The theme for World Hepatitis Day this year is to “Invest in eliminating hepatitis”. This is crucial for Pakistan, where the health sector has been suffering from inadequate funding from the government. The host country for World Hepatitis Day 2019 is Pakistan. The global events will be held in Islamabad, Pakistan on 27-28 July 2019.
As of latest report substantial increase has been witnessed in the number of hepatitis cases in Punjab all due to contaminated water, unhealthy food and poor health practices. In view of this outburst in epidemic, the Dr. Khalid Mehmood, Director, Hepatitis and Infection Control has said that new central laboratories were being established for testing hepatitis A and C.
According to World Health Organization (WHO) “Viral hepatitis B and C (HBV) (HCV) affect 325 million people worldwide causing 1.34 million deaths a year. It is the second major killer infectious disease after tuberculosis, and 9 times more people are infected with hepatitis than HIV. Hepatitis is preventable, treatable, and in the case of hepatitis C, curable. However, over 80 per cent of people living with hepatitis are lacking in access to prevention, testing and treatment services.”
Pakistan has the second highest prevalence of HCV in the world. Hepatitis B and C together make 12 million infected people in the country. Transmission is primarily associated with poor infection control practices in the healthcare settings along with unabated community exposures. According to the official data close to 20 million people are unaware that they are living with the disease.
To address this major public health issue, Pakistan has developed its first “National Hepatitis Strategic Framework (NHSF) 2017-21.” The NHSF was developed with input from National and Provincial Health Departments of the country; and technical assistance of Subject Matter Experts. The NHSF is aligned with WHO Global Health Sector Strategy to eliminate viral hepatitis as a major public health threat.
The NHSF also defines the clear prevention, testing and treatment targets to achieve WHO hepatitis elimination target of 90 per cent by 2030.
The key element of NHSF prevention is focused on interventions to reduce the use of therapeutic injections, improve blood safety, and ensure proper sterilization of invasive medical devices. Pakistan has the highest number of therapeutic injections per person per year. Experts have been stressing to conduct a wide mass-screening program to ascertain the burden of the disease so that a comprehensive strategy is developed to handle the disease.
In majority of the cases injections have been considered the primary cause of the spread of hepatitis. According to a study conducted by WHO, 16 billion injections are given worldwide, out of which more than 40 per cent injections are unnecessary. The infection carried by needles are invisible to the naked eye and the poor recipients have absolutely no idea of the risks of disease transmission.
Usually people from poor economic background, with insufficient health facilities, getting unscreened blood transfusions, using intravenous drug and having minimum awareness about communicable diseases stumble upon the disease easily. In another study the risk factors for possible transmission were observed in people acquiring the services of barbers and dental surgeons using unhygienic instruments.
Therefore, prevention is the key to fight viral hepatitis.
According to WHO, 95 per cent of people infected with HCV can be cured within 2–3 months with highly effective direct-acting antiviral (DAA) drugs. On the basis of the 2015 WHO guidelines on injection safety the NHSF introduced a policy to ensure that syringes used in the health sector are auto-disabled, thus preventing the reuse of syringes and eliminating a major risk factor for HCV in the country.
The Government of Pakistan through its health facilities now provides free diagnosis, treatment, and care for patients with HCV, protecting them from considerable health costs. Furthermore, patients infected with HCV now have free access to new oral medicines. However, there are gaps in the provisions and allocation of testing facilities, kits and trained human resource.
Even though hepatitis has been one of the leading causes of deaths in Pakistan, it made no substantial effort to run sustained public awareness campaigns regarding modes of transmission, diagnosis, prevention and treatment. A vast layer of experts’ opinion do not consider impossible stemming the tide of hepatitis epidemic. Medical advances and cheaper drugs have dramatically reduced the length of treatment and risks of side effects, and improved patient outcomes, in recent years.
Meanwhile, by eradicating quackery, improving upon the quality of water being supplied and introducing a proper waste management system we can to a large extent prevent the spread of not just hepatitis but other contagious diseases like HIV. The Punjab Healthcare Commission has been striving relentlessly for the eradication of quackery from Punjab and has established standards for the proper disposal of hospital waste. Every effort of the PHC is geared towards assisting the healthcare establishments in developing a hazard free and quality healthcare system, which naturally takes care of the diseases like hepatitis.