Advertisements in the form of wall chalking in the nook and cranny of Pakistan as well as print and electronic media campaigns convey a clear message that the menacing the viral infection named hepatitis is rapidly spreading in the country. However, most of these ads come from those individuals, organizations and companies that cause more and more health complications for the hepatitis patients, instead of curing their disease. Thus, they are playing with the lives of the poor patients. A popular misconception about hepatitis is that it is incurable, hearsay regarding its modern treatment and a fear of earning bad name leaves the people on the mercy of quacks but it often results in deep regret. So, given this state of affairs, there is a pressing need to make the people aware that hepatitis is absolutely curable and success rate in modern allopathy is more than 95 percent and that all the disinformation and misconceptions in this regard are completely rubbish and far from reality. Dispelling all the misconceptions is also necessary because, on the one hand, this killer disease is fast spreading in Pakistan while the situation is getting more and more precarious, on the other, due to an acute lack of awareness on the causes of its spread and inadequate preventive measures and treatment facilities.
The famous proverb ‘prevention is better than cure’ holds true for hepatitis as well as minimizing the chances of getting infected with this disease hinges on preventive measures which include avoiding the use of contaminated water, consumption of substandard food and giving special care to personal hygiene. Besides these, use of new syringe while having an injection, transfusion of only the screened blood, using sterilized dental and surgical instruments, cleaning teeth with personal toothbrush, clipping nails with one’s own nail clipper, shaving or trimming hair every time with a new blade, using safe, new needle for getting done tattoos or some other symbols on the body, applying germ-free cosmetics and other beauty products, conceiving a baby only after consulting a doctor and taking an extreme care while establishing sexual relations with affected persons are but some precautions that would help in staying immune from hepatitis and curbing its spread, as well. Nonetheless, due to little knowledge of these preventive measures, the number of people catching this disease is growing at a rapid pace. At present, an estimated 328 million people are living with hepatitis virus infection with an increase of nearly 1.7 million new patients every year. During the year 2015, 1.34 million people died of hepatitis, showing an increase of 22 percent since 2000.
It is in this backdrop that every year 28th of July is observed as World Hepatitis Day. The objectives behind observing this day include creating awareness on this disease, enhancing treatment facilities and making them easily accessible as well as affordable to common people and urging governments and welfare organizations to come forward and play their due role in this regard. It is pertinent to mention here that with more public awareness, we can not only save people from hepatitis but can also minimize the risks of its transfer from one person to another. So, it is imperative to have regular medical checkups and, if needed, get proper medical treatment. Distressingly, most people don’t care for their health and what could be a bigger proof of that than the fact that only 5 percent of people know that they suffer from this killer disease and less than one percent, somehow, have access to modern treatment facilities. The principal reason behind patients’ failure to get proper treatment is the exuberant price of the injection applied to the affected patient. In addition, the complex nature – and huge cost– of hepatitis tests and limited capacity of laboratories are some other important factors. All these deficiencies and inabilities have resulted in the situation where a big chunk of patients is unable get the requisite medical care. Resultantly, they cannot lead a quality life while also contribute to the spread of hepatitis. As per Global Hepatitis Report 2017 by the World Health Organization, globally, in 2015, an estimated 257 million people were living with chronic hepatitis B virus (HBV) infection, and 71 million people with chronic hepatitis C virus (HCV) infection.
There are five main hepatitis viruses, referred to as types A, B, C, D and E. Types A and E spread through faecal (sewage) contamination of food or drinking water while type A is caused by a direct contact with the affected person. Poor personal hygiene and insufficient cleanliness of the surroundings, especially not washing hands with an antiseptic soap after using the toilet as well as before and after preparing food, also cause the spread of this disease. Moreover, B, C and D types of hepatitis spread through transfusion of blood and body fluids, sexual contact and use of unsterilized instruments for surgeries, dental treatment, use of infested needles, blades, nail-clippers and cutters, etc. Similarly, hepatitis E comes usually with the use of contaminated water and becomes more rampant in rainy season, especially during floods.
All five types of hepatitis – A, B, C, D and E – are found in Pakistan. It’s a deplorable fact that Pakistan is the third largest country with hepatitis C cases, as per the data published by World Gastroenterology Organisation. Adding fuel to the fire is the non-availability of the latest data on the situation of hepatitis in Pakistan as most facts and figures currently available are approximately a decade old. As per a 2007-08 survey “Prevalence of Hepatitis B and C in General Population of Pakistan,” conducted by Pakistan Medical Research Council (PMRC), a total of 7.4 percent population of the country at that time was infected with the HCV & HBV. It means that at that time, this ailment had infected nearly 11.8 million Pakistanis. (In the current context, this ratio would be nearly 14.70 million people – or every 14th person). The survey further revealed that prevalence of hepatitis B antigen among healthy population was 2.5 percent while that of hepatitis C was 4.9 percent. Furthermore, Balochistan was the province with the highest percentage of affected population with 4.3% people of the province having contracted this killer disease. In addition, six out of the ten districts with highest prevalence ratio were from Balochistan –two from Sindh and one from Punjab while Islamabad district also making to the list. Balochistan’s Musa Khel district was the worst hit as the ratio with a prevalence ratio of 14.7 percent. Sindh’s Khairpur, Punjab’s Dera Ghazi Khan and Khyber Pakhtunkhwa’s Upper Dir were the other most affected districts.
