DIETARY LISTS FOR HYPERCHOLESTEROLEMIA (HIGH CHOLESTEROL)

DIETARY CONTROL OF HYPERCHOLESTEROLEAMIA

HEALTHY FOODS

• unsaturated fats, such as olive oil,Avocado,nuts and canola oil.
• Whole grains, whole wheat bread and pasta, oatmeal, oat bran, and brown rice.
• Fruits and vegetables, which are high in fiber and can help lower cholesterol levels. 
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• Limit cholesterol in your diet. The highest amounts are found in egg yolks, whole milk products, and organ meats.
• Eat fatty fish. 2 servings of fatty fish (such as salmon or herring) each week.
• Eat nuts, seeds, vegetable oils, and fortified food products, such as orange juice, yogurt, and salad dressing.
• Eat fiber foods, especially oats, barley, and legumes, as well as fruits, vegetables, and other whole grains.
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Balanced Diet for those with High Cholesterol:

Grains: 6 to 8 servings per day (half should be whole grains)

Vegetables: 3 to 5 servings per day

Fruits: 4 to 5 servings per day

Fat-free or low-fat dairy: 2 to 3 servings per day

Lean meat, Skinless poultry.

 Fats and oils: (use unsaturated fats such as olive oil or canola oil)

Nuts, seeds, legumes: 3 to 5 servings per week

2 servings of fatty fish (such as salmon, herring, or lake trout) per week; 

OTHERS

Restricting sodium (salt, including salt already added to food)

Weight reduction also important

Exercise at least 3-5 times a week for 30-45 mins per day .

Diet Plans for Diabetes, Hypertension Cardiovascular disease.

Food plays an important role in the treatment of specific diseases like diabetes, hypertension, cardiovascular diseases etc. The diet should be balanced and within the permissible calorie limits. Food should be distributed into small frequent feeds. The daily requirement should be well distributed between the different meals. Skipping a meal or fasting is not really advisable. 

Cholesterol rich foods (To be avoided by cardiac patients)

1.     Whole milk and milk products

2.     Egg Yolk

3.     Shellfishes like prawn, crab, lobster etc. 

4.     Organ meats like kidney, liver, brain etc. 

5.     Chicken, duck with skin. 

6.     Sweet like pastries, ice creams etc. 

7.     Butter, dalda, coconut oil, palmoil

8.     Fried foods like chips, Samosa etc. 

9.     Alcoholic drinks, creams soups etc. 

Sodium rich foods (To be avoided by Hypertensive Patients)

Salt (Avoid extra salt in food and table)

Baking powder, baking soda, ajinomoto etc

Bakery Products like biscuits, cakes, pastries, chocolates, bread, bun etc. 

Salted chips, nuts, popcorn etc

Pappads, pickles, dried fish etc

Canned and Salt preserved foods

Sauces, soup cubes

Sausages, lobsters, meat and yeast extracts

Carbonated beverages (Soft Drinks)

Readymade foods like cornflakes, noodles, fast foods etc.

Proprietary drinks eg. Horlicks, complan, bournvita etc.

General Instructions

1.     Different cereals contain almost the same amount of carbohydrate and so the quantity of cereal consumed should be noted rather than the type consumed. 

2.     Whole grain cereals are better, preferred for their  fiber content and satiety value.

3.     Fish can be included in the diet, in the curry form. Fried fish is the best avoided. Shell fishes like prawns, lobsters etc should be avoided. 

4.     Poultry (Without Skin) can be used occasionally. Beef, Pork, mutton, liver etc should be avoided by cardiac patients. Trim off Excess fat (if any) before cooking. 

5.     Egg yolk has to be avoided by individuals with hyperlipidemia. 

6.     Use skimmed milk whenever possible, otherwise cream has to be removed before consumption. 

7.     Include more vegetables (esp. raw salads and green leafy vegetables) in your diet, as it is rich in fiber which in turn helps to reduce blood sugar and cholesterol levels. Raw salads with sprouted pulses enhance the nutrient composition. 

