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Bosan A.,U.S. National Institutes of Health | Qureshi H.,Pakistan Medical Research Council | Bile K.M.,World Health Organization | Ahmad I.,U.S. National Institutes of Health | Hafiz R.,U.S. National Institutes of Health
Journal of the Pakistan Medical Association | Year: 2010

A review of published literature on viral hepatitis infections in Pakistan is presented. A total of 220 abstracts available in the Pakmedinet and Medline have been searched. All relevant articles were reviewed to determine the prevalence of hepatitis viral infections in Pakistan. Two hundred and three (203) relevant articles/abstracts including twenty nine supporting references are included in this review. Of the articles on prevalence of hepatitis infection, seven were related to Hepatitis A, fifteen to Hepatitis E while the remaining articles were on frequency of hepatitis B and C in different disease and healthy population groups. These included eight studies on healthy children, three on vertical transmission, nineteen on pregnant women, fifteen on healthy individuals, six on army recruits, thirty one on blood donors, thirteen on health care workers, five on unsafe injections, seventeen on high risk groups, five on patients with provisional diagnosis of hepatitis, thirty three on patients with chronic liver disease, four on genotypes of HBV and five on genotypes of HCV. This review highlights the lack of community-based epidemiological work as the number of subjects studied were predominantly patients, high risk groups and healthy blood donors. High level of Hepatitis A seroconversion was found in children and this viral infection accounts for almost 50%-60% of all cases of acute viral hepatitis in children in Pakistan. Hepatitis E is endemic in the country affecting mostly the adult population and epidemic situations have been reported from many parts of the country. The mean results of HBsAg and Anti-HCV prevalence on the basis of data aggregated from several studies was calculated which shows 2.3% and 2.5% prevalence of HBsAg and Anti-HCV in children, 2.5% and 5.2% among pregnant women, 2.6% and 5.3% in general population, 3.5% and 3.1% in army recruits, 2.4% and 3.6% in blood donors, 6.0% and 5.4% in health care workers, 13.0% and 10.3% in high risk groups, 12.3% and 12.0% in patients with provisional diagnosis of hepatitis and 25.7% and 54% in patients with chronic liver disease respectively. This review has illustrated the high endemicity of hepatitis viral infections in Pakistan where hepatitis B and C potentially account for a serious burden of the disease. This review has triggered the launching of a network intervention for the control of hepatitis viral infectious. This review was used as the basis for the launch of hepatitis programme, but putting it into a formal review took time and the hepatitis program was initiated. Source

Taseer I.U.,Pakistan Medical Research Council
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Viral hepatitis is a global issue. Among the hepatitis viruses hepatitis B and C are important in South Asia including Pakistan. There are various modes of transmission of these viruses. Vertical transmission is also gaining importance. Antepartum screening for HBV and HCV would help the infected women for appropriate antiviral therapy at appropriate time as well as for taking proper care of the newborns. The present study was designed to see the frequency of HBsAg and anti-HCV in pregnant women at Nishtar Hospital, Multan. This was a cross-sectional study carried out using non-probability purposive sampling technique. The period of the study was from June 2006 to August 2007. Five hundred (500) pregnant women attending outpatient department of Gynaecology and Obstetrics were included. Informed consent was taken. A specially designed proforma was filled in. Anti-HCV and HBsAg were tested by device method. Data were analysed on SPSS-11. Out of 500 pregnant women 35 (7.00%) were found to be anti-HCV positive and 23 (4.60%) were positive for HBsAg. Mean age was 26.7 +/- 4.8 years. Majority of the patients 263 (52.60%) were in the age group 26-35 years. 138 (27.60%) women were nulliparous and 282 (56.40%) were para 1-4 and anti-HCV and HBsAg were common in this parity group. Only 80 (16.00%) women were para 5 or more. All anti-HCV and HBsAg positive women were house-wives. Most of them were belonging to rural areas having poor socio-economic status. Among 35 anti-HCV positive women, 20 (57.14%) had history of previous surgery, while 13 (37.14%) had history of multiple injections, 5 (14.28%) received blood transfusion, 4 (11.42%) had ear/nose piercing while tattooing was seen in only 2 (5.71%). Among 23 HBsAg positive women, 10 (43.47%) had history of previous surgery. History of multiple injections was present in 6 (26.08%) patients, 4 (17.39%) patients had history of blood transfusion, tattooing, ear/nose piercing, history of dental procedure, history of sharing needles was observed in 1 each. Frequency of anti-HCV is more common than HBsAg in our study population. Previous history of surgery, multiple injection therapy and blood transfusion were observed as risk factors among anti-HCV and HBsAg positive pregnant women. Source