As regards the prevalence of HCV, nine out of ten most affected districts at national level were from Punjab while the remaining one was from Sindh. The most affected district at the national level was Vehari in Punjab with hepatitis prevalence ratio at 13.1 percent. At the provincial level, Sindh’s Ghotki, KP’s Hangu and Balochistan’s Musa Khel districts were the most affected with HCV. Adding up the ratios of both HBV and HCV (or any one of them), Balochistan’s Musa Khel was the most affected district where this ratio, on average, was 20 percent, followed by Sindh’s Ghotki and Punjab’s Vehari districts with this ratio at 18.6 percent and 15.9 percent, respectively.
The situation in Punjab is, however, extremely alarming because as per the abovementioned survey, nearly 6.7 percent population of the province had antigens of HCV – the biggest ratio at a provincial level. Moreover, the rate of HBV prevalence was 2.4 percent. These figures as a whole suggest that nearly 9.1 percent of the population of the province was suffering from HBV or HCV – again, the biggest for any province of Pakistan. As per the findings of the provincial Hepatitis Control Programme, at present, every 9th person in Punjab is affected with hepatitis.
When the state of affairs becomes such grave, then as per World Health Organization guidelines, there should be a robust programme in place wherein the data on the patient as well as the disease would be collected in an organized manner so as to formulate prudent control policies. In addition, the provision of facilities for the identification and treatment of the disease should also be enhanced and improved. Facilities of diagnosis, screening and treatment of this disease should also be accessible to everyone under a public approach mechanism. Moreover, there should be greater, and timely, availability of funds and modern vaccination facilities. Adopting such a broad-based strategy will help us not only in overcoming the disease but will also enable us to achieve the targets set under the SDG 3: reduce the number of deaths by 65% and increase treatment rates from 1% to 80%, saving 7.1 million lives globally by 2030.
The extremely alarming situation of the prevalence of hepatitis in Punjab warrants immediate, comprehensive steps by the government. Detailing these measures, Dr Saeeda Zahida Sarwar, Programme Manager Hepatitis Control Programme of Punjab Government’s Primary and Secondary Health Department, says that hepatitis clinics are being set up in 100 Tehsil Headquarter Hospitals (THQs) across the province where doctors and paramedics will be available to provide medical care specifically to hepatitis patients. Every patient registered with these clinics will be provided with free-of-cost tests, medicine, and vaccination. Data of the registered patients is being digitized that will help in sending medicine to the patients at their doorsteps through postal services while health authorities will also stay in touch with them. Dr Saeeda said, “We have highly effective modern medicines with a recorded success ratio of more than 95 percent. With the help of these, a patient fully recovers within a period of 3-6 months.” She further told that the Punjab government has allocated an amount of 3.5 billion rupees for providing medical facilities to hepatitis patients. Dr Saeeda further said that the process for the registration of barbers and beauticians had already started. In addition, a provincial hepatitis bill has also been submitted to the Punjab Assembly for further legislation in this regard. Furthermore, auto-destructible syringes, which cannot be re-used, are also being introduced. The government is doing so because one of the biggest factors behind the ominous spread of hepatitis is the use of needles and syringes multiple times. She stressed that extreme care is needed to avoid the use of syringes; and, if doctor thinks that administering an injection is necessary, then it must be made sure that only the new syringe is used.
This suggestion by Dr Saeeda Zahida Sarwar is highly important in the sense that the ratio of inoculation through injections is highest in Pakistan. As per a WHO research, Pakistan has the highest therapeutic use of injections worldwide i.e., 13.6 injections per person per year as against the WHO recommended 3.5 injections per person per year, and it is one of the primary causes of the rising incidence of Hepatitis B and C in the country. It must be kept in mind that more the use of injections, the more are the chances of catching blood infections. Unsafe injections, which account for nearly 5 percent of therapeutic injections, are causing a rise of 33 percent in Hepatitis B and 42 percent in Hepatitis C cases. According to World Hepatitis Alliance, nearly 8 billion injections are unnecessarily given to patients across the world. Nearly 70 percent of medicines that are administered through injections can be replaced with oral medication. Besides, there are nearly 11.8 million drug addicts in the world who use syringes to inject drugs are the ones who are in an urgent need of prevention and treatment facilities. So, a robust policy to stop the hereditary transfer of hepatitis from mother to child is the most pressing need of the hour. Hence, injections, blood transfusion and surgery must also be made safe and the number of drug addicts who use syringes must also be curbed. In addition, the facilities of diagnosis and treatment should also be increased and campaigns through social media and other mass communication mediums should be launched in order to create awareness among the masses. It is the only way to achieve the dream of a strong and healthier Pakistan.