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PAKISTAN: Prevalence of Hepatitis Infection Still Alarming

Ashfaq Yusufzai

PESHAWAR, Pakistan, Jun 24 2010 (IPS) - Unable to afford treatment for his disease, Azizur Rehman, 29, has been suffering from hepatitis C for the past one year. “My elder sister died of the same killer ailment one year ago for lack of treatment,” he laments.

The farmer, who lives in Tajabad locality in the northwestern city of Peshawar, is one of millions of Pakistanis suffering from hepatitis infections.

An estimated 12 percent, or 19 million, of Pakistan’s population of 160 million are suffering from hepatitis, says Dr Umar Ayub Khan, president of the Pakistan Medical Association (PMA). Five percent of the afflicted individuals have hepatitis B and 7 percent have hepatitis C, he adds.

In 2005, he says, “about 10 to 15 percent of Pakistanis suffered from hepatitis B or C due to the re-use of disposable syringes, transfusion of unscreened blood and use of contaminated equipment in (medical) facilities,” citing a study conducted during that year by the PMA. These are essentially the same causes underlying today’s incidence of hepatitis infections, he says.

Hepatitis is an inflammation of the liver commonly caused by a viral infection. Hepatitis viruses are classified as types A, B, C, D, and E. According to the World Health Organization (WHO), hepatitis A and E are generally caused by food or water contamination. Hepatitis B, C and D are acquired through contact with infected body fluids, particularly blood. Hepatitis B is also transmitted by sexual contact.

Liver transplant is usually the only treatment option for patients with end- stage liver disease.

The latest study conducted by the National Programme for Control and Prevention of Hepatitis (NPCPH) has yielded similarly worrisome data. According to Dr Sharif Ahmed, who heads the programme, 3 to 4 percent of Pakistanis are carriers of hepatitis B and 5 to 6 percent of hepatitis C, he said. PMA’s Dr Khan says the number of those with hepatitis B or C could be significantly higher if the entire Pakistani population were screened for the disease.

“We need nationwide efforts to identify people who are infected with HCV [hepatitis C virus] and Hepatitis B virus,” says The Health Foundation (THT), a local non-governmental public service organisation, in a statement. In 2004, some 16 million of the country’s population were reported to have hepatitis infections, says Dr Khan.

According to the World Hepatitis Alliance, which represents 280 hepatitis B and C patient groups from around the world, the hepatitis B and C viruses kill approximately one million people annually.

“Around 500 million people around the world are currently infected with chronic hepatitis B or C and one in three people have been exposed to one or both viruses,” says the Alliance.

Dr Khalife Mahmud Bile, head of the WHO’s country office in Pakistan, has called for the immediate enforcement of measures to prevent further spread of the disease, including the installation of incinerators and water filtration plants, and the provision of screened blood to patients.

“Despite the alarming rate of hepatitis in Pakistan, the Safe Blood Transfusion Act, enacted in 2002, has not yet been fully implemented,” says Dr Khan. “The law prohibits the transfusion of unscreened blood for patients.”

The law also requires the establishment of a five-member Safe Blood Authority under the director-general of federal health services to ensure that blood banks across the country are managed by qualified personnel and that biosafety measures are in line with WHO’s standards.

Failure to set up the planned authority has been blamed on the government’s alleged lacklustre response to the incidence of hepatitis in Pakistan.

Says the THT: “The proper implementation of a National Program for Prevention and Control of Hepatitis in Pakistan to control the deadly disease is still to be ensured.”

Measures to curb the spread of hepatitis in the country have not been entirely lacking.

In 2008 the Ministry of Health launched the five-year (2008-2013) NPCPH to arrest the spread of hepatitis infections. The programme, which has a total outlay of 119 million U.S. dollars, was initially aimed to provide free treatment to hepatitis patients. But it was later decided to focus the programme on the elimination of the causes of the disease.

Waqar Shah, a vegetable vendor afflicted with hepatitis C, is desperate to avail himself of free, or at least significantly more affordable, treatment. He is afraid he could “ultimately die without getting the needed treatment due to its exorbitant cost.”

Dr Ahmed says hepatitis C patients need 72 injections as part of a treatment regime covering a span of two years. Treatment for Pakistan’s hepatitis carriers would cost a total of 97 million dollars, “which is not possible for the cash-strapped country,” he said.

Given the government’s scant resources, free treatment is only a small component of the NPCPH, with only a small percentage of Pakistan’s millions of hepatitis having benefited from it. Since 2008, the programme has given free treatment to 22,779 hepatitis C carriers and 2,931 individuals with hepatitis B, says Dr Ahmed. Around 400,000 hepatitis-infected individuals have been vaccinated and 104 hospitals have been equipped to give free treatment to hepatitis patients, he adds.

Hepatitis C-infected Shah complains that the procedures for availing oneself of free treatment are too complicated for him.

Admittedly, existing measures to address the prevalence of hepatitis infections have not eliminated the need for more vigorous efforts – and greater resource allocation – to ensure that the likes of Rehman and Shah will get the treatment that they badly need before it is too late.