8.   Cardiac and hypertensive patients can take 3-4 servings of fruits. Whenever possible consume fruits with edible skins eg.  apple. guava etc.

 9.  Cardiac and hypertensive patients should minimize their intake of sugar and sweets. 

10.    Garlic, curry leaves, oatbran etc have blood sugar and cholesterol loosing efforts. Ginger, foods in rich with Vit- E and B Carotene reduces the risk of cardiac diseases. 

11.    Alcohol intake injurious to health, 1 ml of Alcohol contains 7 calories. Alcohol can cause hypoglyemia and can increase triglycerides which can be harmful for the heart. 

12.  Cooking oil used should be minimized and may be restricted to 10-15 ml/day. (2-3 tsp). Use cooking methods that require little or no fat.

13.   Hidden fat in bakery products and snacks should also be taken into account. 

14.  Preferably use a combination of cooking oils like sesame. ground nut, sunflower, rice bran, corn oil etc. use of coconut and palm oil should be maintained at minimum levels. 

15. Dinner should be enjoyed two hours before retiring.

16. Include foods from all the different food groups and thus consume a balanced diet.

17.  Regular exercise is most useful but physical strain after a meal should be avoided.

Pneumonia can be deadly in children

Pneumonia is the second major killer of children after malaria in Nigeria. It accounts for about 17 per cent of total infant mortality recorded yearly in the country.

The rate at which Nigerians, particularly children, lose their lives to pneumonia is alarming as the disease kills no fewer than 150, 000 children yearly.

This is unacceptable for a disease that simple measures such as breastfeeding, immunisation and good hygiene can help to prevent.

Unfortunately, the majority of Nigerians are still ignorant of its causes and prevention.

A school nurse recently referred a patient to my centre and the referral form read, “A six-year-old basic 2 girl came down with a day history of cold, cough and fever. She also complained of stomachache. When her parents were informed about her illness, they consented that she be transferred to the school retainership hospital.”

At the hospital, she appeared quite pale. She also had catarrh, even as her breathing became shallow and fast. She was diagnosed with pneumonia based on the history (from her mum), signs, symptoms and chest examination.

A chest X-ray was ordered to confirm the diagnosis and rule out any other chest abnormality. The X- ray result confirmed right lobar pneumonia, (pneumonia involving the right part of the chest). Following this the hospital placed her on admission and commenced with an intravenous antibiotics.

She was in hospital for about five days but had to take three or four more rounds of antibiotics to clear the congestion in her lungs. She was out of school for almost two weeks.

After this experience, the nurse said she would like to advise parents to take sick children to the doctors for advice immediately and would want parents to be aware that pneumonia can present itself in different forms.

Definition: Pneumonia in a layman’s language is defined as chest infection and it happens when the deepest part of the tissue in the lungs becomes infected and inflamed.

The inflammation affects the small airways and the air sacs (alveoli or parenchyma) at the very end of this system.

This makes the body less effective at moving gases such as oxygen and carbon dioxide into and out of our bloodstream.

Causes: Most Nigerians are ignorant about the factors responsible for pneumonia, contrary to the belief that pneumonia is caused by exposure to cold weather and cold water and rainwater. The disease is communicable; usually caused by bacteria, but it also can be caused by certain viral infections.

Often, people who develop pneumonia may have another illness or injury, but it also often affects otherwise healthy people.

It is highly contagious and can last from a few days to weeks.

Signs and symptoms:  Fever, feeling unwell, coughing (with at times pus-coloured phlegm,young children usually swallow any phlegm they may cough up), shortness of breath, fast breathing, post-tussive vomiting (vomiting after an episode of cough), noisy breathing, wheezing and right abdominal pain.

Investigations: A simple chest X- ray will usually confirm the diagnosis of pneumonia. Other tests like Sputum and blood tests are supportive.

