Yoel Alperin

To what extent do differences in the allocation of resources to healthcare between the

United States and Liberia impact the success of preventing Hepatitis B?
WHO. (2015, March). Guidelines for the prevention, care and treatment of persons with
chronic hepatitis B infection. World Health Organization.
This report discusses the epidemiology and clinical treating procedures for Hepatitis B.
Written by the World Health Organization, the article includes an algorithm for WHO
recommendations on the management of persons with chronic hepatitis B as well a
discussion of methods in screening for and prevention of the disease. Though the source
is extensive and filled with current, correct and relevant information, the
recommendations for management are based on information presented in the report.
WHO research may have overlooked information that could change their
recommendation. Additionally, their recommendations are very specific for specific
groups of people therefore treatment for anomalies are not covered.
1. Infectstheliver,causinghepatocellularnecrosisandinflammation(xix)
2. ChronichepatitisBisdefinedaspersistenceofhepatitisBsurfaceantigenforsix
monthsormore(xix)
3. UniversalhepatitisBimmunizationprogramsthattargetinfants,withthefirst
doseatbirth,havebeenhighlyeffectiveinreducingtheincidenceandprevalence
ofhepatitisB(xix)
4. AlgorithmofWHOrecommendationsonthemanagementofpersonswithchronic
hepatitisinfectionGraphic(xxvi)
5. 2billionpeoplehaveevidenceofpastorpresentinfectionwithHBV(10)
6. 650,000peopledieeachyearfromthecomplicationsofCHB(11)
7. Hepadnavirusfamily(13)
8. Liverinjuryoccursthroughimmunemediatedkillingofinfectedlivercells(13)
9. Spreadbypercutaneousormucosalexposuretoinfectedbloodandvariousbody
fluids(13)
10. PerinataltransmissionisthemajorrouteofHBVtransmissioninmanypartsof
theworld.(13)
11. Riskofdevelopingchronicinfectionis90%followingperinatalinfection.(14)
12. RoutineassessmentofHBsAGpositvepersonsisneededtoguidemanagement
andindicatetheneedfortreatment(17)
13. Mostinternationalguidelinesrecommendthatserveralhighriskgroupsbe
screenedforHBsAgandthatthoseatriskandnotimmuneshouldbeoffered
hepatitisBvaccination.Theseinclude,householdandsexualcontactsofpersons
withCHB,HIVinfectedpersons,personswhoinjectdrugs,menwhohavesex
withmen,sexworkersaswellasothergroupsofsuchhasindigenouspeoples,
personswhoareincarceratedandpersonsoftransgender.(19)

Murphy, T., Dr, Kozarsky, P., Dr, & Spradling, P., Dr. (n.d.). Hepatitis B. In J.
Hamborsky, A. Kroger, & C. Wolfe (Eds.), Epidemiology and Prevention of
Vaccine-Preventable Diseases (13th ed., pp. 149-174). Atlanta, GA: CDC.
The section of Epidemiology and Prevention of Vaccine-Preventable Diseases on
Hepatitis B written by the CDC. It covers topics such as clinical features, complications,
laboratory diagnosis, medical management, epidemiology, trends in the United States,
prevention strategies, the Hepatitis Vaccine, post exposure management, etc. The authors
of the section do not supply citations for their research. Though the CDC is considered a
credible source, the authors make not attempt to analyze the credibility of their sources
nor give readers the opportunity to do so.
14. Hasbeenshowntoremaininfectiousonenvironmentalsurfacesformorethan7
daysatroomtemperature.(149)
15. Incubationperiodrangesfrom45to160days
16. Asageincreases,chronicinfectionratedecreases(151)
17. Diagnosisisbasedonclinical,laboratoryandepidemiologicfindings.HBV
infectioncannotbedifferentiatedonthebasisofclinicalsymptomsaloneand
definitivediagnosisdependsontheresultsofserologicaltesting.(152).
18. NospecifictherapyforacuteHBVinfection.Treatmentissupportive.(154).
19. Patientsrequireprolongedtreatmentinordertomaintainsuppressionofviral
replication(154).
20. IntheUS,themostimportantroutesoftransmissionareperinatalandsexual
contact.(155)
21. PersonswitheitheracuteorchronicHBVinfectionshouldbeconsidered
infectiousanytimethatHBsAgispresentintheblood.(156)
22. VaccineisaplasmaderivedvaccinelicensedintheUnitedStatesin1981.Itwas
producedfrom22nmHBsAgparticlespurifiedfromtheplasmaofchronically
infectedhumans(158).
23. AfterthreeintramusculardosesofhepatitisBvaccine,morethan90%ofhealthy
adultsandmorethan95%ofinfants,childrenandadolescentsdevelopadequate
antibodyresponses(159)
24. DeltoidmuscleistherecommendedsiteforhepatitisBvaccination,anterolateral
thighisrecommendedforinfantsandneonates(159)
25. HepatitsBvaccinationisrecommendedforallinfantssoonafterbirthandbefore
hospitaldischarge.Schedulefordosesis0months,1to2,6to18.
David, S.. (1993). Health expenditure and household budgets in rural Liberia. Health
Transition Review, 3(1), 5776.
This article describes the role of health expenditure in household budges in Liberia. The
authors report is based on actual statistics as well as personal observations of households
and transaction in Liberia. The author attempts to apply singular observations to the
behavior of all Liberians which causes a knowledge issue. Without further research and
observation, the authors logic is unsound because his minor premise may not be
accurate.

