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10 Million Hepatitis Positive in Pakistan
  Our 10m Hepatitis patients could create an epidemic: experts
Staff Report
KARACHI: Pakistan is currently home to around 10 to 12 million patients suffering from Hepatitis B and C, Pakistan Society for the Study of Liver Diseases (PSSLD) president, Dr S. M. Wasim Jafri, said Saturday during a press conference to announce the inception of the PSSLD.
There has, however, been no specific countrywide study to determine the prevalence of Hepatitis in Pakistan, Dr Jafri said, and the statistics he quoted are aggregates of separate studies focusing on specific areas. The overall prevalence of the disease in Pakistan, as per these studies, is around 10 to 15 percent, the PSSLD president said, adding that in some areas, such as the Seraiki belt (lower Punjab and upper Sindh), this prevalence increases to around 40 to 50 percent.
Given these high figures, it is imperative that awareness about preventive measures and treatment options be disseminated among the masses, and this, Dr Jafri said, is one of the purposes of the PSSLD. The main objective of the society is to compile appropriate epidemiological data and then delve into the operational phase of the research. Interventions will be organised at various levels to bring about a decrease in the prevalence of the disease in Pakistan. The other major objective of the PSSLD is to develop awareness programmes focussing on the "end users" (people living in areas with a high prevalence of various strains of Hepatitis). The purpose of these programmes would be to sensitise the public, and to develop appropriate guidelines to help people manage different types of Hepatitis.
The PSSLD will also collaborate with professionals in the country, as well as counterparts from other SAARC countries. The society is also organising World Hepatitis Day in Pakistan on July 28. Among the programmes organised for this day is a day-long workshop which will be held at 10:00 a.m. at the Aga Khan University auditorium.
"Our own research, along with those of other practitioners shows that there is a large pool of 10 to 15 million Hepatitis patients in Pakistan. These patients will infect others around them, initiating a vicious circle of disease of epidemical proportions," Dr Jafri said.
Hepatitis B and C are usually transmitted through sexual intercourse, transfusion of unscreened blood, unsterilized surgical instruments, and the reuse of old syringes, doctors at the press conference said. Hepatitis A and E, on the other hand, are transmitted through food and contaminated water. "People need to understand the difference here, and they need to realise that Hepatitis is not only transmitted through 'dirty water'," PSSLD treasurer, Dr Ashfaq Ahmed, said. "We find instances of Hepatitis A and E even in more affluent countries. In Pakistan, we have entire epidemics."
The government has recently incorporated Hepatitis vaccination in the EPI programme, which is a notable step, doctors said. "There's a vaccination course for Hepatitis, comprising three injections which should be administered at birth. Also, pregnant women should be screened for Hepatitis B. If the mother has Hepatitis B, the child should be given an immunoglobulin at birth in order to prevent infection," they said.
Early detection of the disease also increases the probability of complete recovery. No one can claim, however, that the patient will absolutely be cured; there are a lot of factors which count here," Dr Jafri said.
Other factors which make people more susceptible to the disease are marriages within the family, crowded living conditions, and a non-existent infrastructure for health, especially in feudal areas such as the Seraiki belt. "The incidence of Hepatitis in those regions is around 40 to 50 percent now. It could increase to 70 or 80 percent in the future. The situation is bound to get worse if action is not taken," Dr Jafri said.
The transmission methods for Hepatitis B, C and D are very similar to those for HIV/AIDS, doctors said in reply to a question. "One strategy would be to add a list of these diseases to HIV/AIDS advertisements printed by the government. Money is being spent anyway on these ads. They can capitalise on it by adding Hepatitis B, C and D in there too, since the methods of transmission are very similar," PSSLD general secretary, Prof. Saeed Hamid said. "Other strategies would be to involve the indigenous press. What we've discovered through our studies is that people in general, even in remote areas, are very concerned about their health. Everyone knows what 'kaala yarqaan' and 'peela yarqaan' is. So we've reached that stage. The next step would be to educate them about what to do: treatment options, etc."
This raised a question about the cost of the treatment, and the lack of knowledge among general practitioners. Workshops should be held for this, doctors at the press conference said. "The PSSLD has conducted a number of workshops for doctors from around the country. Two were held this year alone," they said. There were follow-ups through email, etc. There has, however, been no assessment of ethical practices among the participants of these workshops, they conceded. "But our teams have a general know-how about the participants, and they know that most of the participants conform to ethical practices," Dr Hamid said.
"I was recently invited to a seminar held in Islamabad under the Prime Minister's Programme on the Prevention of Hepatitis. We made a number of suggestions about team management, disease prevention, etc," Dr Jafri said. "We're hopeful that these suggestions will be incorporated into the implementation strategy of the programme."
The PM's programme has been on for approximately two years, however, and Dr Jafri was asked about his assessment of it. "It is not possible to rate it right now," he replied. "Treatment for Hepatitis takes six months to a year, generally - longer for different strains. Follow-up checks have to be maintained for a number of years after the treatment is complete. I will probably get to know about the results five years after the programme was started. There is no question, however, that the programme will not be successful. It was started when we didn't have any other programmes for Hepatitis, so there has to be some level of success. The amount of success - mild, low, high, etc - is yet to be seen, though."
There are less than 100 hepatologists (liver specialists) in Pakistan, Dr Jafri said. If gastroenterologists are added to this, the number goes beyond 500. Eighty percent of the PSSLD is made up of doctors working in the government sector. A high level of interaction between the State and private practices is therefore expected, leading to higher chances of success, the PSSLD president said.
Doctors quoted the example of Taiwan to prove that Hepatitis B is totally preventable. "Taiwan had the highest prevalence of Hepatitis B (20 percent). Fifteen years ago, a vaccination programme was initiated, and in 2007, the prevalence there is less than one percent. Similar strategies should be used in Pakistan, too," they said.
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