eat better if they were diagnosed with a non-communicable disease like diabetes.
This suggests that obesity has become normalised in South Africa – and this needs to be addressed.
These findings are now being worked into our interventions, and we are cognisant of the contextual realities that may affect young women’s ability to change their lifestyles. We hope that this research, along with whatever findings emerge from our interventions, will inform policy makers and motivate them to implement necessary changes in this community.
Women in Soweto and in South Africa in general need support to live healthier lifestyles. This support needs to come from policy makers. If South Africa does not step up and support young women by providing them with access to safe spaces and affordable healthier foods, and by controlling the oversupply of unhealthy options, the country may not be able to curb its ever increasing rise in obesity and related non-communicable diseases.
-Alessandra Prioreschi: Associate Director and Researcher at the Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand
Measles: Should Vaccinations Be Compulsory?
Following a measles outbreak in Rockland County in New York State, authorities there have declared a state of emergency, with unvaccinated children barred from public spaces, raising important questions about the responsibilities of the state and of individuals when it comes to public health.
Measles virus is spread by people coughing and spluttering on each other. The vaccine, which is highly effective, has been given with mumps and rubella vaccines since the 1970s as part of the MMR injection. The global incidence of measles fell markedly once the vaccine became widely available. But measles control was set back considerably by the work of Andrew Wakefield, which attempted to link the MMR vaccine to autism.
There is no such link, and Wakefield was later struck off by the General Medical Council for his fraudulent work. But damage was done and has proved hard to reverse.
In 2017, the global number of measles cases spiked alarmingly because of gaps in vaccination coverage in some areas, and there were more than 80,000 cases in Europe in 2018.
The World Health Organisation has declared the anti-vaccine movement one of the top ten global health threats for 2019, and the UK government is considering new legislation forcing social media companies to remove content with false information about vaccines. The recent move by the US authorities barring unvaccinated children from public spaces is a different legal approach. They admit it will be hard to police, but say the new law is an important sign that they are taking the outbreak seriously.
Most children suffering from measles simply feel miserable, with fever, swollen glands, running eyes and nose and an itchy rash. The unlucky ones develop breathing difficulty or brain swelling (encephalitis), and one to two per thousand will die from the disease. This was the fate of Roald Dahl’s seven-year-old daughter, Olivia, who died of measles encephalitisin the 1960s before a vaccine existed.
When measles vaccine became available, Dahl was horrified that some parents did not inoculate their children, campaigning in the 1980s and appealing to them directly through an open letter. He recognised parents were worried about the very rare risk of side effects from the jab (about one in a million), but explained that children were more likely to choke to death on a bar of chocolate than from the measles vaccine.
Dahl railed against the British authorities for not doing more to get children vaccinated and delighted in the American approach at the time: vaccination was not obligatory, but by law you had to send your child to school and they would not be allowed in unless they had been vaccinated. Indeed, one of the other new measures introduced by the New York authorities this week is to once again ban unvaccinated children from schools.
With measles rising across America and Europe, should governments go further and make vaccination compulsory? Most would argue that this is a terrible infringement of human rights, but there are precedents. For example, proof of vaccination against yellow fever virus is required for many travellers arriving from countries in Africa and Latin America because of fears of the spread of this terrifying disease. No-one seems to object to that.
Also, on the rare occasions, when parents refuse life-saving medicine for a sick child, perhaps for religious reasons, then the courts overrule these objections through child protection laws. But what about a law mandating that vaccines should be given to protect a child?
Vaccines are seen differently because the child is not actually ill and there are occasional serious side effects. Interestingly, in America, states have the authority to require children to be vaccinated, but they tend not to enforce these laws where there are religious or “philosophical” objections.
There are curious parallels with the introduction of compulsory seat belts in cars in much of the world. In rare circumstances, a seat belt might actually cause harm by rupturing the spleen or damaging the spine. But the benefits massively outweigh the risks and there are not many campaigners who refuse to buckle up.
I have some sympathy for those anxious about vaccinations. They are bombarded daily by contradictory arguments. Unfortunately, some evidence suggests that the more the authorities try to convince people of the benefits of vaccination, the more suspicious they may become.
I remember taking one of my daughters for the MMR injection aged 12 months. As I held her tight, and the needle approached, I couldn’t help but run through the numbers in my head again, needing to convince myself that I was doing the right thing. And there is something unnatural about inflicting pain on your child through the means of a sharp jab, even if you know it is for their benefit. But if there were any lingering doubts, I just had to think of the many patients with vaccine-preventable diseases who I have looked after as part of my overseas research programme.
Working in Vietnam in the 1990s, I cared not only for measles patients but also for children with diphtheria, tetanus and polio – diseases largely confined to the history books in Western medicine. I remember showing around the hospital an English couple newly arrived in Saigon with their young family. “We don’t believe in vaccination for our kids,” they told me. “We believe in a holistic approach. It is important to let them develop their own natural immunity.” By the end of the morning, terrified by what they had seen, they had booked their children into the local clinic for their innoculations.
In Asia, where we have been rolling out programmes to vaccinate against the mosquito-borne Japanese encephalitis virus, a lethal cause of brain swelling, families queue patiently for hours in the tropical sun to get their children inoculated. For them the attitudes of the Western anti-vaccinators are perplexing. It is only in the West, where we rarely see these diseases, that parents have the luxury of whimsical pontification on the extremely small risks of vaccination; faced with the horrors of the diseases they prevent, most people would soon change their minds.
–Tom Solomon; Director of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, and Professor of Neurology, Institute of Infection and Global Health, University of Liverpool
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