Monthly Archives: July 2016

World Hepatitis Day 2016: Examining Eritrea

July 28 is World Hepatitis Day (WHD), one of eight official global public health campaigns marked by the World Health Organization (WHO). WHD aims to raise global awareness of hepatitis and encourage prevention, diagnosis and treatment. Viral hepatitis – a group of infectious diseases known as hepatitis A, B, C, D, and E – affects hundreds of millions of people worldwide, causing acute and chronic disease and killing close to 1.4 million people every year.


The year 2016 is particularly important in the global fight to eliminate hepatitis. Earlier this year, on 28 May, 194 WHO Member States made a historic commitment to eliminate viral hepatitis by 2030. During the 69th World Health Assembly, governments unanimously voted to adopt the first ever Global Viral Hepatitis Strategy, signalling the greatest global commitment in viral hepatitis to date. The strategy sets a goal of eliminating hepatitis B and C by 2030 and includes a set of prevention and treatment targets which, if reached, will reduce annual deaths by 65% and increase treatment to 80%, saving 7.1 million lives globally by 2030. Furthermore, as part of the commitments made during at the 69th World Health Assembly, Nohep, a global movement to eliminate viral hepatitis, is being launched on 28 July to bring people together and provide a platform for people to speak out, be engaged, and take action to ensure global commitments are met and viral hepatitis is eliminated by 2030.


Hepatitis, which is an inflammation of the liver, can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Although hepatitis viruses are the most common cause of hepatitis, other infections, toxic substances (such as alcohol and certain drugs), and autoimmune diseases can also cause hepatitis. Globally, viral hepatitis affects approximately 400 million people, with 6-10 million newly infected annually.


While hepatitis is a global problem, sub-Saharan Africa is particularly burdened. For example, hepatitis B prevalence is highest in sub-Saharan Africa and East Asia, where between 5-10% of the adult population is chronically infected, while with a prevalence of between 5-8% and an estimated 32 million people infected with the hepatitis C virus (HCV), sub-Saharan Africa has the highest burden of the disease in the world (Karoney and Siika 2013; Schweitzer et al. 2015). Moreover, sub-Saharan Africa has a high prevalence for the other viruses as well due to generally poor sanitary conditions and hygienic practices, lack of access to safe water, and poor awareness and education.


Eritrea’s efforts to combat hepatitis have involved a multidimensional, cost-effective, pragmatic approach and broad participation. A range of general public health and development initiatives that have been undertaken have helped to combat the prevalence and spread of hepatitis in the country. These include: sexual health education; widespread advocacy and awareness campaigns; the provision of condoms, the expansion of access to basic sanitation and safe, clean water, particularly in rural areas; improved disposal of sewage within communities; and harm reduction programs.


Another vital step has been immunization and vaccination which, according to the WHO, is, “the most effective and cost-saving means of prevention.” For many years in Eritrea, immunization and vaccination programs have been conducted through an array of cooperative agreements with various international organizations and partners, including the United Nations Development Programme (UNDP), UNICEF, the WHO, and the GAVI Alliance. These partnerships have increased important supplies such as vaccines, syringes, and other materials, while strengthening support for the development, production, and dissemination of social mobilization materials, regional plans, and logistics.


In 2002, Eritrea introduced childhood immunization against hepatitis B as part of the Ministry of Health’s Expanded Program on Immunization, which also delivers immunization for children against seven other vaccine preventable diseases (i.e. Tuberculosis, Diphtheria, Whooping Cough, Tetanus, Polio, Measles and Homophiles influenza type B). According to recently updated data from the WHO and UNICEF, national HepB3 coverage (measuring the number of third doses of Hep-B vaccine administered to infants) in Eritrea is approximately 95%. By comparison, the global average national coverage rate is 87%, while the average for Africa is 81%. In terms of Eritrea’s neighbours, national coverage rates are as follows: Djibouti 84%; Ethiopia 86%; Kenya 89%; Somalia 42%; South Sudan 31%; Sudan 93%, and Uganda 78%.


Table 1: East Africa National HepB3 Coverage Rates 2015 (WHO 2015)



Hepatitis B vaccination programs are particularly important because they gradually result in the reduction of HBV-related chronic hepatitis, liver cirrhosis and hepatocellular cancer. Ultimately, Eritrea’s vaccination programs have played an important role in reducing the prevalence and spread of hepatitis, and recent research studies estimate that the country’s prevalence of hepatitis B is approximately 2.49%, the lowest in Africa (Schweitzer et al. 2015).


