A huge portion of Pakistan’s population continues to be crippled by diseases like cirrhosis, chronic liver disease and hepatocellular carcinoma (liver cancer), all targeting the powerhouse organ of our body: The liver.
One of the biggest culprits behind these diseases is the pathogen named as the ‘viral time bomb’ by World Health Organization (WHO), Hepatitis C Virus (HCV). It has been found that 40-50% of patients suffering from liver diseases have been infected by Hepatitis C in their lifetime. That’s an alarming percentage and should effectively associate HCV with liver diseases in our minds.
According to a National Hepatitis Survey, approximately 8 million people are living with HCV in Pakistan with Punjab having the highest percentage of reported cases. In a country with a huge disease burden and not enough health care resources to meet the required need, control of a deadly virus like HCV requires special attention. Most patients fail to get diagnosed properly and out of the ones that do, many can’t afford the treatment. The key area which needs to be focused upon in elimination of HCV from Pakistan is primary prevention. Primary prevention entails knowing about the risk factors that might predispose an individual to getting infected with HCV and protecting ourselves from them.
HCV gets transmitted through exposure to infected blood and blood products. Keeping that in view, the commonest risk factor known for the spread of HCV in Pakistan is the prescription of unnecessary injections and the reuse of syringes. Pakistan has been reported to have an average rate of nine injections per person annually. It has also been reported that people who received more than four injections per year had 11.9 times greater risk of getting infected by HCV.
With the growing trend of people visiting a general physician’s clinic and getting prescribed unnecessary injections, they are at increased risk of getting infected. Moreover, due to a lack of regulation and negligence of higher health authorities, syringes are being reused in both government and private setups leading to an increased number of new cases every year.
People here have a great affinity towards getting medical and dental procedures done cost effectively, which leads them towards inexperienced doctors and quacks. Health is greatly sacrificed in doing so as the lack of knowledge at these low cost places means no sterilization procedures and failure to comply with safety protocols. Thus, these unsafe medical and dental procedures lead to many patients coming in with one disease and leaving with an added HCV infection.
Another common risk factor for the spread is the sharing of razors by barbers. Most of the barbers as well as their customers have no awareness regarding the risk factors of blood borne diseases hence they do not take care of using new razors or sterilizing the old ones. This has lead to a much higher incidence of HCV in males than females of Pakistan.
Another source of infection is the donated blood that hasn’t been screened for HCV. Blood donors are not tested for the infection and the donated blood carries the virus to the person receiving it. There is a lack of screening protocol in Pakistan of blood donors and blood transfusion products leading to the spread of HCV.
Moving on to another source of transmission, mothers who are carriers of HCV pass it on to their newborns. These pregnant women themselves get exposed to the virus during unsterilized gynecological procedures and blood transfusions and the infection is then passed on to their child. Other less common risk factors include ear and nose piercings from unhygienic places. Sexual contact with intravenous drug users is also a risk factor as these addicts have the tendency to share needles leading to the spread of infection from one to the other.
Having enumerated the risk factors, some of the precautionary measures required at individual level is to quit compromising on health by going to quacks and unqualified doctors. People should make sure that the blood transfusions they are receiving are from an official source and has been properly screened for blood borne diseases. Affected women should be given the required treatment before planning the pregnancy and pregnant women should be screened. Barbers that do not follow sterilization or use of new razors for every customer, should be avoided at all costs. Sexual contact with an infected individual should be avoided and safe sex should be practiced. Getting ear and nose piercings from inexperienced people should be avoided. People who have been diagnosed need to seek immediate treatment. At the state level, it is mandatory for the health authorities to eliminate the unsafe injection practices and to shut down the practice of unqualified doctors around the country. Moreover, low cost but quality health care should be provided to the population so that the practice of turning to quacks is not needed. Screening of blood and blood products should be made necessary in all hospitals and the use of unscreened blood should be banned.
HCV incidence in the population can not be decreased without primary prevention and it’s the duty of every individual along with the Government of Pakistan to focus upon this dangerous endemic gripping us today.
About the Author:
The author is a fourth year medical student at CMH Lahore Medical College working as a freelance contributor keenly interested to write for raising awareness regarding medical issues.