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Saseetharran A, Hiebert L, Gupta N, Nyirahabihirwe F, Kamali I, Ward JW. Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review. BMC Infect Dis 2023; 23:866. [PMID: 38071291 PMCID: PMC10709891 DOI: 10.1186/s12879-023-08861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. METHODS A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. RESULTS There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. CONCLUSIONS This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.
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Affiliation(s)
- Ankeeta Saseetharran
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA.
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
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Hogan S, Page A, Dixit S, McBride KA. HBV prevalence in Sub-continental countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0295670. [PMID: 38064471 PMCID: PMC10707566 DOI: 10.1371/journal.pone.0295670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is a major source of disease burden worldwide, with an estimated 296 million individuals living with infections worldwide. Although vaccine programs exist to control infections, certain sub-populations around the world continue to have very high prevalence of HBV infection. METHODS A systematic search of studies of HBV published after 2010 was conducted for India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan. Each paper was independently screened for risk of bias and inclusion. Data were extracted from included studies before being analysed to estimate pooled prevalence, and to conduct sub-group analyses. Random-effects models were used for estimating summary prevalence due to a high level of heterogeneity between studies, and funnel plots were combined with Egger's test to assess publication bias. Meta-regression was conducted to investigate sources of between-study heterogeneity. RESULTS The pooled prevalence of HBV across all studies was 3% (95% CI 0.02, 0.05). For countries with multiple studies, the pooled prevalence in India was 3% (95% CI 0.02, 0.04), in Pakistan 6% (95% CI 0.03, 0.09), in Bangladesh 5% (95% CI of 0.02, 0.12), and in Nepal 1% (95% CI 0.00, 0.08). There was some evidence of publication bias, and a high level of heterogeneity across studies. Risk of bias analysis found most studies to be of fair or moderate quality. CONCLUSIONS The prevalence of HBV among countries in the sub-continent was higher than the global average, but was not as high as some other regions. Countries with greater numbers of displaced persons had higher prevalence of HBV, with a wide range of prevalence between subpopulations likely reflecting differential uptake, and implementation, of vaccination programs.
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Affiliation(s)
- Sam Hogan
- Translational Health Research Institute, Western Sydney University, Syndey, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Syndey, NSW, Australia
| | - Sameer Dixit
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - Kate A. McBride
- Translational Health Research Institute, Western Sydney University, Syndey, NSW, Australia
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Lee C, Emeto TI, Walsh N. Prevalence of hepatitis B virus amongst refugees, asylum seekers and internally displaced persons in low- and middle-income countries: A systematic review. J Viral Hepat 2023; 30:4-18. [PMID: 36357172 PMCID: PMC10100144 DOI: 10.1111/jvh.13770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022]
Abstract
Hepatitis B, caused by the hepatitis B virus (HBV), is a global public health issue that affects 290 million people worldwide. Most people with hepatitis B are in low- and middle-income countries (LMIC), where health systems and resources are often constrained. Refugees, asylum seekers and internally displaced persons (IDPs) often face barriers in seeking health care and are a priority population at risk of hepatitis B. No systematic review to date has evaluated the prevalence of hepatitis B amongst refugees in in LMIC. We undertook a systematic review of the literature identifying 28 studies addressing this topic. Though few studies on this topic exist, the available evidence suggests a high prevalence amongst refugees in LMIC, with wide variation between and within countries. Possible risk factors contributing to hepatitis B include unsafe injections, low immunization coverage, low awareness, mother-to-child transmission, and limited health services. Further study is needed to better understand the prevalence and risk factors for hepatitis B amongst refugees in LMIC, to inform public health responses. Vulnerable populations such as refugees are an important group to consider in national and global efforts to eliminate hepatitis B.