Table 2: East Africa Estimated Hepatitis B Virus Prevalence (Percentage)



Overall, Eritrea’s multifaceted efforts have had a positive impact in combating and controlling hepatitis. With renewed commitment, effective immunization, vaccination, and prevention programs, an expansion of treatment and health services, as well as continued support from international partners, Eritrea can move towards eliminating viral hepatitis and continue to protect and improve the health and development of its greatest asset – its men, women, and children.

eritrean newborn - health

Reflections on Graduation at CASS – Eritrea

For the last year I have been teaching in Eritrea. On Tuesday 12 July 2016, I had the opportunity to participate in the 9th annual graduation ceremony at the College of Arts and Social Sciences, located in Adi Keih, Eritrea. A total of 180 students proudly received a Diploma or Bachelor of Arts Degree. The College of Arts and Social Sciences (CASS), currently within its sixth academic year as a stand-alone institution, has an annual enrollment of approximately 1500 students, nearly evenly split between males and females (specifically, 51 percent of students are male and 49% are female).

College of Arts and Social Sciences (Adi Keih, Eritrea)

Located near several significant traditional and historical sites, the school has ten total academic departments, nine of which award degrees while one awards diplomas. Of note, CASS has also developed a new and exciting Master’s Degree program in collaboration with the University of Helsinki. The college also boasts a traditional and digital library, a growing collection of resources for visually impaired students, a bookstore, staff and student cafeterias, a recreation lounge featuring satellite television and games, several all-weather outdoor sports courts, highly successful intercollegiate athletic teams, and various student clubs.

Hours after Tuesday’s memorable ceremony, I retreated to my office to quietly reflect on how amazing it was to have been part of such a wonderful occasion. From the beginning of the ceremony until the end, things ran very smoothly, serving as a reflection of the hard work, dedication, sound planning, and selflessness of numerous people from across the close-knit CASS academic community and the surrounding areas. The organization committee’s large investments of time and effort in preparation were not overlooked or unnoticed, but were instead deeply appreciated and highly admired.

While graduation represents the culmination of a student’s academic journey, it is important to remember that it is only possible with the strong support and backing of friends, family, and communities. Simply, graduation is not a day so much about “me” but “we.” One glance into the CASS auditorium helped to illustrate just how so. Seats were filled by people from all walks of life, all sharing some connection, small or large, to the graduates. I will never forget the great pride exhibited by fathers, the loud, piercing ululating and tears of joy shed by mothers, or the sheer admiration expressed by friends and siblings as the graduates slowly, confidently strode across the stage, faces beaming with sheer happiness, to collect their certificates.

Earlier this year, I went back to the place I was born, visiting my family’s old home, as well as various family and friends. It was particularly special and especially moving since it was my first time meeting many of them, while others I had only met as an infant, over 20 years ago. When I was child, my family left Eritrea. Subsequently, I had the opportunity to visit and live in many countries around the world throughout Africa, the Middle East, Europe, and North America. Last year at about this time, I fulfilled a long-time family dream and goal – completing my Ph.D.

Shortly after graduation, I had the possibility to pursue a variety of different jobs and opportunities, but I kindly turned them down. My heart simply wasn’t into it. Somewhat perplexed, some classmates and colleagues asked me “Fikre, why?” I told them the answer, in just four words, “I’m going to Eritrea.”

Thereafter, many would respond, “Eritrea? Why?”

First, and most simply, it is home. No matter where you are in the world, you’ll always have a special bond with home. While it had been many years and although I traveled thousands of miles, I don’t think I’ve ever really left home.

However, another important reason I chose to come home to Eritrea is because of the youth and the students, such as the 180 new graduates of CASS. Not due to some egotistical rationale or saviour-type complex. But instead, because of the inspiration they provide and the admiration they elicit. I admire what they represent and the high-standing principles they wonderfully reflect. I tremendously respect how, regardless of whatever challenge may arise, instead of shirking responsibility or hesitating, so many of them choose to address it directly and head-on. I greatly admire their deep passion for learning, growth, and individual development and commend their pursuit for more.  I can only applaud the fact that the young graduates have already faced and overcome obstacles, barriers, and challenges that many others could barely fathom, let alone begin to face.

Last year, shortly before arriving at CASS, I recall preparing a large collection of materials and lessons I wanted to teach and share. As a teacher, I’d like to think I’ve been able to accomplish a lot of that. But never, in my wildest dreams, could I have expected to attain what I have from the students, many who graduated on Tuesday. Accordingly, to them, I humbly say Yekinyelay. Thank you for your efforts and hard work. Thank you for what you have taught me and for providing amazing lessons and wonderful examples that simply cannot be found in books.

On Tuesday, walking across the CASS campus and around the auditorium, I felt a slight hint of sadness because I understood that students that I had come to know, admire, and appreciate would soon be leaving. However, those emotions were soon overtaken by a deep and profound sense of happiness, anticipation, and pride in the realization that the young, limitless graduates were moving on to pursue their individual or family dreams and aspirations, and play a positive, constructive role in establishing a prosperous, harmonious nation.


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