How to manage noisy breathing in children

A mother recently complained to me that her four-year-old baby usually breathes heavily at night. She was worried because her son always opens his mouth and the loud noise was becoming embarrassing.

After I examined the boy, I noticed that his tonsils were inflamed, a condition called tonsillitis. The X-ray done also showed an enlargement of the adenoids. The two conditions are called adenotonsilitis and are responsible for the boy’s noisy breathing.

Adenoids are the two infection-fighting glands at the back of the nostrils and above the tonsils. Adenoid enlargement refers to the increase in the size of the adenoids.

Noisy breathing is associated with breathing through the mouth, bad breath, snoring, fast breathing and cough. Adenoid enlargement is a major cause of noisy breathing in children.

Other conditions that cause abnormal breathing include asthma, poor dentition and abnormality in the mouth. The adenoids, along with the tonsils, help prevent agents such as bacteria and viruses from entering the body. When infection or inflammation occurs, the adenoids become swollen preventing air from flowing in and out of the nostrils freely.

To breathe, they have to inhale and exhale via mouth. The adenoids also shrink, as a child grows older.

Causes

The exact cause of enlarged adenoids is not always clear. Chronic infection of the upper respiratory tract and allergies may cause the adenoids to enlarge.

Symptoms

When adenoids cause obstruction, the child now develops snoring (noisy breathing) because of the obstruction of the passage of the nose at the back, will have bad breath with bad odour and will not gain weight as expected since he uses a lot of energy to breath. Most of the children will have recurrent catarrh, low to high-grade fever, cough, noisy breathing from birth.

Diagnosis

Diagnosis of adenotonsilitis begins with a history and physical exam. The tonsil can be viewed via direct light source when the child opens his mouth. Adenoids cannot be seen by looking in the mouth directly. The doctor can see them by using a special mirror in the mouth or a flexible tube (called an endoscope) placed through the nose. In young children, the easiest way to find an enlarged adenoid is with an X-ray called postnasal X-ray.

Complications: It may result in Otitis media (infection of middle ear), Chronis sinusitis, obstruction of the airway, recurrent chest infection and sleep problems like sleep apnea. It may also affect the facial appearance of the child, which in medical terms is referred to as adenoid faces.

Prevention

Effective treatment of allergies may prevent some cases of adenoidal hypertrophy. Many times, the condition cannot be prevented. There is the need to prevent children from dusty environment and things like smoking, frying things, sweeping, sharing of items with mates in the school.”

Treatments: Use antibiotics, anti-inflammatory (analgesics), oral corticosteroids and anti-allergy drugs, among others. Surgical removal of the adenoids (adenoidectomy) is sometimes necessary for those who do not respond to medicine.

According to MayoClinic.com, babies can have as many as 10 upper respiratory infections–better known as the common cold–before age 2. It’s also common for newborn babies to have some nasal congestion in the first two months of life. All of that sniffling and stuffiness can make your baby uncomfortable and interfere with his sleep, making for a sad and grumpy little one.

Call the doctor

Newborns can become dehydrated quickly, and colds can easily develop into croup or pneumonia. If your newborn is having trouble breathing, has a runny nose, sounds “stuffy” or has a rattling or raspy sound coming from her chest, call your pediatrician. Chances are it’s just normal newborn congestion or simply a cold, but with newborns, it’s best to err on the side of safety.

Clear congestion

A stuffy nose can make it hard for your newborn to suck, so keeping his nasal passages clear is important. If your pediatrician approves, use a mild nasal saline spray, available at most drug and baby supply stores. Follow the directions on the bottle and gently spray it into one nostril at a time. A drop of breast milk in each nostril may help clear the congestion as well. Use a bulb syringe, also available at drug stores and sometimes given out at the hospital where you gave birth, to suck out the mucous. Squeeze the bulb of the syringe, insert just the tip into baby’s nostril and slowly let the bulb re-inflate, drawing the mucous out. Clean the syringe well with hot water after each use, and make sure it’s fully dry before using it again.

