Prevalence of Hepatitis B and C Infection in District Dir, KhyberPaktunkhwa, Pakistan

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1 World Journal of Zoology 10 (2): , 2015 ISSN IDOSI Publications, 2015 DOI: /idosi.wjz Prevalence of Hepatitis B and C Infection in District Dir, KhyberPaktunkhwa, Pakistan Rahimullah, Saif-ul-islam, Sulaiman Bahadar, Azam Hayat, Muhammad Daud, Adil Hassan, Afzal Ahmad, Fahad Ali, 2 2 Muhammad Ayub Khan and Mujaddad Ur Rehman 1 Department of Microbiology, Hazara University, Mansehra, Dhodial, Khyber Pakhtunkhwa, Pakistan 2 Department of Microbiology, Abbottabad University of Science and Technology, Havelian, Abbottabad, KhyberPakhtunkhwa, Pakistan 3 Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan Abstract: Hepatitis is worldwide major health issue especially in developing countries. Hepatitis virus is the leading cause of morbidity and mortality in rural area of Pakistan. The main aim of the research study was to estimate the prevalence of HBV and HCV in the patients of District Dir. As a whole 765 patients were diagnosed st for hepatitis within four months period (1 Dec 2014 to 31 Mar 2015). For HB-Ag and anti-hcv antibodies all of the blood samples were examined by Immune-chromatographic kit. The total occurrence of HBV and HCV was found (2.6%) and (16.2%) respectively. High frequency was found (17.8%) in males followed by females (14.1%) Similarly, HBV and HCV were found to be more common among married individuals (17.4%) as compared to un-married (13.5%). Moreover, the superior frequency of HBV and HCV was recorded in patients with age group of greater than 60 years (40%) followed by age group of years (15.2). Significance association was found among the age groups. The present study provides the primary information about HBV and HCV prevalence due to lack of public health awareness on transmission of disease. More reliable methods for detection of hepatitis virus, management and control to overcome its future spread are required. It is recommended that public health authorities should instruct the general public concerning prevention. Key words: Hepatitis B Hepatitis C Antigen ICT Dir INTRODUCTION can develop acute hepatitis, chronic hepatitis or a chronic carrier state and hepato-cellular carcinoma (HCC). About Viral Hepatitis is the infection of liver caused by liver 50% of all HCV infections develop to chronic liver disease attacking viruses (Hepatitis A, B, C, D, E, G) and is a major [4]. In Pakistan majority of HCC are linked with Hepatitis cause of morbidity and mortality [1]. HBV and HCV C virus (HCV) Up to now vaccine is not available for HCV infections are important for causing chronic hepatitis and and cost of treatment is extremely high [5]. being leading causes of cirrhosis and hepatocellular Hepatitis B and C are mostly transmitted as a result of carcinoma [2]. The infection Hepatitis B and Hepatitis C is blood to blood contact, injury with contaminated a major health problem throughout the world, especially instruments, sharing of contaminated needles, sexual in developing countries [3]. Hepatitis cause liver contact and also through parental transmission from inflammation, Hepatitis B and C both can lead to liver mother to child [6]. The main route of HCV spread in failure, liver cirrhosis and may finally lead to last phase of Pakistan are use of contaminated needles, syringes and liver illness. Hepatitis C infection has severe sequale; it instruments in medical practice, transfusion of infected Corresponding Author: Sulaiman Bahadar Department of Microbiology, Abbottabad University of Science and Technology,, Havelian, Abbottabad, KhyberPakhtunkhwa, Pakistan. Tel:

