Prevalence of Hepatitis Infection Still Alarming

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PAKISTAN
Prevalence of Hepatitis Infection Still Alarming
By Ashfaq Yusufzai

PESHAWAR, Pakistan, June 25, 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.
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