Qureshi H.,Pakistan Medical Research Council | Bile K.M.,World Health Organization | Jooma R.,Ministry of Health | Alam S.E.,Jinnah Postgraduate Medical Center | Afridi H.U.R.,World Health Organization
Eastern Mediterranean Health Journal | Year: 2010

A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and management of needy CLD patients as a poverty-reduction health intervention. Source

Rao M.H.,Pakistan Medical Research Council | Khan N.,Dow University of Health Sciences
Journal of the Pakistan Medical Association | Year: 2010

Objectives: To compare the statistical methods, types of article and design of studies used in 1998 and 2007 articles of leading indexed and non-indexed medical journals of Pakistan. Methods: Six leading medical journals of Pakistan: (1) JCPSP, (2) JPMA, (3) JAMC, (4) PJMS, (5) PJMR, and (6) PAFMJ, were selected for this study. Articles reviewed were 1057 to achieve the above mentioned objective. Results: The articles reviewed for 1998 and 2007 were 366 and 691, respectively. Original articles contributed the maximum percentage of 65.6%, followed by case reports with 24.8%. The contribution of case reports in 1998 was 20.5% which increased to 27.1% in 2007. There was no statistically significant difference between 'indexed' and 'non-indexed' journals for different type of statistical methods in 1998 or 2007. In total, 749 articles were categorized as 'original articles' or 'short communication'. Among them, 51% articles mentioned study design and 67.3% of them were correct for the respective methodology. In 1998, 202 (74%) articles did not use any statistics or indicated only descriptive statistics, while in 2007, 239 (50.2%) articles did the same. The reader who was familiar with t-test and contingency tables in 1998 could have understood 97.4% of the scientific articles. However, this percentage dropped to 83.0% in 2007. Conclusions: Quality of elaborating methods and usage of biostatistics in 6 leading Pakistani medical journals improved from 1998 to 2007, but has still to come up as compared to other western medical journals. Source

Qureshi H.,Pakistan Medical Research Council | Alam S.E.,Pakistan Medical Research Council | Arif A.,Pakistan Medical Research Council | Ahmed W.,Pakistan Medical Research Council
Journal of the Pakistan Medical Association | Year: 2013

Objectives: To evaluate the response to treatment given on a large scale for hepatitis B and C through a nationwide programme. Methods: Records of patients who received treatment of hepatitis B and C during past 2 years through the Prime Minister's programme for the Prevention and Control of Hepatitis Viral Infection was retrieved randomly from 12 sites after taking consent from the management and the site managers. Data confidentiality was ensured. All data was photocopied and brought to the Pakistan Medical Research Centre at the Jinnah Postgraduate Medical Centre, Karachi, where it was entered and analysed. The inclusion/exclusion criteria and the followup tests that were to be done before, during and after treatment were taken from the National programme manager so that actual data could be matched with the guidelines. Data was analysed through a specially developed programme. Results: A total of 7752 patients received treatment at the 12 sites for hepatitis C. Adherence to inclusion/exclusion criteria or protocol was followed in 7572 (97.6%) patients. Out of 7572 patients, 3440 (45.4%) completed 6 months of interferon therapy, but the polymerase chain reaction test at the end of 6 months was available in 1686 (49%) cases. It was not detected at 6 months in 1133/1686 (67%) cases, while in 553 (33%) cases there was no response. Data for hepatitis B was collected from 8 sites. A total of 454 cases received treatment and 85 (18.72%) fulfilled the inclusion criteria. Treatment was completed by 9 (10.58%) cases, with 3 (3.52%) cases showing Hepatitis B 'e' antigen clearance and anti-HBe (antibody to hepatitis B 'e' antigen) production. Conclusion: Poor followup and inadequate documentation of serological/biochemical tests were the major drawbacks in both hepatitis B and C patients, resulting in wastage of huge human and financial resources without proper planning and accountability. Source

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