Are More Tanzanians Dying From Hepatitis Than From HIV/AIDS?

With the media calling it a ‘silent killer’, is hepatitis causing a public health crisis in the country?

According to Dr John Lwegasha, head of Muhimbili National Hospital’s Gastroenterology and Hepatology Unit in Tanzania, Hepatitis B is responsible for more deaths in the country than HIV.

Dr Lwegasha was quoted in The Citizen in an article discussing the prevalence of the liver disease in Tanzania, and its emergence as a public health crisis.

“In Tanzania, the rate of hepatitis B transmission, which is at 8 per cent, exceeds the rate of HIV transmission which is below 6 per cent according to recent data availed by National Bureau of Statistics (NBS). This is to say hepatitis B is responsible for a [higher] number of deaths than HIV” — Dr John Lwegasha

Media coverage of the disease in Tanzania has focused on the growing number of diagnoses, with some publications dubbing it a ‘silent killer’ due to the fact that it takes five to 10 years for those with Hepatitis to develop a chronic illness, by which time it is too late for intervention measures.

Various reports in local media, including this article in The Guardian, state that Tanzanians are almost twice as likely to get infected with Hepatitis as with HIV, mainly due to unsafe sex.

“Doctors are warning that Tanzania could be on the brink of a major health crisis brought about by the outbreak of viral Hepatitis, which has been described as a silent killer, due to its fast rate of infection and late diagnosis.”

The media reports have sparked alarmist debate on social media and call-in radio, with pundits blaming everything from ‘moral decline’ and the ailing economy, to divine retribution.

So, the question is, does Hepatitis B cause more deaths in Tanzania than HIV/ Aids and is it likely to cause a major health crisis that could threaten the country’s healthcare system?

Pesacheck investigated the claim that Hepatitis causes more deaths than HIV in Tanzania and found that the statement is FALSE for the following reasons:

Hepatitis is a liver infection, most commonly caused by viruses, but also linked to heavy alcohol use, risky sexual behaviour, toxins and autoimmune diseases.

The Hepatitis A and E viruses are primarily transmitted from person to person through contaminated water, food such as shellfish, and uncooked vegetables or fruit prepared by infected food handlers. The viruses circulate widely in populations living in areas with poor sanitation infrastructure.

Hepatitis B and C are however transmitted through infected blood products, unprotected sex, infected items such as needles, razor blades, dental or medical equipment, unscreened blood transfusions, or from mother to child at birth.

According to the WHO, viral Hepatitis affects 400 million people globally and, given the size of the epidemic, anyone and everyone could be at risk.

Globally, an estimated 95% of people with Hepatitis are unaware of their infection. Hepatitis tests are complex and can be costly, with poor laboratory capacity in many countries, including Tanzania, where diagnostic and therapeutic evaluations cost Tsh470,000 (US$21) and medical care costs Tsh250,000 (US$111) per month during the treatment period.

The World Health Organization’s (WHO) data on Hepatitis shows that about 1% of persons living with Hepatitis B globally (2.7 million people) are also infected with HIV. The rate is higher in Tanzania, with 2.8% of individuals tested in a study by BioMed Central showing a Hepatitis B and HIV co-infection.

A look at the Institute for Health Metrics and Evaluation’s data on leading causes of death in Tanzania from 1990 to 2015 shows that HIV/AIDS was responsible for 12.5% of all deaths in the country in 2015, while cirrhosis and other liver conditions caused by Hepatitis B and C accounted for about 0.6% of all deaths in the same period.

Data from HealthGrove’s Disease Burden estimates also show that deaths linked to Hepatitis B per 100,000 people in Tanzania have decreased by 24.6% from 1990 to 2013, an average of 1.1% a year. At 7.9 deaths per 100,000 men in 2013, the average mortality rate for men was higher than that of women, which was 2.1 per 100,000 women. The reason for this is that Hepatitis is complicated by alcohol abuse, which is more prevalent in men than women.

There data proves there is no denying that Hepatitis is a health issue in Tanzania. The WHO’s World Hepatitis Day 2017 report places the country among 17 others that also have a high prevalence of Hepatitis and accounts for 70% of the global burden of the disease.

Local media are right to make the public aware of the rising threat of Hepatitis. However, local news fail to report the fact that Hepatitis prevalence is declining. This may be due to the fact that local information on the prevalence of Hepatitis is harder to obtain than data on HIV/AIDS, making comparison difficult.

Dr Lwegasha’s claim appears to be based on global WHO data for 2017 which shows that viral Hepatitis is becoming more prevalent globally, causing 1.34 million deaths in 2015 — comparable with TB deaths — and exceeding deaths from HIV, which amounted to approximately 1 million globally.

The local situation in Tanzania is different, with HIV/AIDS and related complications causing more deaths than Hepatitis A, B and C, and related liver diseases combined.

The data shows that while infection and transmission rates for Hepatitis are growing, HIV/AIDS causes more deaths overall. Additionally, Tanzania has achieved a 98% immunization rate for infants against Hepatitis B, meaning that prevalence is likely to drop in the future.

The statement that there are more deaths caused by Hepatitis than by HIV/AIDS in Tanzania is therefore FALSE.

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This report was written by PesaCheck Fellow Belinda Japhet, a data journalist and online editor based in Tanzania. The infographics are by PesaCheck Fellow Brian Wachanga, who is a Kenyan civic technologist interested in data visualisation. This report was edited by PesaCheck managing editor Eric Mugendi.

PesaCheck, co-founded by Catherine Gicheru and Justin Arenstein, is East Africa’s first fact-checking initiative. It seeks to help the public separate fact from fiction in public pronouncements about the numbers that shape our world, with a special emphasis on pronouncements about public finances that shape government’s delivery of so-called ‘Sustainable Development Goals’ or SDG public services, such as healthcare, rural development and access to water / sanitation. PesaCheck also tests the accuracy of media reportage. PesaCheck To find out more about the project, visit pesacheck.org.

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PesaCheck is a joint initiative of Code for Africa, through its local Code for Tanzania chapter, and the Data Zetu initiative to give Tanzanian citizens actionable data, in partnership with a coalition of local media organisations, with additional support from the International Center for Journalists(ICFJ).

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