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Plans to Eliminate HBV, HCV By 2030

Iran as a member of the World Health Organization, the global health agency, has pledged to eliminate hepatitis B and C as public health challenges by 2030. The Health Ministry is implementing schemes to achieve this goal.

“Unprotected sex and risky sexual behavior among jail inmates and addicts in rehabilitation centers have necessitated making them the main target groups of the programs,” said Dr. Mohammad Mahdi Guya, head of the ministry’s Center for Infectious Diseases, at a press conference on the occasion of World Hepatitis Day (July 28).

Fortunately the groups that are at high risk of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, including prisoners and intravenous drug users, are easily accessible, he said, according to Fararu News website

So far, 35,000 prisoners have been vaccinated against hepatitis B and the ministry plans to extend coverage to all prisoners by the end of the current fiscal year in March 2017.

All prisoners are compulsorily screened for the diseases, and free treatment is provided by the ministry.

A group that is not easily accessible but at great risk of developing HBV, are sex workers. The establishment of specific health centers for this stratum would be an effective measure to keep the disease in check. However there are many constraints in this regard, Guya noted.

“Based on official figures, currently, HBV infection rate is less than 1% among people younger than 28 years of age. The figure is less than 0.5% for individuals below the age of 22.”

The prevalence rate of hepatitis B was 5% at one time, but has fallen to less than 2% in all provinces except Sistan-Baluchistan and Golestan where it is a little above 2%.

The decline can be attributed to implementation of the national immunization program that started in 1993 for infants and high-risk age groups.

HBV Prevention Programs

Since then, annually almost all infants (90%) have been given hepatitis B vaccine.

In 2006, the ministry decided to vaccinate, over a four-year period, all those who were born between 1989 and 1992, as they had entered the reproductive years and were at risk of getting the disease if they were sexually active.

In order to reach the goals set by 2030, the Health Ministry should vaccinate all unvaccinated people under the age 40 by the end of 2026. Vaccination of all municipal workers, people working in beauty salons, healthcare workers and infants for HBV is on the agenda.

While official figures say 1.4 million people are infected with the hepatitis B virus, unofficial sources claim that 7% of Iranians carry the virus.

The infected people may or may not show symptoms of the infection since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves, Guya said.

Infection in Drug Addicts

While HBV can be transmitted via unprotected sex, contact with infected blood, sharing needles, syringes, razors, or toothbrushes with infected person, and mother-to-child during childbirth, HCV is rarely transmitted through unprotected sex.

The main routes of hepatitis C transmission are primarily by needle-sharing with infected people during IV drug use and also mother-to-child in childbirth.

There are between 180,000 to 250,000 people infected with HCV in the country and most of them are injecting drug users. About 96% of infected prisoners are men.

Since 1996, all donated blood is screened for HCV in the country and therefore the risk of acquiring HCV infection from transfused blood has been reduced to almost zero.

At a recent seminar on ‘Eliminating Hepatitis C by 2030’ held at Iran University of Medical Sciences in Tehran, Deputy Health Minister for Research Reza Malekzadeh announced that a domestically produced antiviral biosimilar Interferon (IFN)-based medicine has been introduced under the name ‘Sovodak’ for treatment of HCV. Given the relatively young age of the HCV infected population in the country, timely intervention is necessary to reverse the rising trend.

HCV infection is a growing global health issue. Those living with chronic HCV infection are at risk of developing advanced liver diseases such as cirrhosis and hepatocellular carcinoma (HCC).

Setting up harm reduction centers (where homeless men and women can visit to get tested for HIV/AIDS, hepatitis B and C, and receive necessary education as well as means of prevention), methadone therapy for de-addiction which lacks the risks of transmitting the virus and drop-in centers (DICs) for street addicts are among other measures taken to reduce hepatitis infection rate.

Global Data

According to the WHO, in 2013, viral hepatitis was a leading cause of death worldwide (1.46 million deaths, a toll higher than that from HIV, tuberculosis or malaria, and on the increase since 1990). More than 90% of this burden is due to the sequelae of infections with HBV and HCV.

So far, HBV infection has affected 400 million people worldwide.

Prevention can reduce the rate of new infections, but the number of those already infected would remain high for a generation. In the absence of additional efforts, 19 million hepatitis-related deaths are anticipated from 2015 to 2030. Treatment now can prevent deaths in the short- and medium term.