Use a humidifier in your newborn’s room to help keep the air moist and ease congestion. Keep it away from the crib or bassinet so the mist doesn’t spray directly on the baby, and make sure the cord is kept well out of baby’s reach. Change the water every day to ensure that mold doesn’t grow in the tub. Sitting with your newborn in the bathroom with the hot water running and the door closed may help loosen congestion as well. Let the steam fill the room and sit with your baby for a few minutes, but be sure he doesn’t get too warm. If his cheeks start to get red or he looks more uncomfortable, move to a cooler room.

Letting your baby sleep partially reclined in a car seat or swing can help his breathing if his chest is congested. Be sure he’s buckled in and that the seat is on the floor and can’t be knocked over.

In conclusion, parents should release their children for necessary surgery that may be beneficial to such children at adulthood. The failure to do this make the patients to snore heavily later in life. It may also affect their speech.

High cholesterol is dangerous, prevent it!

During the last festive period, a woman in her middle age developed partial stroke and was admitted in the hospital. She recovered fully but the family felt that the problem might not be stroke since the woman’s blood pressure had never been high and her blood sugar level had always been within the normal range, meaning she was not hypertensive or diabetic.

Her blood sample, which was sent to the lab for investigations, showed elevated blood cholesterol, a condition called hypercholesterolemia. It was later found that high cholesterol was responsible for the first stroke she suffered.

Hypercholesterolemia, or high cholesterol, occurs when there is too much cholesterol in the body. Cholesterol is a soft, waxy, fat-like substance that is a natural component of all the cells in the body. The body makes all the cholesterol it needs. However, added cholesterol, which comes from the foods eaten, may cause harm. High cholesterol raises the risk for heart disease, heart attack, and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaque) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs. Blood cells that get caught on the plaque form clots, which can break loose and completely block blood flow through an artery, causing heart attack or stroke. 

While heredity may be a factor for some people, the main culprits are lack of exercise and diets high in saturated fat. High cholesterol can be prevented, sometimes with lifestyle changes (diet and exercise) alone. If these do not work, your doctor may recommend medications to lower your cholesterol levels.

Signs and symptoms

In the early stages, there are usually no symptoms of high cholesterol. The only way to tell if the cholesterol is high is through a blood test.

Causes

In some cases, high cholesterol levels may be inherited; the liver may make too much cholesterol, or the body may not remove bad cholesterol from the blood efficiently. High cholesterol and elevated triglycerides can also be associated with other diseases, such as diabetes. But often, high cholesterol is caused by eating foods high in saturated fat and not getting enough exercise. High cholesterol is more common in people who are overweight or obese.

Risk factors: Being overweight or obese, eating a diet high in saturated fat and trans fatty acids (found in processed and fried foods); not getting enough exercise; family history of heart disease; high blood pressure; smoking; and diabetes.

Diagnosis: Most people do not have any symptoms of high cholesterol. A blood test is the only way to check levels of cholesterol in the blood. If the levels are above 200 mg/dL, the doctor will do a fasting lipid profile, a test performed after you abstain from food for nine to 12 hours.

Lipid profile

A lipid test generally determines four distinct numbers: total cholesterol, LDL, HDL and triglycerides. The LDL or low-density lipoprotein and the HDL or high-density lipoprotein are the two fundamental “cholesterol types”. The LDL is known to be negative (bad) when in excess. Therefore, minimising it will be much better. HDL, known to be the positive (good), is better when elevated. In addition, the lipid profile appraises the triglycerides (whole fat in a person’s body). They have an impact on the health in the same manner cholesterol does. At last, the total cholesterol (sum of HDL, LDL and 20 per cent of triglycerides) is integrated as well in the results.

It is important to say at this juncture that people with chronic conditions like hypertension, diabetes, obesity, among others, should have their lipids check periodically.

