Till the use, reuse and misuse of syringes continues, Dr Quaid Saeed, at the World Health Organisation (WHO), does not see the government or health specialists winning the battle against the spread of hepatitis C virus in Pakistan. Of Pakistan’s 180 million, an estimated 12 to 15m are infected with various forms of hepatitis viruses. The country also has the highest number of patients with chronic liver disease in the world, said Saeed, who is national programme officer on HIV/AIDS and hepatitis at the WHO.

Nine out of 10 injections administered in the country are unnecessary, said Dr Arshad Altaf, of the Safety Injection Global Network (SIGN) Pakistan, a coalition of volunteers aiming to achieve safe and appropriate use of injections throughout the world. “All evidence for the spread of HCV points to use of non-sterile syringes in Pakistan”, Altaf told Dawn.

The same is confirmed by Dr Aftab Mohsin, former national programme manager of the Prime Minister’s Programme for Prevention and Control of Hepatitis (which has now been devolved to the provinces).

“It’s not just quacks, I hold qualified dentists and medical practitioners responsible for unsafe practices of administering unnecessary injections, and using non-sterile syringes or needles”, said Mohsin, who is also one of Pakistan’s leading liver and gastroenterology physicians.

“Unfortunately, there is no legislation in place to ban reuse and misuse of syringes”, said Mohsin, to which WHO’s Saeed added, that there was “no law to date that prohibits quacks from practising”.

Coupled with poverty and illiteracy, other reasons for the spread of what is known as a silent epidemic (as the symptoms do not show until 15 to 20 years later), said Saeed, are use of non-sterilised dental instruments by roadside dentists and contaminated blood transfusions.

While there is a Safe Blood Transfusion Act, enacted in 2002, Saeed said it has yet to be fully implemented. “Every year 1.2 million pints of blood is transfused of which only 60pc is screened for hepatitis and HIV, the remaining 40pc is transfused unchecked.

However, Mohsin added, the legislation was “very assiduously implemented in thousands of blood banks across Punjab”, but the same cannot be said about blood banks in the other three provinces.

Hepatitis is an inflammation of the liver commonly caused by a viral infection. hepatitis viruses are classified as types A, B, C, D, and E. While hepatitis A and E are generally caused by food or water contamination. Hepatitis B, C and D are acquired through contact with infected body fluids, particularly blood. For those infected with hepatitis B, said Saeed, 80pc of the patients recover naturally and may not suffer from liver damage and out of those infected with hepatitis C, 80pc may become chronic carriers".

Liver transplant is usually the only treatment option for patients with end-stage liver disease. Unfortunately, there is no vaccine to prevent spread of hepatitis C. But for the HCV genotype 3 prevalent among most patients in Pakistan, an antiviral therapy using conventional Interferon is used to treat the patients.

“Our practices are terrible and our treatment is far worse,” pointed out Mohsin, recommending pegylated interferon to the conventional one.

Anywhere between 2 to 3pc of Pakistanis are carriers of hepatitis B and 4 to 5pc of hepatitis C. However, the number of those with hepatitis B or C could be significantly higher, said Saeed, if the entire population was screened for the disease.

WHO defines the risk as ‘high’ if the disease is prevalent in more than 8pc of the population, ‘intermediate’ as 2-8 pc, and ‘low’ if less than 2pc.