26. Health care expenses constitute a major part of domestic spending (57)
27. Rural Liberians, like the majority of Africans, face the choice of using home
remedies for their health problems, or consulting traditional healers, or Western
health practitioners. (60)
28. Literature on health-care behavior among Liberians points to illness classification,
age, gender and cost as being factors which influence treatment decisions (60)
29. Kpelle marriage is based on set of formal rights and obligations which spouses
legally have toward each otherA husbands obligations arepaying for her
medical expenses (62).
30. Husband as the breadwinner is an ideological construct based on the perception of
men as superior to women (63).
31. The most vulnerable to health problems are children, women of childbearing age,
and old people major causes of infant mortality: malaria, diarrhea, measles,
pneumonia, neonatal tetanus and protein-energy malnutrition (63)
32. Medicine store travelling medics of dubious qualifications (black baggers) (64)
33. Most people have basic knowledge of herbal and other treatments for common
illnesses and health problems such as skin infections, body pain, worms, diarrhea,
hepatitis, contraception and the inducement of abortion.
34. Traditional vs Western medicine- decision made based on perceived nature o the
illness (possible spiritual cause) the perceived efficacy of the treatment and the
availability of time and money (64)
35. Major health expenses of Gbaomu- treatment of children, major illnesses that
required hospitalization (only if operation was involved) childbirth and minor
problems (circumcision, contraceptives and ingredients for abortifacients) (65)
36. Hospitalization fees based on familys socioeconomic status (65)
37. Health expenses are not regular nor constant in amountwomens health
problems often involve a matter of life or death or the cessation of farm work and
cannot easily be ignored (65)
38. Example of sick child father does everything to save the cost of treatment ->
child looses eyesight
Varpilah, S. T., Safer, M., Frenkel, E., Baba, D., Massaquoi, M., & Barrow, G. (2011).
Rebuilding human resources for health: a case study from Liberia. Human
Resources for Health, 9(1), 110.
This case study discusses the devastation and then gradual rebuilding of the Liberian
healthcare system following a fourteen-year civil war. The researchers determined that
the factors of rebuilding human resources for healthcare were strong, coordinated
leadership, identifying gaps, emergency human resource planning, equitable distribution
of health workers, and enhanced health worker performance, productivity and retention.
By concluding the aforementioned factors are imperative for the rebuilding of healthcare,
it does not follow that improving these factors in other nations will create the same
results.
39. Fourteen year civil war healthcare system was devastated. Most health
professionals fled or died during the fighting. (1)
40. Slow economic growth in late 1970s health professionals leave Liberia (1)

41. Instability increased and the currency value decreased, high level professionals
leave the country creating large vacancies in the health system at all levels
42. Non governmental organization emergency aid organizations began. NGO centric
health care system in which health facilities were dependent on external aid to
function. 420 health facilities 45% of which were being managed by NGOs and
faith based organizations.
43. Displaced people move to Monrovia outgrow citys capacity to provide health
services