Have your blood checked today.

I will like to say that eating food containing fat or cholesterol does not lead to high cholesterol (hypercholesterolemia) since the body needs it for normal body metabolism. However, evidenced-based medicine shows that reducing the amount of food containing cholesterol is healthy and beneficial to all, especially those with hypercholesterolemia, hypertension and other heart-related disorders.

High blood cholesterol is treated with lifestyle changes and medicines. The main goal of treatment is to lower the low-density lipoprotein cholesterol level enough to reduce the risk for coronary heart disease, heart attack, and other related health problems. I once saw a patient with high cholesterol, after due explanation, I wrote in his case note TLC for three months. The patient asked the nurse about the cost of TLC. The nurse explained to him that TLC was an abbreviation for Therapeutic Lifestyle Changes and that it was a do-it-yourself treatment and with no fee charged for it.

Therapeutic Lifestyle Changes: TLC helps in lowering the LDL cholesterol. TLC is a three-part programme that includes a healthy diet, weight management, and physical activity. It is for anyone whose LDL cholesterol level is high.

Healthy diet: A dietician once said this “your diet is a bank account; good food choices are good investments.” With the TLC diet, less than seven per cent of the daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Not more than a quarter of our daily calories should come from all fats, including saturated, trans, mono-unsaturated, and poly-unsaturated fats. Mono-unsaturated and poly-unsaturated fats are healthier and cholesterol free examples include olive oil, groundnut oil and soybean oil. Foods high in soluble fibre also are part of the TLC diet.

These foods include whole-grain cereals such as oatmeal and oat bran. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. Such fruits are apples, bananas, oranges, pears.

Legumes include kidney beans, lentils, and cowpeas. A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids.

These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Red meat, (beef), goat meat, and porks, among others, have high cholesterol and may be avoided while Skinless poultry can be substituted for meats. Avoid fried meat. You can grill, roast or boil your meat. Frying with the oil increases the amount of cholesterol in the meat. You also should try to limit the amount of refined sugar or sodium (salt) that you eat. Try limiting alcohol intake.

Too much alcohol will raise the blood pressure, cause weight gain and raise triglyceride level. (Triglycerides are a type of fat found in the blood.)
Weight management: If you are overweight or obese, losing weight can help lower LDL cholesterol. Maintaining a healthy weight is especially important if you are at risk for heart disease and other health problems, such as diabetes and stroke. Obesity is associated with metabolic risk factors, which are a large waistline (abdominal obesity), a high triglyceride level, a low HDL cholesterol level, high blood pressure and high blood sugar.

Physical activity: Routine physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol level. People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. It is advisable to do moderate exercise 30 minutes a day five days in a week or one can register in a gym. The more active you are, the more you will benefit.

Cholesterol-lowering medicines: In addition to lifestyle changes, medicines can help control high blood cholesterol, but they do not cure it. Thus, you must continue taking your medicine to keep your cholesterol level in the recommended range. Cholesterol-lowering medicines are statins. These medicines are safe for most people. They are strictly prescription drugs and cannot be got over the counter. In conclusion, while managing your cholesterol, take steps to manage other heart disease risk factors too. For example, if you have high blood pressure, work with your doctor to lower it.

COMMON BREASTFEEDING PROBLEMS

Mrs BY had a baby 3 weeks ago, she was said to have developed a high grade fever with chills and rigor. She said she cannot go for outings due to her cultural belief which forbids new mum with babies who are less than 6 weeks from going out. She then called the hospital she delivered who recommended antimalarial and paracetamol for her. She did not get better and decides to see a doctor in a clinic close to her house. She was examined by the doctor, the temp was 39 degree centigrade, the two breasts were swollen, tender and an area of redness (inflammation) was seen. The doctor explained saying that this is a breastfeeding problem and not malaria but mastitis. She was treated with antibiotics and analgesics and got well. She was also reassured that she can continue with her medications and breastfeeding.

