Pakistan as a developing country is struggling in many fields including the health system which is in a very poor state; resulting in a 122 rank out of 190 countries in a World Health Organization performance report.
The reasons include-
- Poor socioeconomic conditions
- Low health awareness
- Overcrowded cities
- Unsafe drinking water
- Inadequate sanitation
- Inadequate vaccination coverage
- Urban-rural disparities in healthcare delivery
- Imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas.
Pakistan has a high disease burden of hepatitis A to E, with maximum morbidity in hepatitis A and E and maximum mortality in hepatitis B, C and D. Pakistan has the world’s second highest prevalence of hepatitis C, second only to Egypt. A recent survey reflects that Hepatitis C virus (HCV) & Hepatitis B virus (HBV )disease continues to rise in Pakistan and millions of Pakistani (20%) are at a risk of a slow progression of a chronic liver disease, cancer, and death. Dr. Shahzad Khan Siddique said Pakistan carries one of the world’s highest burdens of chronic hepatitis and mortality due to liver failures and hepatocellular carcinomas. It is estimated that nearly five million people in the country have been exposed to hepatitis B virus and about eight million to the hepatitis C virus.
Within the Eastern Mediterranean Region, Pakistan and Egypt bear 80pc of the disease burden and within Pakistan, over thirteen million people are suffering from hepatitis B or C. Each year about 250,000 new cases are added. A majority of people catch this infection from the healthcare settings without being aware of it. The disease is called a silent killer because many patients remain undiagnosed and untreated for many years before developing complications and death.
Critical situation of hepatitis patient in Pakistan
Owing to lack of preventive measures and treatment facilities, hepatitis prevalence in Pakistan is the highest on the globe, as five lakh hepatitis patients die annually, while over five hundred people lose life to hepatitis every day. Methods to contain the spread of the disease, have already surpassed that from AIDS. Dr. Sharif Astori, Polyclinic Blood Bank Head said that the HCV disease witnessed an alarming increase this year too and could cause an epidemic like situation if urgent preventive measures were not taken.
According to WHO, about 15 million people are exposed to hepatitis C virus in Pakistan. The information obtained from Institute of Medical Sciences (PIMS) revealed that around four and half thousand Hepatitis C patients sought treatment at the hospital every year. Similarly, out of a total 4556 health blood donor in Polyclinic, 377 donors were diagnosed with Hepatitis C. He said that the most of the people unaware of their disease and could not test or else the number could be increased alarmingly. Expert says lack of efficient sewerage system, lack of clean drinking water, Unscreened blood transfusions, reuse of needles and syringes, sharing of needles by drug addicts, use of unsterilized surgical and dental instruments, roadside dentists and barbers are factors which have led to an epidemic like a situation in Pakistan.
Year wise analysis of the case of hepatitis B and C shows that hepatitis B was more prevalent in the 1980s and 1990s; thereafter a proportionate decline of hepatitis B and gradual rise of hepatitis C was observed as evident by Figure. Few community-based studies have been conducted and this infection was found endemic in Pakistan. The highest prevalence of hepatitis B was found in the province of Baluchistan(10%) followed by the province of Sindh (7%). On the contrary, the highest prevalence of hepatitis C was found in the province of Punjab (6.7%) followed by Sindh (5.0%).
The statistics given below are based on an old hospital-based study from 1994 to 2007 by a search of the PubMed database of the National Library of Medicine, National Institutes of Health (USA), & Pakmedinet.com. An interesting aspect highlighted is the changing pattern of viral hepatitis over the two decades. Hepatitis B was the commonest virus for chronic liver disease before 1995-1996, but as on date eight million Pakistani’s are diagnosed with hepatitis C virus.
Acute viral Hepatitis A is a common infection among children in Pakistan and accounts for 50-60% of all cases of acute viral hepatitis in children. Almost 96% of the population is exposed to HAV by the age of 5 years and 98-100% at adulthood.
Hepatitis E is a disease of mild to moderate severity (mortality rate of 0.4 – 4.0%) except in pregnancy, where the mortality rate may reach 20% in last trimester of pregnancy especially during epidemics. HEV is a major cause of acute viral hepatitis (AVH) in Pakistan particularly in adults from lower socioeconomic groups. Hepatitis E virus typically spreads by fecal contamination of water. The infection is endemic in developing countries and turns into mini-epidemics in grave situations. Hepatitis E is endemic in Pakistan and occurs mostly during summers, rains, and floods. Major epidemic outbreaks occur in areas where drinking water gets contaminated with sewage and where people have a communal living and drinking water from a common contaminated source.
Both hepatitis B and C are common infections affecting masses and are the leading causes of chronic liver disease. Pakistan is in the intermediate zone of hepatitis B and C prevalence areas. Higher prevalence of Hepatitis B and C has been reported in certain areas of Pakistan in small-scale studies. Pakistan is the country with highest number of intramuscular injections injected per person per year. Horizontal transmission in children appears to contribute more than vertical transmission for the prevalence of chronic hepatitis B in this region. Unprotected sex further adds to the high figures.
A high prevalence of hepatitis B and C have also been observed in security personnel in our study. A recent study revealed that 98% of security personnel were living away from their homes and two third of them had illicit sexual relations. There is a fair chance that these men may have developed the disease due to illicit sexual behavior. There is some evidence, where, army recruits have shown a higher prevalence of hepatitis B compared with the prevalence in the general population.
Statistics synthesized by risk population defined according to the risk of exposure to HCV infection is as follows:
General population (populations at low risk): these included blood donors, pregnant women, children, refugees, household-based survey participants and national army recruits, among others.
High-risk populations: these included populations such as healthcare workers (HCWs), household contacts of HCV-infected patients, patients with diabetes, exposed to frequent medical injections and/or blood transfusions
Populations with liver-related conditions: these included patients with liver-related conditions of an epidemiological significance to HCV infection such as patients with a chronic liver disease, acute viral hepatitis, hepatocellular carcinoma and liver cirrhosis, among others.
At least two million people have been diagnosed with hepatitis C and 1.1 million with hepatitis B in Sindh. 12.9 % of Ghotki’s population, 9.1% of Dadu’s population, eight% of Khairpur Mir’s and 7.5% of the population of Sanghar is affected by the disease.