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Affiliation(s)
- Caroline Lee
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,University of New South Wales, Kensington, New South Wales, Australia
| | - Theophilus I Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Nick Walsh
- Monash University, Clayton, Victoria, Australia
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Robotin MC, Wallace J, Gallego G, George J. Hepatitis B and Liver Cancer: Community Awareness, Knowledge and Beliefs of Middle Eastern Migrants in Sydney, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168534. [PMID: 34444285 PMCID: PMC8394558 DOI: 10.3390/ijerph18168534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Chronic hepatitis B (CHB) is a significant global health challenge given an increasing morbidity and inadequate public health response, Migrant populations are primarily affected by CHB in industrialised countries, and while more than 7% of Australians with CHB were born in Africa or the Middle East, little is known of their awareness or knowledge of viral hepatitis and its impact. This qualitative study, using semi-structured interviews with Assyrian and Arabic community leaders and focus groups (FG) with 66 community members sought to identify hepatitis and liver cancer knowledge and awareness among local Arabic and Assyrian-speaking communities in Western Sydney. Interviews were thematically analysed, with findings framing the topics for the FGs which were analysed using a framework analysis. Themes identified across both methods included limited awareness or knowledge of viral hepatitis or liver cancer, stigma associated with both conditions, variable levels of health literacy and trust in medical practitioners, and fear that receiving “bad news” would deter people from seeking care. Preferred sources of health information were family doctors, family members, the internet and the ethnic media. The study gave valuable information for the design of an educational program and provided useful information for the planning of culturally appropriate hepatitis screening and treatment services for these communities.
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Affiliation(s)
- Monica C. Robotin
- School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia;
| | - Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia;
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Bundoora, VIC 3086, Australia
| | - Gisselle Gallego
- Auburn Clinical School, School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia
- Correspondence: ; Tel.: +61-2-8204-4237
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia;
- Westmead Clinical School, The University of Sydney, Sydney, NSW 2006, Australia
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Ullah N, Khan I, Kakakhel MA, Xi L, Bai Y, Kalra BS, Guanlan L, Kumar T, Shah M, Zhang C. Serological prevalence of hepatitis B virus (HBV) in Mardan district, Khyber Pakhtunkhwa, Pakistan. BRAZ J BIOL 2021; 82:e245813. [PMID: 34287527 DOI: 10.1590/1519-6984.245813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022] Open
Abstract
Hepatitis B virus infection is perilous among the five types of Hepatitis, as it remains clinically asymptomatic. The present study draws up-to-date prevalence of Hepatitis B virus (HBV) in the general population of Mardan, Khyber Pakhtunkhwa Pakistan. The blood samples from 4803 individuals including 2399 male and 2404 females were investigated. All the suspected samples were analyzed for hepatitis B surface antigen using Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and followed by Reverse transcription-polymerase chain reaction (RT-PCR). Results showed that 312 (13.00%) out of 2399 individuals contained antibodies in their blood against HBV, while among the different age groups, the highest incidences of HBV antibodies were found in the age of 21-30 groups (10.73%). Furthermore, the ICT positive samples were screened by nested polymerase chain reaction to detect the existence of active HBV-DNA. It was observed that 169 (7.04%) out of (2399) male of the total population (4803) tested was positive. On the other hand, the female 463 (19.25%) possessed antibodies in their blood against HBV. Accumulatively, our results showed a higher percentage of HBV prevalence in males than females in the age group 21-30 years. The total HCV infected in Mardan general population was recorded at 5.7% comprising both male and female.