Worldwide, breastfeeding is recognized as the best way to feed an infant because it protects mother and infant from a variety of health problems. Even so, many women who start out breastfeeding stop before the recommended minimum of exclusive breastfeeding for six months. Often women stop because common problems (listed below) interfere with their ability to breastfeed. With sound guidance and appropriate medical treatment, most women can overcome these obstacles and continue breastfeeding for longer periods.

BREAST ENGORGEMENT

Engorgement is a medical condition that can be experienced by breastfeeding mothers. The breast milk will come in around 24 to 72 hours after birth. A degree of fullness may be experienced in the breasts at this time. After a feed at least one breast should feel soft and light (well drained). Engorgement is caused by a build-up of blood, milk and other fluids in the breast. It will occur if the baby is not feeding and attaching well and the breasts aren’t drained well during a feed. Less commonly it may occur if the body is making more milk than the baby needs. 

Signs and symptoms: Engorgement results in very full and often painful breasts.

Treatment of engorgement: Ensure your baby is attached well when breastfeeding. Feed the baby frequently at least 8 to 12 times every 24 hours. Do not limit the baby’s time at the breast. Express a small amount of milk before you feed to soften your breast and help the baby to attach. Use cool towel or clothe from the refrigerator (not freezer) for comfort.

BLOCKED MILK DUCTS

A blocked duct causes tender or painful lumps as a result of milk building up in the breast behind a duct. Milk ducts are small tubes inside the breast that carry milk through to the nipples.

Signs and symptoms: A painful red lump or swollen spot on the breast. One may also see a white spot on the nipple which is another sign that a duct may be blocked. Blocked or plugged ducts are areas of the breast where the flow of milk is blocked. They can stretch the nearby breast tissue and cause a painful breast lump.

Management of blocked ducts: Feed frequently from the affected side first. Gently stroke the breast towards the nipple during the feed. This may assist the let-down reflex. For comfort and to reduce swelling from excess fluid apply a cold cloth or towel. Express after feeding. If there is a white spot on the nipple – soak the nipple with a warm moist cloth and the health worker rub or scratch off the spot with a sterile needle to allow the duct to open and the milk to flow again. Use paracetamol or anti-inflammatory tablets according to directions.

Prevention: Ensure correct positioning and attachment. Frequent drainage of the breast. Alter your position during breast feeds to include underarm position, cradle position or lying on your side. Check for a white ‘spot’ on the nipple as this may be blocking the milk duct. Avoid sudden long gaps between breastfeeds or expressing for your baby, tight or restrictive clothing such as a bra, pressing or holding one area of the breast too tightly, especially close to the nipple.

MASTITIS

Mastitis occurs when there is a blockage of milk in the milk duct. Some milk may leak out of the duct into the surrounding tissues causing inflammation and infection. Milk ducts are small tubes inside the breast that carry milk through to the nipples

Signs and symptoms: the breast has a red, painful area, An aching flu-like feeling such as a fever, feeling shivery and generally unwell. Seek medical help if fever lasts more than 6 hours.

Treatment of mastitis Drain the breast frequently. Attach the baby to the affected side first. You may need antibiotics for 10 to 14 days. Keep the breast drained by expressing the affected breast after each feed. Cool cloths from refrigerator (not freezer) can relieve discomfort and pain. Anti-inflammatory medication such as ibuprofen will reduce the inflammation and pain. Paracetamol may be taken to ease discomfort.

NIPPLE PAIN, SORES AND CRACKS

Another common reason mother’s stop breastfeeding early is nipple pain. The causes of nipple pain includes: Nipple injury (caused by the baby or a breast pump), Sore nipples are one of the most common complaints by new mothers. If the nipples are cracked or raw, one can put expressed breastmilk or a nipple cream, petroleum jelly, ointment on them, and cover them with a nonstick pad. This will keep the injured part of the nipple from sticking to the bra Nipple vasoconstriction, which means the blood vessels in the nipple tighten and do not let enough blood through. To determine the cause of your pain, your healthcare provider will examine you and your baby, and watch you breastfeed.

