Fresh water could turn hepatitis tide

20 June 2019 | Health

Unless the lack of clean running water and toilets within informal settlements is tackled urgently, the 19-month tide of hepatitis E infections across the country which has infected thousands and killed 45 will be difficult to stem and threatens to become an endemic disease such as HIV or malaria.

In addition to the more than 5 300 cases of hepatitis E reported in most of the 14 regions since September 2017, the latest situation report ending 2 June, revealed 37 cases of hepatitis A cases in the Omusati region.

Hepatitis E and hepatitis A are both transmitted through the faecal-oral route or via contaminated food and water and occur in areas with poor sanitation. According to Unicef, Namibia “has of the lowest sanitation coverage in eastern and southern Africa” and nearly half of Namibians defecate in the open.

“We need to break the chain of transmission. We haven't broken it yet,” Dr Bernard Haufiku, who is heading the National Health Emergency Management committee in response to the outbreak, told Namibian Sun this week. He underlined that hepatitis E and now hepatitis A, “far from being only a health issue, is a socioeconomic issue” related to poverty, unemployment, poor hygiene and other struggles faced by communities living in the country's poorest, and unserviced informal settlements.

He stressed the outbreak “begins with sanitation, water provision and personal hygiene. And it will end with us addressing those three challenges. Those are the three fundamental challenges we are facing.”

Running water

According to the Namibia Inter-censal Demographic Survey (NIDS) 2016, 26% of urban households lacked access to sanitation, with an estimated 288 000 people therefore forced to resort to using the bush or riverbeds as toilets.

Informal settlements in the Khomas Region account for nearly 3 500 of all hepatitis E cases, while 1 249 cases in informal settlements in the Erongo Region have been reported to date.

Haufiku said although the provision of clean water to all Namibians is “a daunting task”, especially considering the costs and the ongoing drought, it should be “priority number one” in the fight to end the outbreak.

In line with these priorities, a high-level meeting held in Windhoek recently, which included representatives from the City of Windhoek and several ministries, focused on a push for a concept called Community Led Total Sanitation (CLTS).

CLTS is aimed at enabling communities to analyse their sanitation conditions and collectively understand the impact of open defecation on public health and their environment.

It aims to completely eliminate open defecation. Haufiku underlined the strategy can only work if clean water is provided to these communities. “We have to make it a priority.”

Haufiku told Namibian Sun this week that preventing the outbreak from becoming endemic is why “breaking the chain of transmission” is vital.

He warned that endemic diseases are “much more difficult to eliminate”.

Yet, despite the challenges he pointed out a notable success in recent months has been a steep drop in fatalities from hepatitis E. He said the significant decrease is a credit to those working on the frontlines, including doctors, nurses and the health facilities where the first responders are based.

JANA-MARI SMITH