What Factors, both Sociological and Socio-Economic, Impact upon the Prevalence and Treatment of Hepatitis C in Pakistan

by

Acknowledgement

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

Table of Contents

CHAPTER # 1: INTRODUCTION3

Background3

Aims and Objectives4

Rationale of Study5

CHAPTER # 2: LITERATURE REVIEW8

Quality of Life as a Concept9

Sick-Role13

Stigma17

Labeling Theory20

CHAPTER # 3: METHODOLOGY23

Establishing Reliability of Instruments23

Predictor Variables Measures23

Socio-Demographic Attributes23

Route of Transmission24

Disease Status25

HCV-SPECIFIC25

Pathological Measure (Severity of Disease)25

Clinical Measures26

HCV-RNA26

HCV GENOTYPE26

Treatment Status26

Study design and setting27

Data collection and serology28

Data management and analysis plan29

Ethical issues30

CHAPTER # 4: FINDINGS31

Demographic features of the study population36

Area of study population36

Accommodation37

Educational status37

Ethnic origin38

Occupation of parents38

Prior knowledge regarding Hepatitis B and C39

Risk factors39

Therapeutic injections39

Previous immunization39

Visit to the Barber in those with positive serology40

Piercing of nose and ears in those with positive serology40

Dental treatment40

Tattooing41

Health-Related Quality Of Life41

CHAPTER # 5: DISCUSSION47

Of Sociological Importance52

Conclusion56

REFERENCES58

Chapter # 1: Introduction

Background

Viral hepatitis is a major public health problem in all parts of the world. Pakistan is in the intermediate prevalence of HBV with a carrier rate of 3-4%. Chronic hepatitis B is a serious problem in Pakistan. In community-based study 31% percent had hepatitis B core antibody and 4.3% had hepatitis B surface antigen. In a previous study, the frequency of HBsAg in healthy people, 2.9% and HBs Ab 35%. Horizontal transmission, particularly in early childhood, for most cases of chronic HBV infection in the intermediate class prevalence areas such as Pakistan. Children can HBV infection through horizontal transmission through small breaks in the skin or mucous membranes or close physical contact with other children to acquire. Zuberi et al. described HBsAg prevalence of 2.5% in pregnant women and of these 17% and 61% HBeAg anti-HBe positive. Low frequency of HBsAg and HBeAg in pregnant women makes vertical transmission of less important cause of transmission.

The burden of HCV chronic liver disease (CLD) in Pakistan has increased. Previous studies have shown that of all patients with CLD was 16.6% anti-HCV-positive recent data shows nearly 60-70% of patients with CLD, usually a positive result for anti-HCV. It was shown that about 50% of patients with hepatocellular carcinoma (HCC) in Pakistan are anti-HCV-positive. Blood transfusion is still a major cause of HCV in the country as a review of blood banks in major urban centers in the country showed that only about 25% of their testing of donated blood and blood products for HCV infection in order to keep costs down. . Several studies have shown a correlation between the use of therapeutic injections with contaminated needles and transmission of HCV. There is an enormous dependence on parenteral therapy for treatment in the form of injections and infusion of drops of cultural beliefs in the power of parenteral therapy driven. Additional risk factors may be important ways of transmission are excessive use of barbers for shaving, ear piercing and non-sterile surgical and dental unskilled health care (quack) included.

The average age of development in developing countries, including Pakistan CLD is much lower compared with developed countries, suggesting that people in ...