Are you having issues with establishing breastfeeding? Talk to a lactation expert today (doctors, gynaecologists, paediatricians, nurses and other health workers who are highly skilled in breastfeeding issues). There are foods and medications called galactagogue that can help to increase breastmilk supply, this works best when a mother has low prolactin levels (i.e when there is a genuine, not a perceived, low milk supply issue), and after a mother has received support and education to improve her breastfeeding or expressing technique.

HEPATITIS B AND C MANAGEMENT IN NIGERIA

Hepatitis. Prevention, Diagnosis and Management

I read the pathetic story of a concerned citizen entitled, Hepatitis management in Nigeria: A red alert, published in the newspaper.
The writer said, “I find it compelling to call attention to the dangerous state of medical knowledge in Nigeria, as experienced in the last three years of my battling a chronic disease called Hepatitis B. Without prejudice to my respect for professionals in Nigeria, I owe it a duty as a concerned Nigerian to raise a red flag on this.”
The patient raised many issues: how the medical experts were unable to help him out of his dilemma; how he was able to join an hepatitis online community group abroad where he got the up-to-date information about the management of hepatitis; how he has been able to stay alive several years after the diagnosis; and how he lost a friend to the complications of hepatitis B Virus due to inadequate management.
There is also the issue of not knowing what to do, where to go for treatment and who to see when it comes to hepatitis.
While working at a National Paediatric Hospital, I had several encounters with many young men who are willing to donate blood to save the life of sick children, but most of them failed to meet the requirements, as they were infected with either Hepatitis B or C.
Also, women attending antenatal clinics were screened, and a few of them had the virus. Such women were counseled on the risk to the pregnancy, the possible effects on the unborn babies as well as on their partners.
Hepatitis is an inflammation/infection of the liver and can result in liver cell damage and destruction. Many people mistakenly think that hepatitis means viral hepatitis, and that all forms of hepatitis are contagious. Actually, the word ‘hepatitis’ just refers to any inflammation of the liver; or the irritation or swelling of liver cells from any cause.
Causes of hepatitis
Toxic hepatitis: This form can occur if someone drinks a lot of alcohol, takes certain illegal drugs or medications, or is exposed to poisons.
Viral hepatitis: There are lots of hepatitis viruses: from Hepatitis A virus to Hepatitis G virus. Though the viruses differ, they have one thing in common: They cause infection and inflammation that are harmful to liver cells.
Non viral infective hepatitis: Malaria Hepatitis and also autoimmune liver disease
The biggest obstacle confronting hepatitis treatment in Nigeria is not necessarily the deadly nature of the virus or even the spread of the disease, but a lack of awareness among Nigerians about the importance of discovering their hepatitis status.
Hepatitis B affects people of all ages. Most adults who become infected with Hepatitis B get rid of the virus within six months. This type of short infection is known as an acute case of Hepatitis B. About 10 per cent of adults infected with the Hepatitis B virus develop a chronic, life-long infection.
People with chronic infection may or may not have symptoms. Those who do not develop symptoms are referred to as carriers. Hepatitis B is acquired through contact with infected blood and body fluids. These viruses are usually transmitted by contaminated needles (in the case of intravenous drug users). Having unprotected sex with someone who is infected can also pass on the Hepatitis B virus. Having chronic Hepatitis B may lead to permanent liver damage, including liver cirrhosis and cancer.
The diagnosis of hepatitis B Virus is a major issue, as it has an impact on every part of life for the person who receives the diagnosis. It is a potentially chronic and life-limiting illness, associated with considerable social stigma, effects on quality of life, and consequences for decisions about work, relationships and having children.
Diagnosis of hepatitis B Virus is the first step in an effective treatment pathway for those with HBV. After diagnosis is treatment, but most of those infected stop at this first step partly due to reassurance by the health workers that there is no imminent danger, thereby postponing the evil day.
