FREQUENCY OF HEPATITIS B AND C IN PATIENTS VISITING OUTPATIENT DEPARTMENT OF DISTRICT HEAD QUARTERS HOSPITAL LAKKI

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1 ORIGINAL ARTICLE FREQUENCY OF HEPATITIS B AND C IN PATIENTS VISITING OUTPATIENT DEPARTMENT OF DISTRICT HEAD QUARTERS HOSPITAL LAKKI 4 INTRODUCTION prevalence area with a carrier rate of 3-4 %. Some hospital- based studies have revealed that 30-4% Hepatitis B virus (HBV) was first isolated 5,6 of the cases of chronic liver disease and 78% of in 963. An estimated two billion people are 6 the cases of hepatocellular carcinoma were infected with HBV worldwide; among them 350 positive for HBs Ag. millions are chronic carriers: hepatitis B surface 7 antigen (HBs Ag) positive. More than 50,000 die Hepatitis C was first cloned in 989. each year from HBV related acute and chronic Prevalence of hepatitis C varies from 0.5% to 9% 3 liver disease. Pakistan is in the intermediate HBV ABSTRACT Objective: To find out the frequency of hepatitis B and C among the patients visiting out patient department. Methodology: A total of 443 subjects were screened for HBs Ag and anti-hcv in this descriptive study st conducted from January 008 to 3 December 008 in out patient department (OPD) District Headquarter Hospital Lakki. Patients of either sex and more that 5 years of age were screened for both hepatitis B and C. Patients with evidence of hepatitis B or C in the past were excluded. The HBs Ag and Anti-HCV screening was performed through Immunochromatographic (ICT) method. All sera showing reactivity were then confirmed with Enzyme Linked Immumosorbent Assay (ELISA). The information of the patients was recorded on a proforma and analyzed. Results: The frequency of hepatitis B was found to be 75 (.%) with a male predominance of 38 (4.97%). Prevalence of hepatitis C was 58 (4.0%) with a male predominance 39 (4.%), whereas in 5 (0.35%) cases both hepatitis B and C were present. Highest frequency of HBs Ag was detected in the settled area of the district while anti HCV was positive in high proportions in the frontier region (FR). Overall prevalence of hepatitis was more common in rural population than the urban population. Conclusion: Hepatitis B is more common than hepatitis C in District Lakki. The high frequency of hepatitis needs to launch a major public awareness program and preventive measures to prevent its further spread. Key wards: Hepatitis B, Hepatitis C, Prevalence. This article may be cited as: Khan MI, Muhammad M. Frequency of Hepatitis B and C in patients visiting outpatient department of District Head quarters Hospital Lakki. J Postgrad Med Inst 0; 6(): Address for Correspondence: Dr. Muhammad Ismail Khan, Department of ENT, Mufti Mehmood Teaching Hospital, D.I.Khan - Pakistan mumtaz_kmc@yahoo.com Date Received: March, 0 Date Revised: October 5, 0 Date Accepted: October 0, 0 Muhammad Ismail Khan, Mumtaz Muhammad Department of ENT, Mufti Mehmood Teaching Hospital, D.I.Khan - Pakistan Research Registrar, Post Graduate Medical Institute, Peshawar - Pakistan in different parts of the world. World Health Organization estimates that about 70 million people i.e. 3% of world population are infected with Hepatitis C virus and are at the risk of developing liver cirrhosis or hepatocellular 8 carcinoma. Pakistan is also facing a huge burden of the same disease. The prevalence of HBV and HCV infection among general public in Pakistan is 9,0 0% and 4-0% respectively. Earlier studies showed that of all patients presenting with chronic liver disease (CLD), 6.6% are anti-hcv positive. More recent data shows nearly 60-70% patients with CLD tend to be positive for anti- 3, 4. HCV It has been demonstrated that nearly 50% patients with hepatocellular carcinoma (HCC) in 5 Pakistan are anti-hcv positive. 0 Vol. 6 No. 0 :