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the exchange of body fluids and blood.

Globally, between 130 and 150 million people have chronic hepatitis C infection.

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What you did not know about Uganda Martyrs

Pilgrims draw 'holy water' from the man-made lake at Namugongo Martyrs shrine

It is martyrs day – a day named in recognition of the deaths by burning, of several youths, who insisted on practising their faith.

Most of the youths were set on fire at Namugongo, hence the huge hut-like structure with its outstanding copper pillars at the Catholic shrine.

The tall green trees around this shrine give off a soothing breeze. Far beyond the green of the trees, is a sizeable manmade lake with a conspicuous pavilion. Prisca Baike spoke to Fr John Mukasa Muwonge, a promoter of the Uganda martyrs, for some of the mysteries of the youths, including how they booked their place in history despite upsetting Kabaka Daniel Mwanga II of Buganda.

Prior to the June 3, 1886 mass execution of the martyrs at the Namugongo Anglican shrine, there had been several other executions in this place. The most prominent execution was the 1862 burning of 22 Muslims, who were killed for getting circumcised ahead of the Kabaka, contrary to a decree at the time.

He says Buganda kingdom had 13 execution sites and the official execution site was in Namugongo, where the Anglican shrine stands.

At this place, the only mode of execution was by burning the culprits while they were alive, unlike other execution sites where other methods like hanging and stabbing were used. Usually boys and men who refused to join the Kabaka on hunting expeditions to other kingdoms, as well as chiefs and princes the Kabaka distrusted, were executed here.

Mass killing

The first Christians executed were Noah Sserwanga, Joseph Lugalama and Mark Kakumba, all Anglicans. The trio was executed on January 31, 1885 at Mpiimeerebera execution site in Busega where the Uganda Martyrs church stands today. Much later on November 15, 1885, Joseph Mukasa Balikuddembe became the first Catholic martyr to be executed, at Nakivubo, where the former Owino market – now named after him – stands today.

After Balikuddembe’s death, there was a lull until the executions resumed in earnest, starting May 26, 1886 when the Kabaka summoned several pages to the Munyonyo palace.

At the time, the Kabaka was residing in Munyonyo after his Mengo palace caught fire on February 22, 1886. The Kabaka was reportedly incensed that the youths had disobeyed his orders not to pray anymore.

The Kabaka’s soothsayers had warned Mwanga that the white men (missionaries) would use the youths to bring down the kingdom. So, when none of the youths would apologise for disobeying the Kabaka, an enraged Mwanga ordered their execution. Denis Ssebugwawo was beheaded at the palace and the rest were condemned to death and handed over to Mukajjanga.

As the youths were chained and marched from Munyonyo to Namugongo, they made a grim procession, singing to cheer one another. However, there were altercations between the executioners and the victims, usually the former taunting the latter to renounce their faith, ultimately resulting in deaths by stabbing. Andrea Kaggwa was killed in one such incident just after Munyonyo, and Ponsiano Ngondwe followed as the procession passed Kyamula.

The following day (May 27, 1886), Atanasius Bazzekuketta was killed at Nakivubo and later on, Gonzaga Gonza at Lubaawo Naalya, near Kyaliwajjala. Earlier that day, at Old Kampala, Matia Mulumba had his arms and legs cut off and bits of flesh cut from all over his back. All these were burnt right before him but he did not die until May 30 as his wounds were treated with herbs by his persecutors who wanted him to suffer a painful death.

Still, on May 27, a smaller group of persecutors proceeded to Mityana where they killed Noah Mawagali on May 31, 1886. He was speared, tied to a fig tree and left for dogs to feast on, before his body was thrown at a junction, to threaten other believers. The larger group - about 22 boys – arrived at Namugongo shrine on May 27, and were tied up and kept waiting, as the executioners collected the huge pile of firewood that would be used to make the huge bonfire, in which the youths were burnt on June 3, 1886.

While many more would be executed across Buganda well until 1887, including one of the Kabaka’s sisters, Clara, those burnt at Namugongo remain the face of the group, as their predicament was well documented by the French White Fathers, including Fr Simeon Lourdel (better known as Mapeera).