Chronic hepatitis B Virus happens if the hepatitis test (HBsAg) is repeated in six months from the time the test was first done and it came out as positive. It is said to be chronic HBV.
Hepatitis profile/viral markers :There are six parameters used in the management of HBV.
HBsAg — This is a marker of current infection or recent vaccine. Positive result means that the person is either infected or recently immunised. This is the first test and the beginning of the management. Every patient with positive result must be tested for the remaining HBV markers.
Anti-HBs — This is the marker of immunity from resolved infection or vaccine. Any patient with this is fully immunized either from the Hepatitis B vaccine or from total recovery from virus. This category of people don’t require treatment
Anti-HBc — This is a marker of current or past infection .It will show those that are recently infected (acute HBV) or those infected in the past (chronic carrier).
HBeAg — This is a marker of viral replication and infectivity. Any patient with a positive result is highly infected and may need adequate treatment.
Anti-HBe — This is a marker of the immune control in chronic hepatitis B
HBV DNA — This is a marker of viral replication commonly called viral load. Any patient with high viral load result is highly infected and will need adequate treatment. It is also used to monitor the progress with treatment.
ALT — This is a marker of liver inflammation, not a viral marker but a liver function test. When it is high, it shows the liver is undergoing inflammation.
Treatment
The treatments for acute and chronic infection are considered separately. The majority of hepatitis B Virus encountered in Nigeria is due to chronic infections. Treatment of acute hepatitis B Virus is supportive in most cases, consisting of bed rest, nutritional support and symptomatic management such as simple analgesia and anti-nausea medications.
The treatment of chronic HBV can be life-long and it is explained below:
General (lifestyle modification): Alcohol consumption should be ceased, cigarette smokers should be advised to quit, weight reduction with sound nutritional advice is ideal. Eat plenty of vegetables, legumes and fruits. Eat plenty of cereals, preferably whole grain, lean meat, fish, poultry, milk, yoghurt, cheese and regularly drinking water. AVOID SPOILT GROUNDNUTS/PEANUTS! Poorly preserved groundnuts contain toxins (aflatoxin)that are poisonous to the liver.
Vaccination: The diagnosis of hepatitis B is also an opportunity to prevent its spread through vaccination. The standard regime is at three doses at between zero and six months respectively. Post-vaccine laboratory test is required to be sure the person is fully immune.
For the person who has already acquired hepatitis B, it is too late to vaccinate against HBV, but further liver injury by another virus — hepatitis A — can be prevented.
Hepatitis B immune globulin is indicated as a post exposure prophylaxis for people at risk of developing hepatitis B because they have been recently exposed to body fluids of individuals who have hepatitis B.
Newborn treatment: Up to 90 per cent of infants born to HBeAg-positive mothers acquire the infection if untreated. The concurrent administration of two injectables Hepatitis B immunoglobulin and the Hepatitis B vaccine to the newborn immediately after birth is effective in preventing vertical transmission of the virus.
If the neonate has taken the two injectables, the mother with HBV infection can breastfeed the neonate safely because there is no increased risk of transmission. Children born to HBV-positive mothers should be assessed for their hepatitis B status after the completion of the course of vaccination.
Sexual partners of HBV positive persons should be counselled to protect themselves from sexual exposure to infectious body fluids such as semen and vaginal secretions, by using condoms; or by receiving full immunisation against hepatitis B virus.
Medication: The treatment may be appropriate in some patients. It is very rare that anti-viral drug treatment will lead to a cure for HBV infection.i.e.it is treatable but not curable. The long-term aim of treatment is to arrest or reverse the progression of liver damage, with the ultimate goal of preventing cirrhosis, cancer of the liver and liver failure.

Dr Adesanya has several certifications on Hepatitis management from western Australian government sponsored e-learning programme.