Hepatitis C in Pakistan

Abstract

The Government of Pakistan is striving to provide comprehensive health coverage to its people and the efforts to strengthening health services through expanding key national preventive and promote interventions. Hepatitis has become a major public health issue in recent years. The Annual Incidence rate of HCV ~ 3-4 Million; Disease specific death rate is 1Million. In Pakistan the Current prevalence rate of Hepatitis C is 5-6% (7.5 Million infection). Unsafe injection and unhygienic invasive practices (Dentists, Barbers, Beauty Parlors, Ear and Nose Piercing recreational drug drug use and unsafe sexual practices among Transvestites(hijras etc.)are major contributing facots be the major causes of the disease. The overall social and economic impact of chronic Hepatitis B&C are devastating. Most Hepatitis C patients present with cirrhotic disease to emergency departments. Public Health awareness is being actively disseminated but they are hard to scale due to the large population of Pakistan and politically condition of the country.

(Youngpakistanithinkers.org, N.D)

Hepatitis C virus

Hepatitis C is a worldwide problem

World Health Organization (WHO) estimates about 3% of the world’s population has been infected with HCV and that there are more than 170 million chronic carriers who are at risk of developing liver cirrhosis and/or liver cancer.

The cause of the hepatitis C, HCV is a spherical, enveloped, single stranded RNA virus belonging to the Flaviviridae.

Clinical Presentation of Hepatitis C

Mostly nonspecific symptoms such as nausea, fatigue, jaundice, abdominal pain and darkening of urine

Of exposed persons approximately 60%- to 75% will become chronic carriers and potentially infect others.

Most patients are diagnosed once they have advanced liver disease, cirrhosis or hepatocellular carcinoma

Epidemiology Worldwide

It is estimated that approximately 3% of the world is which 170 million people.

Prevalence in northern Europe is about 0.01-0.02% in the United Kingdom and northern Europe, 1-1.5% in southern Europe, and 6.5% in parts of equatorial Africa

In Egypt rates are ~22% mostly due to parenternal antischistosomal therapy.

In the United States there are about 3.9 million people infected with Hepatitis C. Mostly among minority populations such as black and Hispanic in association with low levels of education and lower economic status.

Diagnosis of Hepatitis C

The tests most commonly used in the diagnosis of hepatitis C are liver chemistry, serology, HCV RNA testing, and liver biopsy.

Liver chemistry is elevated aminotransferase and ALT levels indicating liver injury.

Specifically for Hepatitis C is recombinant hepatitis C antigens used in enzyme linked immunosorbant assay serological test to detect anti-Hepatitis C in patients sera.

Hepatitis RNA testing- can help in assessing prognosis

Liver biopsy most invasive but reliable. Can help determine exact etiology of liver illness and severity of patient.

Overview of Pakistan

Pakistan is a densely populated country with a population of 193,238,868

GDP-$2,900

Total Life Expectancy-66.71

Child Mortality- 89.6

Adult Mortality Male -192

Adult Mortality Female-158.16

Health Expenditure per capita-22.6

Health Expenditure as a % of GDP-2.6%

Major Causes of Death-Coronary Artery Disease, Cancer, Infections

Burden of Hepatitis in Pakistan

Hepatitis C (Hep C) poses serious threat to Pakistani social infrastructure. This highly contagious infection has potential to debilitate a large number of the workforce in coming years that will translate into financial losses in overall countries productivity.

Currently 6-8 % of the rural population and12-24 % of urban and suburban population is infected with Hep C. Prevalent widespread unsafe healthcare practices are causing worsening of the Hep C infection rate. Current estimates put around 18 million people having been exposed to Hep C and about 44 % of these individuals (8-9 million) are actively infected.

In all major hospitals, almost half of the hospitalized patients are due to secondary complications of Hepatitis C such as end-stage liver disease, such as cirrhosis of liver, bleeding esophageal varices or hepatic failure. It is estimated that these patients can easily overwhelm the existing hospital systems if the transmission does not decrease.

Modes of Transmission

Most Hepatitis is transmitted in Pakistan due to unsafe injection and unhygienic invasive practices (Dentists, Barbers, Beauty Parlors, Ear and Nose Piercing etc

Blood supply used for transfusions without adequate screening for infection

Recreational Intravenous Drug Users and shared needles

Vertical transmission

Hemodialysis Units

Unethical healthcare industry allowing for improper disposal of sharps posing environmental risk of needle sticks

High risk population of Hijras (transvestites' ) that become coinfected with other diseases such as HIV.

Risk Factors

High-Risk Population and Comorbidities

Public Health Impact of Hepatitis C

Published Etiology Studies

Prevention Programs

Specific Interventions and Outcomes

Availability of Medical Treatment and Public Health Education

Receptiveness of Intervention Outreach

Constraints and Limitations of Interventions

Capacity building infrastructure is needed to adequately distribute Human Resources and Financial allocation.

Decentralization of Power /hierarchy related to government interventions.

Improved communication between districts and federal government to improve surveillance and containment of infection.

Poor Data collection techniques as well tools changes cause delay in reporting progress of various activities to all stakeholders that need ongoing updates

Lack of stern oversight for local persons in areas smaller areas that can use optimally resources limit Monitoring and Supervision

Poor logistics of interventions including payroll of local workers and payment for marketing/public health interventions.

Achievements and Initiatives

Public Health Recommendations

There is a need for strong surveillance system with a trained staffed to monitor and evaluate.

Blood Supply should have a national safety standard that should be strictly enforced.

Health education through Public Health Awareness campaigns to reach how to the high risk populations for diagnosing and treatment

Dental offices and other healthcare organizations should adhere to disinfect instruments.

Outreach for recreational drug users for needle exchange program

Future Strategic Goals of Public Health Interventions

Bibliographay

Schub, T., & Mennella, H. (2013). In Pravikoff D, Pravikoff D(Eds.), Hepatitis C. Glendale, California: Cinahl Information Systems. Retrieved from http://search.ebscohost.com/login.aspx direct=true&db=rzh&AN=5000000407&site=eds-live&scope=site&authtype=ip,uid&custid=s8987071