2 Most common route of transmission of SPSS version. Hepatitis B and C virus is parenteral, mainly as a result of contaminated blood transfusion or blood RESULTS to blood contact, injury with contaminated sharp Total of 443 subjects were screened for instruments, with infected needle pricks or sexual HBs Ag and anti-hcv. Nine hundred and twenty contacts and also through vertical transmission two (63.90%) were male and 5 (36.0%) were 6 from mother to child. Poor literary, low female. The frequency of Hepatitis B and C socioeconomic status and poor hygienic conditions (combined) was found to be 38(6.50%), out of also have a role in the prevalence of Hepatitis B which 75 (.%) were HBs Ag positive with 7 and Hepatitis C. male to female ratio of 38:37, 58 (4.0%) were The objective of this study was to find out positive for Anti- HCV with male to female ratio the prevalence of Hepatitis B and C among the of 39:9, and 5 (0.35%) were both anti-hcv and patients visiting out patient department at District HBs Ag positive with male to female ratio of 3:. Head Quarter Hospital Lakki for various illnesses. The frequency of Hepatitis B and C was more in rd th 3 and 4 decade of life. The mean age of the METHODOLOGY patients suffering from Hepatitis was years. The frequency of Hepatitis B and C in This cross sectional study was carried out various age groups is given in Table. in out patient department of District Head Quarters st Hospital (DHQ) Lakki Marwat from January The frequency of Hepatitis B amongst 008 to 3 December 008. This hospital is a 00 urban and rural population was 3/75 (3.5%) bedded category B hospital where patients from and 5/75 (86.85%) respectively. The frequency the whole district including far flung areas come of hepatitis C amongst urban and rural population for treatment. OPD is part of the hospital where was 7/58 (9.30%) and 4/58 (70.70%) patients are received, initial assessment is done respectively while frequency of Hepatitis B and and are either managed and sent home or referred Hepatitis C combined amongst urban and rural to appropriate department depending upon the population was /5 (0%) and 4/5 (80%) initial assessment. respectively (Table and Figure ). All patients coming to out patient The frequency of Hepatitis B, C and department (OPD) were approached for informed Hepatitis B and C simultaneously amongst the consent and included in the study. Patients with various ethnic origins like Marwats, Behtanni, evidence of hepatitis B or C in the past were Afghan refugees and others like Banochi and excluded from the study. The HBs Ag and Anti- Khattaks is also given in Table and Figure. HCV screening were performed through Immuno- Jaundice which is considered as a reliable chromatographic method. All sera showing sign for hepatitis was present in 8/75 (0.8%) reactivity were then confirmed with ELISA test in of HBs Ag positive, 6/58 (0.34%) Anti-HCV pathology Department DHQ Hospital Lakki positive and in 3/5 (60%) HBsAg and Anti-HCV Marwat. The information of the patients was positive patients. Only 7/75 (4%) patients had recorded on an especially designed proforma vaccination against hepatitis B. 3/75 (3.4%) having details regarding ethnic origin, social and HBs Ag positive, /58 (8.96%) Anti-HCV educational status and rural and urban inhabitation. positive and /5 (0%) HBs Ag and Anti-HCV The data obtained were analyzed statistically using positive patients had awareness of the disease. Table : Frequency of Hepatitis B and Hepatitis C (n=443) Number of patients screened Male Female Number of patients with positive viral serology HBS Ag Positive Anti HCV Antibody Both HBS Ag Positive and Anti HCV Antibody (63.90%) 5 (36.0%) 38 (6.50%) 75 (.3%) 58 (4.0%) 5 (0.35%) 0 Vol. 6 No. 0 :

3 Table : Demographic Features of Hepatitis B & C Positive Patients Parameters HBs Ag (n=75) %age HCV (n=58) % age HBs Ag + HCV (n=5) % age Age (Years) Population Group Ethnic Origin Urban Rural Marwats Behtanni Refugees Others Figure : Population Group urban, 3 3.5% rural, % urban rual Figure : Ethnic Origin % 6.8% 39.8% % Marawat Betanni Refugees Others DISCUSSION rapid spread in our country. This is the reason that prevalence rates in developing or underdeveloped Infection due to Hepatitis B and Hepatitis countries are much higher as compared to C viruses are significant public health problems developed countries. The overall seropositivity of around the globe. Pakistan is highly endemic for Hbs Ag and Anti-HCV in general Pakistani 8 9- Hepatitis B and Hepatitis C Poor knowledge and population ranges between 4-5% which is lack of awareness about Hepatitis B and C virus alarming. In our study the prevalence of HBs Ag among the general public is the main cause of its and Anti-HCV was.% and 4.0% while 0 Vol. 6 No. 0 :