Charles Lwanga was killed where the Namugongo Roman Catholic basilica stands today, while the rest were killed at Nakiyanja – where the Anglican shrine stands. Unlike the rest who were executed by the head executioner Mukajjanga, Lwanga was killed by Ssenkoole, the assistant executioner, as the two had a grudge going back to 1884 when Lwanga was in charge of developing the Kabaka’s lake in Mengo.

Ssenkoole had refused to work under Lwanga’s supervision, arguing that he would not work for someone younger than him. He was fined a goat and three calabashes of local beer, a matter that he never forgot.

The Basilica

The Namugongo church started in Kyaliwajjala where Vienna College is currently built. This is where the then Nsambya based Mill Hill missionaries used to converge every Sunday. Later the church was moved to Namugongo, where Charles Lwanga was killed and a church built there. The martyrs’ execution was the first such incident in Africa and their heroism was talked about in the Catholic Church, resulting in their canonisation in Rome in 1964.

With this, the then Archbishop Emmanuel Nsubuga, spearheaded the construction of the new basilica, in time for the Pope’s arrival in Africa in 1969. The shrine, which features 22 vertical copper pillars - one for each martyr, was completed in 1975. The man-made lake came about due to the brick making work in the 1950s during the construction of Namugongo girls’ primary school, led by Msgr Lawrence Mbwega and the Mill hill missionaries.

After extracting a lot of soil for the bricks, a huge pond was left in the swampy area. Mbwega started rearing fish in the pond and growing sugar canes and yams around it. However, the beauty of the pond attracted several pilgrims to pray from there; so, he turned it into a manmade lake around which mass could be celebrated. He also constructed a pavilion, from where he and other priests would conduct mass.

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Government plans to bring acid attacks under heinous crimes category

New Delhi: Faced with the growing number of acid attacks on women, government is planning to categorise such cases as heinous crimes and fix a time-frame for investigation and trial for speedy justice.

All such cases where maximum punishment of life imprisonment or death sentence is possible will be categorised as heinous crimes, a Home Ministry statement said today.

As per Criminal Law (Amendment) Act 2013, a person convicted for acid attack is sentenced to imprisonment for ten years or life.

The trial of the offences (under Section 376A-D of IPC is to be completed within 60 days. The Home Ministry is now planning to extend this provision further by suitable amendments in CrPC for time bound investigation and trial of all cases related to heinous crimes.

Government also proposes to bring suitable amendments in law to fix time-frame for disposal of appeals by courts especially in cases of heinous crimes including acid attack to ensure speedy justice.

The decisions to strengthen legal and administrative framework to check acid attacks were taken by Home Minister Rajnath Singh showing utmost concern to the victims of acid attacks, the statement said.

The government has also taken a number of steps to regulate sale of acid, increase punishment for perpetrators of acid attack and compensation for the victims etc.

In order to regulate the sale of acid, a web application having functionalities like registration of stockists and retailers, issue of licenses by the district administration, targeting sale of acid to individuals only after recording personal details like proof of identity and proof of address of the purchaser will be developed.

This measure will considerably reduce unauthorised sale of acid in the country, it said.

The victims of acid attacks need to be treated by hospitals in a hassle-free manner.

The Home Ministry will develop a new mechanism in consultation with the Ministry of Health and Family Welfare, Ministry of Finance and Insurance companies so that victims of acid attacks are treated on a cashless basis and the treatment amount is paid from the central victim compensation fund which is proposed to be set up by the Home Ministry.

Steps will be taken to include acid attack victims in the category of physically challenged persons/persons with disability so that they are able to access the benefits of reservation, training, self-employment loan etc. as admissible to the physically challenged persons. This will help in rehabilitation of acid attack victims.

So far, several states, Maharashtra, Karnataka, Kerala, Haryana, Punjab, MP, Sikkim and Arunachal Pradesh have framed rules to regulate sale of acid and corrosive substances.

However, acid is easily available in Delhi, Uttar Pradesh, Madhya Pradesh, Bihar etc.

There have been reports of increasing number of acid attack cases. Though no official statistics are available about the number of such cases, an estimated 400 cases of acid attacks are registered every month across the country.

According to a report of the Law Commission, acid throwing is an extremely violent crime by which the perpetrator of the crime seeks to inflict severe physical and mental suffering on his victim. This kind of violence is often motivated by deep-seated jealousy or feelings of revenge against a woman.

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