2 blood and blood product when donor blood is not screen, MATERIALS AND METHODS use of intravenous drug, face and armpit shaving with contaminated razors and poor personal hygiene habits [8]. Collection of Samples: A study was conducted in Different techniques used for investigation of Islamabad Medical Laboratory, Teimargara K.P.K Pakistan hepatitis, involve immune chromatography (ICT), Enzyme from 1st Dec 2014 to 31 Mar A total 765 blood Linked Immunosorbent Assay (ELISA) and Polymerase samples were collected from Hepatitis B and C suspected Chain Reaction (PCR) for rapid diagnosis mostly ICT kits patients. For Individual information included history, sex, are used for the reason of faster, easy to carry out and not age and maternal status were obtained by interviewing the more expensive ELISA and PCR are expensive technique patients. and available only in main tertiary care hospitals and well develop labs [9]. Immuno-Chromatographic Tests (ICT): A total of Based on worldwide estimation 180 million persons 765 serum samples of patients were screened for including 4 million persons in USA are infected with HCV Hepatitis B surface Ag (HBs-Ag) and Anti-HCV by [10]. It is estimated that each year about one million Immuno-chromatographic strep according to the person die due to HBV related chronic liver illness [11]. instruction of the manufacturer. Prevalence of Hepatitis B High prevalence rates of HCV (up to 13%) have been and C in present study were classified according to found in Africa and Asia while highest (about 15% in questioners were assembled in sex, marital status and age Egypt [12]. In Pakistan 10% of HBV prevalence is reported wise [26, 27]. and 6.7% of HCV prevalence in women and 1.3% in children in 2010 [13]. Numerous studies have been RESULTS conducted in Pakistan about occurrence rate of Hepatitis B infection based on a variety of population groups. Out of 765 patients, a total 144 (18.8) patients were According to different study groups, among healthy found positive for HBV and HCV. Among these 20(2.6%) blood donors, 2-10%, among health care workers 5-9% and 124 (16.2%) were positive for HBV and HCV and among the generalpopulation3.6 to 18.66%, among respectively (Graph 1). pregnant women 3-16% Hepatitis B has been reported Out of 765 patients, Four hundred and twenty five [13, 14]. A current study determine Hepatitis C occurrence (425) were males and three hundred and forty (340) were within provinces as 5% in Sindh, 6.7% in Punjab, 1.1% in females. Among males patients HBV and HCV 12(2.8%) Khyber Pakhtunkhwa and 1.5% in Baluchistan. Figure for and 76 (17.8%) respectively with overall prevalence of Hepatitis B was 2.55% in Sindh, 2.4% in Punjab, 1.31% in 20.7%. Similarly among females patients HBV, HCV PakhtunKhwa and 4.3% in Baluchistan [16]. The aim of 8(2.3%) and 48(14.1%) respectively with overall the research study was to check the prevalence of HBV prevalence of (16.4%). Out of 765 patients 521married and and HCV in district Dir. 244 were unmarried. Among the married patients HBV and Graph 1: Overall prevalence percentage of HBV and HCV in screened patients Table 1: Gender wise prevalence of HBV, HCV Gender Total no of sample No of positive sample No of positive HBV No of positive HCV Male (20.7%) 12(2.8%) 76(17.8%) Female (16.4%) 8(2.3%) 48(14.1%) Total (18.2%) 20(2.6%) 124(16.2%) 143

3 Table 2: Prevalence of HBV and HCV in married and unmarried Marital Status No of Samples No. of positive sample No of positive HBV No. of positive HCV Married (19.6%) 14(2.6%) 91(17.4%) Un married (16.3%) 6(2.4%) 33(13.5%) Total (18.8%) 20(2.6%) 124(16.2%) Table 3: Age wise distribution of HBV and HCV Age groups Total no. of Samples No of Positive Samples HBV Positive HCV Positive (8.57%) 2(1.9%) 8(7.6%) (10.7%) 4(2.05%) 19(9.7) 41 6o (16.4%) 9(2.6%) 51(15.2%) >60 years (45.3%) 5(3.8%) 46(35.3%) Total (18.8%) 20(2.6%) 124(16.2%) Graph 2: Gender wise prevalence of HBV and HCV Graph 3: Prevalance of HBV and HCV in Married and non married persons Graph 4: Age wise prevalence of HBV and HCV 144