4 0.35% were positive for both HBs Ag and Anti- spread of infection through unscreened blood HCV. In a study by Bhopal FG et al 8.66 % transfusion, reuse of syringes and other medical patients were positive for HBV and 6.33% for and dental equipments and instruments, ear and 3 HCV. Results from another study showed 6.4% nose piercing from market, circumcision and for HBsAg and 8.66% for HCV antibody positive shaving from the barbers and so on is extremely patients respectively. These results are higher than important. Because of the lack of health resources ours but are similar to our findings of high rate of especially at rural areas and deficiency of well HBsAg to HCV. trained medical personals the prevalence is increasing at an alarming rate. It is required to On further reviewing the literature the prevent this disease by health education and seroprevalence of hepatitis B is.% to 3.53% in 4,5, creating awareness among the general public Rawalpindi.5% in Islamabad,.6% to 5.05% through involvement of electronic and print media, in Lahore, 3% to 5.45% in Karachi 4% from local body health educators, volunteers, Non 33 Jamshoro (Sindh). So the prevalence of Hepatitis Government Organizations (NGO's) and religious B is between.% to 5.46% in different parts of scholars. Awareness programs regarding Hepatitis the country which is quite low when compared to B and C at school level should be started to save our study. our future generation. Awareness and education The seroprevalence of Hepatitis C programs for public and paramedical staff should observed in our study is 4.0%. On reviewing the be initiated on urgent basis with the help of literature the prevalence of Hepatitis C is 4.57% in NGO's, medical authorities and local represen- 34 Buner (N.W.F.P) comparable to our study, 9% in tatives. 35 Mardan (N.W.F.P), significantly higher to our 7,8 study, 5.7% to 3.5% from Lahore again higher CONCLUSION 8,3 to our study and.% to 4.6% from Karachi Hepatitis B is more common than hepatitis which is low to comparable to our results. C in this part of Khyber Pakhtunkhwa. Moreover it is more common in male as compared to female The results when compared with the population. international studies there is a marked difference in the prevalence rates. A study conducted in Grant Support, Financial Disclosure Greece revealed prevalence of HBV as.6% and 36 and Conflict of Interest HCV as 0.5%. A study from Japan showed 37 prevalence of HBV as.8% while HCV as 7.%. 38 A study from Turkey reported the prevalence of Anti HCV.4% which is low to our findings None Declared REFERENCES 38 (4.0%) but HBs Ag in that study was 6.6% which is also significantly lower to our study. Cusheri A. Acute and chronic viral hepatitis. In: Cusheri A, Steel JC, Moosa AR, editors. (.%). Another study of 4 patients screened 5 before surgery showed that HCV was.6% positive which is significantly higher to our findings (4.0%) while HBsAg was.% positive which is quite low when compared to our study (.%). In our study it was also noted that low socioeconomic status and poor knowledge of hepatitis B and C are associated with high prevalence which is also supported by another 39 study. It was also found in our study that hepatitis B and Hepatitis C prevalence is high in rural population as compared to urban population as supported by another study. It may be due to increased rural population, illiteracy, poverty, lack of proper precautions, quackery in the rural area and less degree of awareness regarding the causative agent and transmission. Keeping in view the high frequency of HBs Ag and anti- HCV in our country, we need nationwide efforts to identify people who are infected with HCV and Hepatitis B virus. Mass education of the public regarding Essential surgical practice. 5th ed. London: Oxford University Press; 00. p World Health Organization. Hepatitis B. Geneva: WHO; EASL Jury. EASL International consensus conference on hepatitis B.3-4 September, 00 Geneva, Switzerland. J Hepatol 003;38: Andre F. Hepatitis B epidemiology in Asia: the Middle East and Africa. Vaccine 000;8: Tong CY, Khan R, Beeching NJ, Tariq WU, Hart CA, Ahmad N, et al. The occurrence of hepatitis B virus and HCV in Pakistani patients with chronic live disease and hepatocellular carcinoma. Epidemiol Infect 996;7: Khan TS, Rizvi FJ. Hepatitis B seropositivity among chronic liver disease patients in Hazara d i v i s i o n P a k i s t a n. J Ay u b M e d C o l l Abbottabad 003;5: Vol. 6 No. 0 :

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