Bilharzia is the road to liver failure [Archives:2008/1150/Health]

April 28 2008

Mahmoud Assamiee
Forty-four-year-old mother Khuzam Bint Qayed was unable to survive cirrhosis. The mother of seven, who traveled from her home in Taiz governorate to a public hospital in Sana'a, died after a 10-year fight with the incurable disease.

In fact, her suffering began when she was a child, swimming, washing and drinking from a well in her village, where she got bilharzia. She paid no attention to the blood accompanying her urine or stools, nor the strong stomachache. Thus, such ignorance led her to develop cirrhosis, wherein the liver gradually loses its ability to function normally. This is called liver failure, sometimes referred to as end-stage liver disease.

Ghulam Rabbani, the World Health Organization's representative in Yemen, noted that WHO statistics reveal that 3 million Yemenis are infected with bilharzia, 20 percent of whom are suffering dangerous complications, while 20 percent have liver failure or cirrhosis.

“Bilharzia leads to liver failure or cirrhosis, which is incurable and leads to death,” Rabbani explained, calling for the media's assistance in achieving success in WHO's mission to eradicate bilharzia.

According to Rabbani, Yemen and Sudan are the only countries in the Middle Eastern region still suffering bilharzia, while similar countries such as Egypt and Afghanistan, which were plagued by the disease, have succeeded in eradicating it through continuous anti-bilharzia campaigns.

In this vein, Yemen began conducting anti-bilharzia campaigns last March 2008 in Al-Mahwit, Al-Dhale', Taiz, Abyan, Dhamar and Lahj governorates. These five-year campaigns provide anti-bilharzia medication to children between ages 6 and 18 in these targeted governorates.

Dr. Abdulkarim Zaid, internal medicine consultant and head of the Endoscope Department at Kuwait Educational Hospital in Sana'a, indicates that there's a strong link between bilharzia and cirrhosis.

“Bilharzia is caused by several species of flatworm, two of which are Schistoma mansoni and Schistoma hematobium. If an infected individual is not cured, bilharzia will lay eggs in the colon. These eggs then are transmitted to the liver via the hepatic portal vein. When they gather in the liver, they damage it, causing liver failure,” Zaid explained, adding that this parasitic disease most commonly is found in areas with water contaminated by freshwater snails, which may carry the parasite.

Zaid further noted that Sana'a and Hajjah are the two Yemeni governorates most plagued with bilharzia.

Symptoms of bilharzia are a severe allergic reaction or itching of the entire body, blood in the urine or stool and a strong stomachache. Zaid says bilharzia may reach the liver within a month of infection, but it takes many years to cause liver failure.

He continues, “Humans can live on 10 percent of the liver without feeling any complications, which is why liver patients don't feel the symptoms of the disease, often discovering it in its late stages.”

“In order to eradicate bilharzias, wells containing [such freshwater snail] shells must be filled, the water must be cleaned and a sanitation network must cover those areas infected with bilharzia,” says internal medicine and liver consultant Dr. Abdulhafiz Al-Silwi.

He adds that medicating children is useless, further pointing out that bilharzia will remain in Yemen as long as its streams and pools are vulnerable to uncleanliness caused by the urine and stools of those rural peoples without bathrooms.

According to Al-Silwi, although liver failure also can result from other diseases such as Hepatitis B and C, as well as disorders resulting in enzyme shortages or increasing the quantities of iron and copper in the liver, the most common reason for liver failure in Yemen is bilharzias. “We don't have statistics, but we're now working on counting these cases since 1996,” he added.

Complications due to bilharzia include liver failure and vomiting blood, followed by death, if the sick individual doesn't undergo a liver transplant. However, Zaid noted, “Such surgery doesn't exist in Yemen because it costs $1 million.”

Dirhem Thabit, 41, has cirrhosis of the liver caused by bilharzias and has had two surgeries to repair his liver, one in 2004 and the other in 2006.

“I developed liver cirrhosis from bilharzia. When I was a child, I used to swim in pools in our village in Taiz,” Thabit recounted, “I didn't have any bilharzia tests during that time and only discovered the disease when I felt its serious complications once it reached my liver.” He notes that although he no longer has bilharzia, his liver now is damaged and his body is weak. He adds, “Liver failure brought me hypertension, for which I now have medicine for this new disease.”