4 HCV was found 14 (2.6%) and91 (17.4%) respectively with higher in married patients followed by un-married patients. overall prevalence of (20.1%). Similarly among the The outcome of this study was agreement with the unmarried patients HBV and HCV 6 (2.4%) and 33 (13.5%) outcome of Ayele and Solomon [22], reported the respectively with overall prevalence of 15.9%. Hepatitis B and C prevalence is higher in married patients. The rate of HBV concerning the age group of The occurrence of Hepatitis B and C is higher in about patients ranging from 0-20, 21-40, and greater than 60 year followed by the age group of years result of 60 years of age was found 02 (1.9%), 04 (2.05%) and 09 the this study were also concluded in several studies (2.6%), 5(3.8%) respectively (Table 3). Similarly, HCV in that the occurrence of hepatitis is increases until the age patients with age group ranging from 0-20 years, 21-40, of 30 years and it rises even higher between those over and greater than 60 years of age was found 08 the age of 40 years Rey-Cuille et al. [23] and Abdel-Hady (7.6%), 19 (9.7%), 51 (15.2%) and 46 (35.3%) respectively. and Kelly [24] and Triki et al. [25]. DISCUSSION CONCLUSION Several studies have been conducted about the This study that Hepatitis B prevalence is occurrence of Hepatitis B and C disease in a variety of comparatively low compared to Hepatitis C. in addition, inhabitants groups in Pakistan. In current study contrast among males high prevalence was recorded than females. to HBV anti-hcv positivity was found much higher. It is suggested that vast care should be implemented Gul-e-atif et al. [17] reported Prevalence (2.65%) for HBV during surgical measures or treatments and blood and (10.42%) for HCV patients. This result is much similar transfusions. Further awareness movement against to that of the current study, reported low prevalence of Hepatitis B and C infections should be approved to Hepatitis B contrast to Hepatitis C. In another study of instruct the common people on the risk factors and Irfan et al. [18] reported low prevalence of Hepatitis B rout of transmit ion in order to decrease the rate of contrast to Hepatitis C. Moreover, the prevalence of infection. Hepatitis B in the present study was found 2.6%. Gul-e-atif et al [17] reported the prevalence of Hepatitis B REFERENCES 2.6%and Chaudhary et al. [19] reported 2.8%. So these results are in reliable with that reported by other studies, 1. Hafeez-ud-din, Siddiqui, T.S., W.L. Ahrasaband and as the occurrence of Hepatitis B in different parts of M.A. Sharif, Prevalence of Hepatitis B and C in country is among 2.11% to 5.46% Chaudhary et al. [19]. healthy adult males of paramilitary personnel in Risk reason among the positive cases may be the surgical Punjab. J. Ayub Med. Coll. Abbottabad, 24: 3. interference, because it has been projected that citizens of 2. Nazar, H., N. Nadia, A. Shazia, A. Zulfiqar and Farhat, these areas selected injections for fever and common Prevalence of Hepatitis B And Hepatitis C In sickness. These injections are more frequently provided Blood Donors Of Karachi. J. Ayub Med. Coll. by informal, unqualified health staff. Moreover patients Abbottabad, 26: 5. ready to pay extra charge to physician s for injections but 3. Kalepoto, G.N., H.S. Bhally and G. Khaliq, will not pay for oral medications. In addition, sterility of Epidemiology of blood-borne viruses. A study of injections not maintained frequently, due to economic health blood donors in southern Pakistan. J. Pak. restrictions and lack of knowledge between the healthcare Med. Assoc., 27: providers and the population in general Ali et al. [20] 4. Basit, A., K. Rahim, Ahmad, I. Shafiqe, M. Mushtaq, frequency of HBs-Ag and anti-hcv antibodies higher in S. Khan, I. Shaheen, H Prevalence of hepatitis male as contras to females Wasfi and Sadek [21]. In this B and C infection in Pakistan. J. Inf. Mol. Biol., study same conclusion were obtained about high 2(3): occurrence of Hepatitis B and C in man contrast to 5. Umar, M. and M. Bilal, Hepatitis C, A Mega women. Prevalence of Hepatitis is higher in males might Menace: A Pakistani Perspective. J. Pion. Med. Sci., be due to truth that men make more ordinary visits to 2: barber and they may be more probably to get injured and 6. Kumar et al., Robbin and Cotran pathologic may share equipments. Moreover, male also like to have th basis of diseasse, Elswvier 7 ed., pp: numerous sex contacts and go behind insecure sex. In this 7. Kamal, G.I., Pathologic features of Chronic study the prevalence of Hepatitis B and C was found Hepatitis. Am. J. Clin. Path., 11:

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