…as data reveals hidden gaps in detection and care
New evidence has made Lesotho’s fight against viral hepatitis more urgent. The disease is more complicated and uneven than experts thought, and thousands may be living with it undiagnosed until they develop serious liver problems.
Health experts have called hepatitis B a “silent killer” because it spreads quietly and often shows no symptoms for years, sometimes decades, before causing liver failure or cancer. New research from BMJ Public Health and the World Health Organization is changing how the country sees the size of the problem and the gaps in its response.
The WHO Global Hepatitis Report 2026 says Africa is still one of the regions most affected by hepatitis B, with about 24 deaths per 100,000 people. Lesotho is part of this high-burden area, where deaths from hepatitis B continue even as other infectious diseases are starting to stabilise.
The report points out that the disease’s long delay before symptoms appear is a big reason for late diagnosis. Up to 95 per cent of babies infected with hepatitis B develop a long-term infection and often have no symptoms for 20 to 40 years before serious problems show up.
By the time symptoms show, many patients already have cirrhosis or liver cancer.
“Those infected in early childhood often show no symptoms until their 40s or 50s,” the report notes.
However, local research shows a more detailed picture. A survey of over 6,700 people in two districts found that 1.2 per cent of those aged 10 and older have hepatitis B. This is below the 5 per cent level usually used to define high-burden countries.
Even with this lower national rate, the reports warn against being complacent. The data show clear hotspots, especially among people in cities, adult men, people living with HIV, and tobacco users.
People living with HIV made up over 40 per cent of hepatitis B cases found in the study, showing a strong link between the two diseases.
The reports indicated that the biggest problem is finding cases early.
The health system does a good job of finding hepatitis B in patients who are already in HIV care. About 92 per cent of people with both infections get treatment because they use the same drugs. But many people are not in the system at all.
These people are called “mono-infected” patients. They have hepatitis B but not HIV, so they often miss out on regular screening.
The BMJ study found that almost one-third of these patients already needed antiviral treatment because of liver damage, but they were only found through special research screening.
These findings reveal a major blind spot in the health system: late diagnosis occurs because there is insufficient screening for everyone.
Prevention is also limited by problems in the health system, even though an effective vaccine is available.
The hepatitis B vaccine is 95 per cent effective, but it must be given within 24 hours of birth to prevent mother-to-child transmission. In Africa, only 17 per cent of babies got the vaccine on time in 2024.
Because of this, 1.4 per cent of children under five have chronic hepatitis B, which is much higher than the global goal of 0.1 per cent by 2030.
Hepatitis C is less common than hepatitis B, but it is still a public health concern. It is mainly spread through unsafe medical injections and sharing needles.
Health experts believe hepatitis can be eliminated, but only if screening is quickly expanded beyond HIV clinics to general primary healthcare.
Local health specialist Molumaela Lepeli, a PhD candidate and public health worker, said hepatitis is often underestimated because it develops quietly.
“I would say Hepatitis is a rare disease in Lesotho. However, even if one case calls for public concern, it has to be taken seriously, and investigations have to be conducted to find out about the cause,” he said.
He also said that ongoing misunderstandings in communities, such as confusing hepatitis with “Sebete se se soeu,” still delay diagnosis and treatment.
“Every missed diagnosis is a preventable death,” the WHO report warns.
Health authorities say the tools to eliminate hepatitis are already available, including vaccines, tests, and effective treatments. The main challenge is making sure people are diagnosed early and have equal access to care.
Lepeli warned that if screening is not expanded quickly and better integrated into primary healthcare, hepatitis would keep causing deaths quietly, long before it shows up in national statistics.
Summary
- New research from BMJ Public Health and the World Health Organization is changing how the country sees the size of the problem and the gaps in its response.
- People living with HIV made up over 40 per cent of hepatitis B cases found in the study, showing a strong link between the two diseases.
- The health system does a good job of finding hepatitis B in patients who are already in HIV care.
Ntsoaki Motaung is an award-winning health journalist from Lesotho, specializing in community health stories with a focus on sexual and reproductive health and rights, as well as HIV. She has contributed to platforms like “Be in the KNOW,” highlighting issues such as the exclusion of people with disabilities from HIV prevention efforts in Lesotho.
In addition to her journalism, Ntsoaki serves as the Country Coordinator for the Regional Media Action Plan Support Network (REMAPSEN). She is also a 2023 CPHIA Journalism Fellow.