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Affiliation(s)
- N Ullah
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - I Khan
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - M A Kakakhel
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - L Xi
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - Y Bai
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - B S Kalra
- Virtual University of Pakistan, Department of Bioinformatics and Computational Biology, Lahore, Pakistan
| | - L Guanlan
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
| | - T Kumar
- State Key Laboratory of grassland Agro-ecosystem, Key Laboratory of Grassland, Livestock Industry Innovation, , Collage of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou, Gansu, China
| | - M Shah
- University of Swat, Centre for Animal Sciences & Fisheries, Charbagh, Pakistan
| | - C Zhang
- Lanzhou University, School of Life Sciences, MOE Key Laboratory of Cell Activities and Stress Adaptations, Lanzhou, Gansu, China
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Anwar F, Khan M, Salman M, Ahmad S, Abdullah, Ullah F, Khan J, Haq I, Abbas M. Seroprevalence of hepatitis B virus in human population of district Buner Khyber Pakhtunkhwa Pakistan. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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National prevalence rate of hepatitis B and C in Pakistan and its risk factors. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-019-01081-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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8
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Butt N, Ali Khan M, Haleem F, Butt S, Reema S, Qureshi T, Abbasi A. Epidemiology, Clinical Characteristics, and Management Status of Hepatitis B: A Cross-sectional Study in a Tertiary Care Hospital at Karachi, Pakistan. Cureus 2019; 11:e3880. [PMID: 30899631 PMCID: PMC6420331 DOI: 10.7759/cureus.3880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection is a serious health problem in Pakistan. In view of the serious socioeconomic consequences, identifying patient characteristics and the current treatment for the disease will enhance HBV regulation and its medical management. Aims To describe the epidemiology, clinical characteristics, and current management status of patients infected by HBV. Methods We undertook an observational, cross-sectional, and epidemiological study at the Jinnah Postgraduate Medical Centre, Karachi, during the period from January 2014 to November 2017. Male and female patients of any age and with documentation for an HBV infection were eligible for inclusion in the study. An HBV infection was defined as a positive hepatitis B surface antigen test. Results A total of 500 patients were analyzed. The mean age at presentation was 29.86±13.68 years. The majority of the patients (25.6%) were ethnically Sindhi followed by Pathan (24.4%), indicating a high prevalence among the rural-based population of Pakistan. The mean duration of the disease was 3.51±4.46 years. The most common cause for the spread was positive family history (40.4%) followed by roadside barbers (30.0%). Most patients were Child-Pugh (CP) class A (84.6%) and the median Modified End-Stage Liver Disease (MELD) score was 7. Upper gastrointestinal bleeding was the most frequent hepatic complication (6.2%). Antiviral medications had been received by 18.6% of patients previously. Peg-interferon (6.0%) was the major antiviral medication prescribed to treatment-experienced patients. Conclusions This observational, real-life study has identified some gaps between clinical practice and guideline recommendations in Pakistan. To achieve better health outcomes, several improvements, such as disease monitoring and optimizing antiviral regimens, should be made to improve disease management.
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Affiliation(s)
- Nazish Butt
- Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - M Ali Khan
- Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Farhan Haleem
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Sehrish Butt
- Biomedical and Biological Sciences, Dow University of Health Sciences, Karachi, PAK
| | - Sehrish Reema
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Talha Qureshi
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Amanullah Abbasi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Khan NU, Zalan A, Petruzziello A, Ud Din I, Haq F, Hayat Y. Determining the Actual Prevalence of Hepatitis B in Khyber Pakhtunkhwa-Pakistan: A Meta-Analysis. Open Virol J 2018; 12:33-41. [PMID: 29576813 PMCID: PMC5848220 DOI: 10.2174/1874357901812010033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/26/2017] [Accepted: 12/28/2017] [Indexed: 02/07/2023] Open
Abstract
Background: Hepatitis B is considered the most dangerous among the five types of Hepatitis, as it is clinically asymptomatic. It can silently damage the liver over many years without being diagnosed. Hepatitis B is one of the top risks of liver complications in Khyber Pakhtunkhwa (KP), a province of Pakistan, with an average prevalence rate of 2.70%. Aims: We aimed to carefully review the previously published data on prevalence of Hepatitis B Virus (HBV) in KP-Pakistan and use the statistical approach to obtain more precise estimate of the prevalence of HBV in KP-Pakistan. This study on one hand will provide a more reliable and consolidated estimate (pooled estimate) of HBV in the stated region, on the other hand, it enabled us to judge the heterogeneity among the estimates found from these studies. The study is intended to provide more authentic prevalence record and help government/ non-government organizations and health professionals, which plan to initiate HBV prevention programs in KP-Pakistan. Methods: A meta-analysis was performed based on studies found in literature search from electronic databases and bibliography on the prevalence of HBV in KP-Pakistan from 2007 to 2017. Abstracts and results of twenty papers were thoroughly studied and the data were extracted. The findings from these studies were distributed in two groups (general and population at high risk) constituting 15 and 5 studies respectively. Results: The combined prevalence by considering random model for the general population of KP-Pakistan was observed to be 2.71%, while population at high risk was reasonably high i.e. 5.64%. By comparing this prevalence rate to the highest global prevalence of HBV in the adult population of Western Pacific Region (6.2%), significant (p-value= 0.000) heterogeneity was observed among the estimates in each group. However, the funnel plot provides a symmetric look, eliminating the effect of publication bias. We can say that HBV has an alarming prevalence rate in KP-Pakistan. However, HBV is thrice more prevalent in male population of KP-Pakistan than the female population. Conclusion: The above results lead that HBV infection has reached an alarming state in KP-Pakistan, though projects like Prime Minister’s Program for Prevention & Control of Hepatitis which are contributing in improving the health of the people of KP by trying to prevent and control the incidence of HBV. More massive vaccination and awareness programs should be initiated to prevent the spread of HBV on urgent basis. Provision of diagnostics and treatment facilities against HBV in healthcare units of KP-Pakistan should be assured.
