By Caroline Nankabirwa
Uganda joins the rest of the world later this month to mark World Hepatitis Day on July 28, under the theme “Hepatitis: Let’s break it down,” a call to remove barriers between people and the services that can save their lives.
It is also a moment to ask: will the country meet the World Health Organisation’s target of eliminating hepatitis as a public health threat by 2030?
Hepatitis has five main types, A to E, but hepatitis B and C stand out as the most dangerous. Together, they cause roughly 80 percent of liver cancer cases worldwide and are often called silent killers because they can progress for years without symptoms.
The World Health Organisation estimates that 287 million people were living with chronic hepatitis B or C in 2024, and 1.3 million died from the two diseases that year. Hepatitis B deaths alone rose by 17 percent between 2015 and 2024, largely due to limited diagnosis and treatment.
In Uganda, the current hepatitis prevalence is unknown, but the 2016/17 Uganda Population-based HIV Impact Assessment estimated adult hepatitis B prevalence at 4.3 percent, higher among men (5.6 percent) than women (3.1 percent), and highest in the northern region.
Evidence from the Uganda Cancer Institute shows just how serious a threat hepatitis is: the Institute records 170 to 200 new liver cancer cases every year, and hepatitis B accounts for 80 percent of the liver cancer cases reported at Mulago hospital annually.
How Is Hepatitis Transmitted?
Hepatitis B spreads mainly through infected blood and body fluids. This can happen from mother to child at birth, through unprotected sex, or through unsafe injections and sharp instruments in health facilities, communities, or among people who inject drugs.
Hepatitis C spreads in a similar way, transmitted when infected blood enters the body of someone who is not infected.
Hepatitis Is Often Silent Until It's Too Late
Most people show no symptoms when first infected, and they end up undiagnosed until liver damage has occurred. Getting tested is the only way to know if you have hepatitis.
Some people develop acute illness lasting several weeks, including jaundice, dark urine, fatigue, nausea, vomiting and abdominal pain while severe cases can progress to liver failure and death.
By the time warning signs appear, the damage can no longer be reversed.
Why the Burden Keeps Growing
Much of the danger lies with adults born before 2002, who missed infant hepatitis vaccination and remain unaware of their status until liver damage is advanced.
Vaccination awareness remains low, completion of the three-dose schedule is inconsistent, and some pregnant women hesitate over misconceptions.
Children are especially vulnerable: while adults clear the virus in over 95 percent of cases, children infected in infancy develop chronic disease in about 95 percent of cases.
What Uganda Has Done So Far
Uganda has taken significant strides toward tackling hepatitis. Efforts date to 2002, when the hepatitis B vaccine was integrated into the national immunisation programme for infants.
Momentum accelerated in 2014, when the Ministry of Health declared hepatitis B a formidable epidemic disease, mandating vaccination for all health workers.
Standardisation of care followed in May 2019 with national guidelines governing testing, treatment and patient monitoring.
In 2023, the Ministry of Health began administering the hepatitis B birth-dose vaccine within 24 hours of delivery — the critical window for interrupting mother-to-child transmission.
The government has since broadened its response: making free antivirals available at designated facilities, screening all donated blood before transfusion, and ensuring high-risk pregnant women receive antivirals alongside the birth-dose vaccine, with immunoglobulin administered to protect the newborn.
The Gaps That Remain
Despite this progress, public awareness is still low. Many Ugandans routinely test for HIV before sex or marriage but give little thought to hepatitis, though it is more deadly.
Hepatitis B also has no coordinated tracking system like HIV, so diagnosed patients are often lost to follow-up, and specialist hepatitis care remains concentrated in a handful of referral hospitals.
Left unaddressed, the disease will keep spreading quietly until it overwhelms the health system.
What Needs to Be Done?
The Ministry of Health should roll out more frequent nationwide sensitisation, vaccination and testing campaigns, engaging voluntary partners such as churches, Rotary, community radios and the annual Kabaka’s Birthday Run. Greater awareness helps people seek screening and treatment early, avoiding complications and further transmission.
Government should also work with global health partners to implement the Africa Elimination of Vertical Transmission (AEVT) plan and increase health-sector budget allocations to fund activities under the “Triple Elimination Strategy,” which integrates HIV, hepatitis and syphilis services into routine reproductive and primary health care.
Finally, the Ministry should open more hepatitis clinics nationwide at Health Centre IV level for routine screening and management, with regular data from these clinics feeding into national clinical surveillance and updated fact sheets to track the country’s progress toward eliminating hepatitis by 2030.
The writer is an Expert Associate at the Blueprint Consortium Africa, Kampala.
