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WHO survey finds half of countries do not have clinical guidelines for treating hepatitis

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4715 (Published 24 July 2013) Cite this as: BMJ 2013;347:f4715
  1. Anne Gulland
  1. 1London

Only half of countries around the world have clinical guidelines for the treatment of hepatitis and less than half have key medications for treating hepatitis B and C on their list of essential medicines, a survey by the World Health Organization has found.1

The first ever survey on the global response to hepatitis found that only 64 out of the 126 member states that responded have clinical guidelines for the treatment of the disease. And just 35 of these countries stated that the guidelines include recommendations for cases with HIV co-infection.

In its introduction to the survey, WHO said that hepatitis treatment was undergoing a “revolution,” with new medications being developed which will improve control and provide higher cure rates for hepatitis B and C. It said that member states had to make progress in providing medicines and training healthcare staff.

Just 34.9% of respondents have entecavir and 48.4% have tenofovir—both essential treatments for hepatitis B—on their essential medicines list. And only 54.8% reported including pegylated interferon, the current mainstay of hepatitis C treatment, on their list.

In 2010 WHO declared the five main hepatitis types a global public health problem, estimating that together hepatitis B and C caused 1.4 million deaths in 2010, including deaths from acute infection, liver cancer, and cirrhosis. This compares with 660 000 estimated deaths from malaria in 2010, and 1.4 million deaths from tuberculosis and 1.7 million deaths from HIV in 2011.

Fewer than four out of 10 respondents (37.3%) reported the existence of a national hepatitis prevention and control plan and fewer (28.6%) had a government unit dedicated to hepatitis. More than half of the countries reported that they had just two members of staff dedicated to fighting the disease.

Unsurprisingly, response rates to the WHO survey were higher among richer countries, with just 12 out of a possible 46 countries in the WHO African region responding to the survey. Africa has some of the highest rates of hepatitis in the world, with the prevalence of hepatitis B infection at around 8% in west Africa and 5% to 7% in central, eastern, and southern Africa. This compares to less than 2% in central and tropical Latin America and 2% to 4% in the WHO Eastern Mediterranean region.

WHO said that the survey showed that national governments needed to do much more to “comprehensively address this global killer.”

Notes

Cite this as: BMJ 2013;347:f4715

References

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