Article

Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors

Institute for Global Health, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, 37203-1738, USA.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases (Impact Factor: 2.33). 11/2008; 13(1):9-19. DOI: 10.1016/j.ijid.2008.06.019
Source: PubMed

ABSTRACT Pakistan carries one of the world's highest burdens of chronic hepatitis and mortality due to liver failure and hepatocellular carcinomas. However, national level estimates of the prevalence of and risk factors for hepatitis B and hepatitis C are currently not available.
We reviewed the medical and public health literature over a 13-year period (January 1994-September 2007) to estimate the prevalence of active hepatitis B and chronic hepatitis C in Pakistan, analyzing data separately for the general and high-risk populations and for each of the four provinces. We included 84 publications with 139 studies (42 studies had two or more sub-studies).
Methodological differences in studies made it inappropriate to conduct a formal meta-analysis to determine accurate national prevalence estimates, but we estimated the likely range of prevalence in different population sub-groups. A weighted average of hepatitis B antigen prevalence in pediatric populations was 2.4% (range 1.7-5.5%) and for hepatitis C antibody was 2.1% (range 0.4-5.4%). A weighted average of hepatitis B antigen prevalence among healthy adults (blood donors and non-donors) was 2.4% (range 1.4-11.0%) and for hepatitis C antibody was 3.0% (range 0.3-31.9%). Rates in the high-risk subgroups were far higher.
Data suggest a moderate to high prevalence of hepatitis B and hepatitis C in different areas of Pakistan. The published literature on the modes of transmission of hepatitis B and hepatitis C in Pakistan implicate contaminated needle use in medical care and drug abuse and unsafe blood and blood product transfusion as the major causal factors.

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    • "Among IDUs in USA and Europe, transmissions occur via sharing injection equipments such as syringes, needles and other paraphernalia (Mathei et al. 2006). Both modes of HCV transmission (unsafe blood transfusion and IDUs) are significant for certain communities [studies indicate prevalence percentages of 48.67 ± 1.75 % and 57 ± 17.7 %, respectively, in Pakistan (Waheed et al. 2009) see also Ali et al. (2009)]. "
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    • "Secretions, body fluids and infectious blood are main sources of transmission (Alter, 2006; Ali et al., 2009). Vertical transmission of HBsAg and HBeAg in pregnant women may also occur but with low incidence (Abbas et al., 2003). "
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    ABSTRACT: Chronic hepatitis is a common liver infection usually caused by different viruses, where Hepatitis B virus (HBV) has been documented as the major cause and lead to many complications. Globally about 2 billion people are HBV positive and 7-9 million are in carrier state in Pakistan. In this study the prevalence of HBV was confirmed by q-PCR based on age , gender and area. Total 183 serum samples were processed through real-time PCR for detection of HBV DNA and age wise, gender wise and area wise data was analyzed through Chi square test. Genomic DNA of HBV was detected in 99 (54.06%) samples out of total 183 ELISA positive samples of suspected liver disease patients. Out of 99 patients, 66.66% were male and 33.33 % were female patients. Positive cases in age wise people of <20 years was 37.37%, 21-40 years 42.42% and in 41-60 years (16.16%) and in age > 60 years 4.04% was observed. In Tehsil wise distribution, 54.54% HBV DNA positive samples were found in Tehsil Mardan, 32.32% in Takhtbhai and 15.15% in Kattlang. This study concludes that male infectivity rate with HBV is relatively higher then female in District Mardan. People between 21-40 years were found more prone to HBV infection. Among the three tehsil of district Mardan, the highest numbers of HBV infected patients were found in tehsil Mardan with 54 (54.54%) patients.
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    • "Sharps are more likely to be contaminated with BBPs given the high prevalence of HBV and HCV among general population (range 0.3–31.9%) [Ali et al., 2009; Janjua et al., 2010a]. Thus, the risk of a SI is high and likelihood of acquiring a BBP after a SI is also high among FLCF workers in Pakistan. "
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    ABSTRACT: BACKGROUND: We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan. METHOD: HCWs working at public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic(NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression. RESULTS: From 365 clinics, 485 HCWs were interviewed. Overall annual rate of SIs was 192/100 HCWs/year; 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93; 95%CI: 0.89-0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02; 95%CI: 1.36-2.98) licensed (RR: 2.86; 9%CI: 1.81-4.51) or non-licensed assistant (RR: 2.78; 95%CI: 1.72-4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06; 95%CI: 1.03-1.08), and compliance with UPs scores (RR: 0.93; 95%CI: 0.87-0.97) were significant predictors of SIs. CONCLUSION: Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
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