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Affiliation(s)
- Najeeb Ullah Khan
- Institute of Biotechnology and Genetic Engineering (Health Division), The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Ali Zalan
- Institute of Biotechnology and Genetic Engineering (Health Division), The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Arnolfo Petruzziello
- Virology and Molecular Biology Unit "V. Tridente", Istituto Nazionale Tumori - Fondazione "G. Pascale", IRCCS Italia, Naples, Italy
| | - Iftikhar Ud Din
- Department of Mathematics, Stats & Computer Science, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Fazle Haq
- Department of Mathematics, Stats & Computer Science, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Yousaf Hayat
- Department of Mathematics, Stats & Computer Science, The University of Agriculture Peshawar, Peshawar, Pakistan
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Khalil AT, Ali M, Tanveer F, Ovais M, Idrees M, Shinwari ZK, Hollenbeck JE. Emerging Viral Infections in Pakistan: Issues, Concerns, and Future Prospects. Health Secur 2017. [DOI: 10.1089/hs.2016.0072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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11
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Arain SQ, Talpur FN, Channa NA, Ali MS, Afridi HI. Serum lipid profile as a marker of liver impairment in hepatitis B Cirrhosis patients. Lipids Health Dis 2017; 16:51. [PMID: 28249586 PMCID: PMC5333387 DOI: 10.1186/s12944-017-0437-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic HBV infection is a major cause of Cirrhosis and an important risk factor to develop hepatocellular carcinoma. The study is conducted to find out the changes in the lipid metabolism of HBV-cirrhosis patients. METHODS In the present study, serum lipid profiles of patients with HBV-cirrhosis were assessed by utilizing micro-lab and gas chromatography, while risk factors for transmission of HBV-cirrhosis studied through the standard questionnaire. RESULTS The epidemiological and etiological risk factors strongly associated with HBV-cirrhosis patients compared to controls, included as family history, shave from the barber, blood transfusion (without proper screening), mutual sharing of household contents, positive surgery history, and dental treatment. The HBV-cirrhosis patients have significantly lower level (p < 0.001) of lipid profile including total cholesterol (96.65 mg/dl), TAG (82.85 mg/dl), VLDL-C (16.57 mg/dl), LDL-C (68.27 mg/dl), HDL-C (27 mg/dl) and total lipid (424.76 mg/dl) in comparison to controls, indicating hypolipidemia in patients. The MELD score indicated mild prognostic values of the hepatic function for the study group. The result of total fatty acid composition of HBV-cirrhotic patients with comparison of control subjects reveals that palmitic (24.54 g/100 g) and palmitoleic acid (4.65 g/100 g) were significantly (p < 0.05) higher whereas eicosatrienoic (0.09 g/100 g), arachidonic (3.57 g/100 g), linoleic (22.75 g/100 g) and α-linolenic acid (0.12 g/100 g) were significantly lower. Marker for stearoyl-CoA desaturase (SCD = ∆9-desaturase) activity i.e. palmitoleic: palmitic (0.2) and oleic: stearic acid (1.5) ratios, originated higher in HBV-cirrhotic patients, while PUFA: SFA (0.6) was lower in HBV-cirrhosis patients as compared with control subjects. The serum SFA and MUFA were increased while PUFA were reduced in both total and free form. CONCLUSION Present study concluded that hypolipidemia observed in HBV-cirrhosis patients, MELD were found to be independent predictors of survival and alteration in fatty acid composition, possibly due to impairment in fatty acid metabolism by enzymatic elongation and desaturation.
