The findings of a new survey, commissioned by Gilead Sciences, on Singaporeans' awareness, knowledge and attitudes towards liver health showed that more than half (58%) of the general population do not recognise that viral hepatitis can cause liver failure. Additionally, many Singaporeans hold misperceptions of risk factors and complications of viral hepatitis, including eating contaminated raw seafood (66%) and the fecal oral route (52%) as modes of hepatitis B transmission, or being unaware that sexual intercourse was a transmission risk (52%). These misconceptions, especially among those aged 25 and below, could hinder efforts to control the spread of hepatitis B and C within the community.

Notably, only 65% of respondents have attended a health screening in the past two years even though majority (91%) agree that regular screening is important in maintaining liver health. Among respondents who attended health screenings, only 36% were aware that tests for liver diseases were included. Moreover, of the 61 respondents who reported to have been diagnosed with liver disease, 70% of them are currently not on treatment citing cost, as well as preference for traditional medicine over Western medicine (44%).

These and other key findings were published in the Journal of Gastroenterology and Hepatology.

Professor Tan Chee Kiat, Senior Consultant, Department of Gastroenterology and Hepatology, Singapore General Hospital, and co-author of the publication said: "This is an alarming observation particularly as viral hepatitis symptoms tend to be silent and remain undiagnosed until the disease progresses to liver cirrhosis, failure or cancer. While the prevalence of viral hepatitis is low in Singapore, we cannot be complacent. Hepatitis B-related liver cancer is still a substantial problem and complications arising from chronic hepatitis B infection are common indications for liver transplants in Singapore." 

Hepatitis B causes 60 to 70% of the total number of liver cancer cases in the country[3] while liver cancer was ranked the second most common cancer-causing mortality in 2018[4]. Liver cirrhosis, attributed to nearly 1% of deaths for years of life lost due to disease[5] and chronic viral hepatitis infection, accounted for the majority of hospitalised cirrhosis cases (70%) in Singapore between 2006 and 2011[6].

"Misperception and inaction can have devastating consequences, not only on mortality rates in Singapore, but also on eventual healthcare and economic burden. There needs to be multi-sectoral collaboration to enhance education and public awareness through the most effective communication channels to treat as well as eliminate viral hepatitis in Singapore," he added.

Innovating public health education

As highlighted in the survey findings, there is an urgent unmet need for better public health education efforts to boost awareness and knowledge of liver disease development.

A pivot in public health educational events from hospital-based to digital platforms might strengthen future public health education. When queried on the channels of preference of receiving disease information in Singapore, only 27% indicated patient disease awareness talks. In comparison, at least four in 10 respondents indicated doctor's consultation, internet search and TV as their top three choices.

"The study shines a light on the need to engage the public in a more creative and accessible way to not only dispel misperception but also encourage Singaporeans to be more proactive in taking action," said Stanley Li, General Manager for Singapore, Hong Kong, S.A.R., China and Malaysia, Gilead Sciences. "This Singapore-focused study is a starting point that we hope will inform the path forward towards eliminating viral hepatitis."

This World Hepatitis Day, the World Health Organization's urgent call on all countries to work together to eliminate viral hepatitis by 2030 is reflected in this year's theme: "Hepatitis can't wait". Gilead supports the efforts of governments and partners with professional and community-based organisations, healthcare providers, and payers to accelerate progress towards the 2030 viral hepatitis elimination goals. 

[1] Hepatitis B: What You Need to Know, HealthXchange.sg. Available from: https://www.healthxchange.sg/digestive-system/liver/hepatitis-b-need-know

[2] The Global Cancer Observatory. Singapore | Source: Globocan 2018 [Internet]. International Agency for Research on Cancer | World Health Organization; 2020 Oct [cited 2020 Dec 3] p.2. Available from: https://gco.iarc.fr/today/data/factsheets/populations/702-singapore-fact-sheets.pdf

[3] Hepatitis B: What You Need to Know, HealthXchange.sg. Available from: https://www.healthxchange.sg/digestive-system/liver/hepatitis-b-need-know

[4] The Global Cancer Observatory. Singapore | Source: Globocan 2018 [Internet]. International Agency for Research on Cancer | World Health Organization; 2020 Oct [cited 2020 Dec 3] p. 2. Available from: https://gco.iarc.fr/today/data/factsheets/populations/702-singapore-fact-sheets.pdf

[5] Epidemiology & Disease Control Division, Singapore Burden of Disease and Injury Working Group. Singapore Burden of Disease Study 2010 [Internet]. Epidemiology & Disease Control Division | Ministry of Health, Singapore; 2014. Available from: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/singapore-burden-of-disease-study-2010-report_v3.pdf

[6] Chang PE, Wong GW, Li JW, Lui HF, Chow WC, Tan CK. Epidemiology and clinical evolution of liver cirrhosis in singapore. Ann Acad Med Singapore 2015; 44: 218– 225. Available from: https://onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fjgh.15496&key=26292950

About the Singapore Liver Index Study

The cross-sectional, web-based study was conducted in February 2020 and compiled by Kantar Health with funding from Gilead Sciences. It aims to evaluate the degree of public awareness and knowledge regarding liver health and diseases in Singapore and was disseminated to 500 adult Singaporeans. The study found that the levels of understanding of liver diseases, its risk factors, and potential complications are suboptimal among the Singapore public. The findings also inform the need for public education efforts to be aligned with respondents' information-seeking preferences, which could overcome misconceptions and increase knowledge about liver diseases. The study was first published in the Journal of Gastroenterology and Hepatology in March 2021.

About Gilead Sciences

Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California.