About one-third of the hepatitis B and C cases in Pakistan can be prevented by interventions directed towards a few selected and modifiable risk factors, a recent study shows.
The findings suggest that 2.7 and 6pc of hepatitis B and C infections could be prevented by a single intervention: avoiding reuse of contaminated syringes.
This practice is a major source of transmitting blood-borne infections to the general population. Likewise, a high frequency of lifetime injections is another modifiable factor associated with hepatitis.
The study, Population-attributable estimates for risk factors associated with hepatitis B and C: policy implications for Pakistan and other South Asian countries, was published last month in an online publication and was conducted by a team of Aga Khan University (AKU) experts.
The study, for the first time, provides a quantitative assessment about the potential reduction in disease prevalence (hepatitis B and C) if the exposures or risk factors are eliminated from Pakistani population.
For this purpose, data from a (2010) national survey from Pakistan was analysed and a systematic review of international studies of the South Asian region was carried out.
Citing the survey, the research states that the overall prevalence of hepatitis B surface antigen and anti-HCV antibody is 2.5pc and 4.8pc, respectively, consistent with an ongoing high burden of chronic liver disease.
“It also confirms existence of many of the previously identified common risk factors that are associated with transmission of infection, and that are mostly easily modifiable, in Pakistan,” the study says, quoting the survey’s data.
The present analysis showed that people who had been administered more than 10 therapeutic injections over the past one year were 4.5 times more at risk of contracting the HBV infection compared to those who had received no injections, yielding a 3.5pc PAR (population-attributable risk). PAR tells us how much risk of the disease one can reduce by eliminating the particular risk factors.
Likewise, the practice of reusing syringes yielded 3.7 times higher results compared to those who had received no injections, giving a PAR of 2.7pc.
Another modifiable risk factor, the practice of being shaved by barbers, yielded 4.1 times higher results compared to shaving at home, with a PAR of 2.1pc.
Similarly, the sharing of smoking devices (cigarette, hookah and Beeri) was found 2.5 times more associated with the HBV infection, giving the highest PAR of 4.4pc.
The HCV infection among those with more than 10 therapeutic injections in the past one year was found to be 8.1 times higher than those who had received no injections, yielding a PAR of 11.3pc.
Likewise, the practice of reusing syringes was 6.8 times more associated with the occurrence of the HCV, giving a PAR of 6.2pc. The practice of sharing smoking devices was 11.5 times more associated with the HCV, with a PAR of 5.1pc.
Those reporting tattooing were 8.3 times more at risk of having HCV infection, yielding a PAR of 3.5pc.
“In the overall study population, 34pc of hepatitis cases could be attributed to at least one of the seven well-established risk factors. Therefore, a substantial number of cases of hepatitis B and C could be prevented by eliminating these risk factors,” the study says.
According to the study, viral hepatitis is a major mortal public disease worldwide. The World Health Organisation estimates that nearly 350 million people are chronically infected with hepatitis B virus and 170m with hepatitis C virus.
South Asia, it says, is an endemic region where about 70pc to 90pc of the population become exposed to HBV before the age of 40 and 8pc to 20pc people go on to become HBV carriers.
South Asian countries share certain common risk factors for transmission of viral hepatitis because of non-implementation of international best practices, for example, therapeutic injections from reused needles and syringes, unscreened blood donations, shaving by barbers, sharing of needles by injecting drug users, reuse of needles for ear and nose piercing, tattooing and improperly sterilised dental and surgical instruments.
“By introducing specific interventions, a substantial number of hepatitis B and hepatitis C infections in Pakistan and other South Asian countries can be prevented,” the study says while pointing out that the interventions were quite low-cost, except for the use of non-reusable auto-disposable syringes.