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Affiliation(s)
- Sadia Qamar Arain
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, 76080, Pakistan.,Institute of Biochemistry University of Sindh, Jamshoro, Pakistan
| | - Farah Naz Talpur
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, 76080, Pakistan.
| | | | | | - Hassan Imran Afridi
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, 76080, Pakistan
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Prevalence of Blood-Borne Viruses in Health Care Workers of a Northern District in Pakistan: Risk Factors and Preventive Behaviors. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:2393942. [PMID: 27525015 PMCID: PMC4976191 DOI: 10.1155/2016/2393942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/20/2016] [Accepted: 06/19/2016] [Indexed: 11/20/2022]
Abstract
Background. Blood-borne viral infections like viral hepatitis are highly prevalent in Pakistan. There is also a potential threat of human immunodeficiency virus (HIV) spread in the country. Health care workers (HCWs) are a high risk population for acquiring such viral infections and potential spread to the patients. This study aimed to determine the frequency of three blood-borne viruses: HCV, HBV, and HIV in HCWs of district Malakand in northern Khyber Pakhtunkhwa (KPK) province of Pakistan. Moreover, risk factors and preventive behaviors among HCWs were investigated in detail. Materials and Methods. Prevalence was investigated using serological assays followed by real time polymerase chain reaction (RT-PCR) based characterization. A total of 626 health care workers working at 17 different health care units, belonging to 6 different job categories, were included in this study. Results. HIV was not detected in the HCWs while rate of prevalence of HCV and HBV was far less (0.8 % and 0.64 %, resp.) as compared to general population (4.7%–38%). The majority of HCWs were aware of the mode of spread of these viruses and associated risk factors. Needle stick injury was found to be the most important risk factor for possible acquisition of these infections.
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Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepatogastroenterol 2016; 6:70-81. [PMID: 29201731 PMCID: PMC5578565 DOI: 10.5005/jp-journals-10018-1172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022] Open
Abstract
Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies. How to cite this article Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):70-81.
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Affiliation(s)
- Amna Subhan Butt
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Sharif
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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14
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Prevalence of hepatitis B virus in the Kurram Agency, Pakistan: A 5-year observational study in a war-affected region. J Clin Virol 2016; 82:17-19. [PMID: 27393939 DOI: 10.1016/j.jcv.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatitis B is an inflammatory liver illness caused by the hepatitis B virus. The exact magnitude and extent of the hepatitis B virus in Pakistan is still unknown, but at least 10 million people are estimated to be infected with chronic hepatitis B virus. OBJECTIVES The objective of this study was to determine the seroprevalence of hepatitis B surface antigen (HBsAg) in the war-affected area since 2009. STUDY DESIGN Observational study. RESULTS A total of 4922 healthy subjects were tested for the detection of HBsAg during 2009-2013, and 14.95% subjects were found to be reactive for HBsAg. The highest seroprevalence (26.0%) of HBsAg was found in those individuals who were less than 35 years of age. Male subjects were more affected (16.6%) than females. The seroprevalence of HBsAg was significantly associated with <35 years of age and male gender (P<0.005 for both). Moreover, an increasing trend over 5 years was observed, as 8.6% subjects were positive for HBsAg in 2009 and subsequently 10.4% in 2010, 14.6% in 2011, 18.9% in 2012, and 21.7% were reactive for HBsAg in 2013. CONCLUSION This study concluded that HBsAg was more prevalent in the war-affected region. The prevalence rate was increasing with time as the highest rate was found in 2013. Present observations will help to provide the background for awareness and bring the increasing levels of hepatitis B to the attention of health professionals and government authorities in order to increase the capacity of the health systems in such troubled areas.
