For Michael Akok, a 28-year-old year old fourth year university student, being diagnosed with viral hepatitis was a devastating blow. He had silently endured life-threatening pain, unaware of his condition until a medical test revealed the truth.

"I had been experiencing extreme fatigue and nausea for quite some time. Recently, I developed occasional confusion and forgetful, I could sweat even when it is cold. Cognizant of the potential huge medical bill, so I took time without seeking treatment," Michael explained. "One day, I decided to visit Juba Teaching Hospital for treatment, and after testing, I was diagnosed with liver disease secondary to chronic hepatitis B. I was shocked but not scared because I knew that that are some drugs that can suppressed the virus," she added.

Seated in a small room while narrating his story at Juba hospital, filled with the reassuring hope of regaining his health, Micheal is now receiving treatment at Juba Teaching Hospital. "I feel much better now. I have been receiving treatment for the last three years. I am strong and hopeful that I will recover," she said.

Michaels’s experience underscores the significant impact of hepatitis in South Sudan.
The Hepatitis Challenge in South Sudan.

Dr. Bino Andrea, a specialist hepatologist at Juba Teaching Hospital, highlighted the increasing burden of chronic hepatitis B and C. "The number of admissions due to hepatitis has been rising. One of the most challenging aspects is that people seek treatment when it is already too late, making it difficult for us to save lives," said Dr. Bino.
Hepatitis is a liver inflammation caused by various infectious viruses and noninfectious agents, including alcohol and certain drugs. It leads to a range of health problems, some of which can be fatal. Acute infection may occur with limited or no symptoms or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain.

Viral Hepatitis Burden in South Sudan
Seventy percent of all new global infections of viral hepatitis B and C occur in sub-Saharan Africa due to insufficient interventions. Hepatitis mortality remains high due to low treatment coverage. Less than 2% of the infected population is aware of their status, and correspondingly, less than 1% access effective treatments, leading to needless deaths. Cirrhosis and liver cancer are usually the main causes of death.
South Sudan has one of the highest hepatitis burdens in sub-Saharan Africa. Cases of acute hepatitis, such as Hepatitis E Virus (HEV), have been consistently reported since 2014, with recurrent outbreaks in Bentiu, Rubkona County, Unity State.
Currently, the country is responding to Hepatitis E outbreaks in different parts of the country. Since the outbreak began in 2018, a total of 5667 cases have been documented, including to 27 deaths fatalities. Of these cases, 43% occurred in individuals aged 15 to 44 years.

Insufficient Funding and Call to Action
Government funding for viral hepatitis through health budgets is insufficient, and donor funding is lacking, making it difficult to implement necessary interventions toward elimination.

"Hepatitis remains a major concern for South Sudan. We must align all our efforts to reduce the impact of the disease on our communities," said Honourable Yolanda Awel Deng, Minister of Health. "We must invest our energies and resources to acquire highly effective prevention and treatment tools and technologies to address the hepatitis burden."
Dr. Humphrey Karamagi, WHO Representative for South Sudan, emphasized the need for increased investment. "Limited investment in the hepatitis program hinders our ability to implement targeted interventions. There is no better time than now for us to intensify our efforts and collaboratively work to reduce the prevalence of viral hepatitis in our country," he said.

WHO's Targeted Health Interventions
To address these challenges, the World Health Organization (WHO) has intensified its support to the Ministry of Health. This includes high-level advocacy, integrating national strategies and guidelines for hepatitis and sexually transmitted infections into HIV programs, and adopting new WHO guidelines for diagnosis and care. WHO also engages affected communities and civil society through awareness raising.
Additionally, WHO provides technical assistance for integrating the elimination of mother-to-child transmission of HIV, STIs, and Hepatitis B, as well as guidelines for key and vulnerable populations. Recent efforts focus on advocating for the introduction of the Hepatitis B birth dose and scaling up infant and childhood hepatitis B vaccination. WHO also offers capacity building for healthcare workers to scale up diagnostic and treatment services for Hepatitis B and C.

Michael’s journey and the broader hepatitis challenge in South Sudan highlight the urgent need for comprehensive and sustained efforts to combat this devastating disease.