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Sami SM, Salama II, Elmosalami DM, Abdel-Latif GA, Abdel Hamid AT. Knowledge of and risky behaviours towards hepatitis B virus infection among Egyptian school children. Arab J Gastroenterol 2015; 16:94-8. [PMID: 26454553 DOI: 10.1016/j.ajg.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/01/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND STUDY AIMS Success in the prevention of hepatitis B virus (HBV) depends to a large extent on the adolescents' HBV knowledge and their risky behaviours. This study aims to assess the knowledge of and the risky behaviours towards HBV among school students and to determine the significant predictors affecting their knowledge. PATIENTS AND METHODS A cross-sectional study was approved in four Egyptian governorates (Dakahleya, Gharbeya, Cairo, and Beni-Suef) on 574 students aged 11-17years. A questionnaire was filled through a face-to-face interview to collect data about the socio-demographic character, HBV knowledge, and risky behaviours among children who were chosen for this study. RESULTS While 75% of students had poor levels of HBV knowledge, 1.7% had good levels of knowledge. As regards gender, more than 60% of students shared scissors and went to dental clinic with no significant difference. While boys reported a significant history of hospitalisation (50.2%) and wound stitches (36%), girls reported a lesser degree of the same (40.2% and 22.6, respectively), p<0.01. During logistic regression analysis, the most important predictors of poor HBV knowledge were age <15years and living in Cairo governorate, with adjusted odds ratio (AOR) 1.5 and 5.0, respectively. CONCLUSION The majority of students chosen for the study had low levels of knowledge and high risky behaviours towards viral hepatitis. In order to minimise the risky behaviours among adolescents, health education programmes should be conducted concerning the mode of transmission and prevention of viral hepatitis.
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Affiliation(s)
- Samia M Sami
- Child Health Department, National Research Center, Cairo, Egypt
| | - Iman I Salama
- Community Medicine Research Department, National Research Center, Cairo, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department, National Research Center, Cairo, Egypt.
| | - Ghada A Abdel-Latif
- Community Medicine Research Department, National Research Center, Cairo, Egypt
| | - Amany T Abdel Hamid
- Community Medicine Research Department, National Research Center, Cairo, Egypt
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Ibrar M, Rauf A, Ben Hadda T, Mubarak MS, Patel S. Quantitative ethnobotanical survey of medicinal flora thriving in Malakand Pass Hills, Khyber Pakhtunkhwa, Pakistan. JOURNAL OF ETHNOPHARMACOLOGY 2015; 169:335-346. [PMID: 25952168 DOI: 10.1016/j.jep.2015.04.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 06/04/2023]
Abstract
STUDY OBJECTIVE Ethnobotanical knowledge is proving to be invaluable for drug discovery in the wake of effective prospecting from biodiversity. On the other hand, the escalating human pressure is threatening the endogenous flora. Situated at the foothill of the Himalayas, Pakistan boasts of rich floristic distribution. However, many lush yet imperiled regions of this country has never been explored. It inspired us to evaluate and document the taxonomic composition, significance of medicinal plants and associated traditional knowledge in the District of Malakand, Khyber Pakhtunkhwa Province. MATERIALS AND METHODS Vegetation growing in Malakand pass hills, Pakistan was studied and data were collected using an open-ended questionnaire, in addition to interviewing the local elderly, knowledgeable persons, and herbal practitioners. Relative Frequency Citation (RFC) and Use Value (UV) of the medicinal plants were calculated and their correlation was determined by Pearson correlation coefficient. RESULTS This study encompasses 92 plant species belonging to 56 families thriving in the study area. The information gathered includes ethnobotanical inventory and their pharmacological uses. Quantitative analysis throws light on the consistence of RFC and UV. Asteraceae and Lamiaceae were the most abundant families represented by 6 species each. Shoots were the most used parts (23.6%) and wound healing (7.91%) was the most common therapeutic use. CONCLUSION The result obtained from the study implies that local inhabitants rely on these plants for their medicinal requirements. Also, the statistics reveal that, the vegetation can be assessed for potential drug leads. However, urban expansion is threatening the existence of indigenous flora and old generation with ancient herbal wisdom is perishing. So, it appears imperative to preserve the traditional knowledge. This survey is expected to contribute to the discovery of novel bioactive constituents, stimulate conservation efforts of the perturbed flora and promote sustainable exploitation of the medicinal bounty.
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Affiliation(s)
- Muhammad Ibrar
- Department of Botany, University of Peshawar, Peshawar 25120, Pakistan
| | - Abdur Rauf
- Institute of Chemical Sciences, University of Peshawar, Peshawar 25120, Pakistan.
| | - Taibi Ben Hadda
- Laboratoire Chimie Matériaux, FSO, Université Mohammed Ier, Oujda 60000, Morocco
| | | | - Seema Patel
- Bioinformatics and Medical Informatics Research Center, San Diego State University, San Diego 92182, USA.
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Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vaccin Immunother 2014; 8:293-301. [DOI: 10.4161/hv.19003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pourkarim MR, Vergote V, Amini-Bavil-Olyaee S, Sharifi Z, Sijmons S, Lemey P, Maes P, Alavian SM, Van Ranst M. Molecular characterization of hepatitis B virus (HBV) strains circulating in the northern coast of the Persian Gulf and its comparison with worldwide distribution of HBV subgenotype D1. J Med Virol 2014; 86:745-57. [PMID: 24532489 DOI: 10.1002/jmv.23864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 12/17/2022]
Abstract
Iran is a large country that covers the northern coast of the Persian Gulf. Iranian residents of this coastal region interact closely with people from neighboring countries because of historical and cultural relationships, as well as economic activities. In addition, the inhabitants of this border region have experienced several wars, which have affected public health infrastructures. This study characterized for the first time, the evolution of the full-length genome of HBV strains in asymptomatic carrier patients living in this particular region. In addition, this study was compared and complemented by a comprehensive evolutionary analysis of the worldwide geographical distribution of HBV subgenotype D1. Evolutionary analysis demonstrates that patients living in the northern coast of the Persian Gulf are mainly infected with HBV subgenotype D1, subtype ayw2. Specific mutations related to advanced liver disease were found more frequently in these strains compared to other strains isolated from asymptomatic carriers from other regions of Iran. This global comprehensive analysis showed that HBV subgenotype D1 strains have a worldwide distribution and that human mobility and immigration had a large impact on dispersal of HBV subgenotype D1, subtype ayw2 in Middle Eastern countries such as Iran, Syria, and Turkey. In addition to association of subtype ayw2 with subgenotype D1, it was demonstrated that other HBV subtypes like adw2, ayw1, and ayw3 are associated with HBV subgenotype D1 in different regions of the world. This study also revealed a remarkable distribution of subgenotype D1, subtype ayw4 although this particular subtype is associated with subgenotype D4 of HBV in European countries.
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Affiliation(s)
- Mahmoud Reza Pourkarim
- Department of Microbiology and Immunology, Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium; Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Prevalence of HBV infection in suspected population of conflict-affected area of war against terrorism in North Waziristan FATA Pakistan. INFECTION GENETICS AND EVOLUTION 2012; 12:1865-9. [DOI: 10.1016/j.meegid.2012.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/05/2012] [Accepted: 07/13/2012] [Indexed: 11/18/2022]
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Cremin S, Menton JF, Canier L, Horgan M, Fanning LJ. The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts. Hum Vaccin Immunother 2012; 8:916-20. [PMID: 22777095 DOI: 10.4161/hv.20122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
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Affiliation(s)
- Suzanne Cremin
- STI Clinic, Infirmary, South Victoria University Hospital, Cork, Ireland.
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