Assessing knowledge and practices related to hepatitis c among patients in a rural community in Pakistan
Abstract
Background:Hepatitis C is a major global health problem, with a high disease burden in developing countries like Pakistan. Rural communities in Pakistan have limited awareness about hepatitis C transmission, prevention, and control. This study aimed to assess knowledge and practices related to hepatitis C among patients in the rural community of Lasi Goth, Gadap Town, Karachi.
Material and Method:A quantitative cross-sectional survey was conducted among 150 adult patients (>18 years) with known hepatitis C infection in Lasi Goth. Data was collected through face-to-face interviews using a structured questionnaire. The questionnaire captured socio-demographic information, knowledge about hepatitis C (causative agent, symptoms, transmission), attitudes towards its prevention, and related practices. Descriptive statistics were used to analyze the data.
Results:Of 150 participants, 55% were males and the mean age was 25 years. A majority (69.3%) had heard about hepatitis C, with their main sources being television (28.7%) and other people (38.7%). Knowledge regarding hepatitis C was low, with less than half being aware of the causative agent (42%) and symptoms (41.3%). Around 55% knew it spreads person-to-person, mainly by blood transmission (38%), shared razors/brushes (4.7%), injection drug use (12%), mother to child transmission (18.7%), and sexual contact (26.7%). Most (76%) believed hepatitis C was preventable through blood screening (20%), avoiding sharing razors/brushes (37.3%), and infected persons not donating blood (24.7%). Only 18% reported their families were involved in prevention efforts. A high proportion (88%) were using anti-hepatitis C drugs and 54.7% received hepatitis B vaccination.
Conclusion:Patients from the rural community had limited knowledge about hepatitis C transmission routes and prevention measures. Culturally appropriate educational campaigns are required to raise awareness in rural communities regarding risks, prevention strategies, and control of hepatitis C infection.
Keywords: Hepatitis C, Rural community, Cross-sectional study, Prevention, Pakistan
References
Organization WH. Global hepatitis report 2017. World Health Organization; 2017.
Hajarizadeh B, Grebely J, Dore GJ. Epidemiology and natural history of HCV infection. Nature reviews Gastroenterology & hepatology. 2013;10(9):553-562.
Webster DP, Klenerman P. Dusheiko GM. Hepatitis C Lancet. 2015;385(9973):1124-1135.
Razavi H, Waked I, Sarrazin C, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. Journal of viral hepatitis. 2014;21:34-59.
Umer M, Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data. World journal of gastroenterology. 2016;22(4):1684.
Achakzai M, Kassi M, Kasi PM. Seroprevalences and co-infections of HIV, hepatitis C virus and hepatitis B virus in injecting drug users in Quetta, Pakistan. Tropical doctor. 2007;37(1):43-45.
Edris A, Nour M, Zedan O, et al. Seroprevalence and risk factors for hepatitis B and C virus infection in Damietta Governorate, Egypt. East Mediterr Health J. 2014;20(10):605-13.
Khokhar N, Gill ML, Malik GJ. General seroprevalence of hepatitis C and hepatitis B virus infections in population. Journal of the College of Physicians and Surgeons--pakistan: JCPSP. 2004;14(9):534-536.
Chaudhary IA, Khan SS, Majrooh MA, et al. Seroprevalence of hepatitis-B and C among the patients reporting in surgical OPD at Fauji Foundation Hospital, Rawalpindi: Review of 5 year literature. Pakistan Journal of Medical Sciences. 2007;23(4):514.
Shah HBU, Dar MK, Jamil AA, et al. Knowledge, attitudes and practices of hepatitis B and C among barbers of urban and rural areas of Rawalpindi and Islamabad. Journal of Ayub Medical College Abbottabad. 2015;27(4):832-836.
Janjua N, Nizamy M. Knowledge and practices of barbers about hepatitis B and C transmission in Rawalpindi and Islamabad. Journal of Pakistan medical association. 2004;54(3):116.
Khan AJ, Luby SP, Fikree F, et al. Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bulletin of the World Health Organization. 2000;78:956-963.
Khalid GG, Kyaw KWY, Bousquet C, et al. From risk to care: the hepatitis C screening and diagnostic cascade in a primary health care clinic in Karachi, Pakistan—a cohort study. International Health. 2020;12(1):19-27.
Alter MJ, Margolis HS. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. 1998.
Waheed Y, Shafi T, Safi SZ, et al. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World journal of gastroenterology: WJG. 2009;15(45):5647.
Qureshi H, Bile K, Jooma R, et al. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. EMHJ-Eastern Mediterranean Health Journal, 16 (Supp), 15-23, 2010. 2010.
Launiala A. How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters. 2009;11(1).
Hasan A, Aleemuddin S, Mohib M. A Case Study of The Orangi Pilot Project-Research and Training Institute, Karachi, Pakistan. Draft prepared for a Research Project of the Max Lock Centre, Westminster University, London, UK Localizing Habitat Agenda Research Project Karachi: Arif Hasan & Associates, Architects and Planning Consultants. 2003.
Bhutta ZA, Hafeez A, Rizvi A, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. The Lancet. 2013;381(9884):2207-2218.
Janjua N, Hamza HB, Islam M, et al. Health care risk factors among women and personal behaviours among men explain the high prevalence of hepatitis C virus infection in Karachi, Pakistan. Journal of Viral Hepatitis. 2010;17(5):317-326.
Alam MM, Zaidi SZ, Shaukat S, et al. Common Genotypes of Hepatitis B virus prevalent in Injecting drug abusers (addicts) of North West Frontier Province of Pakistan. Virology Journal. 2007;4(1):1-6.
Mahmud S, Akbarzadeh V, Abu-Raddad LJ. The epidemiology of hepatitis C virus in Iran: systematic review and meta-analyses. Scientific reports. 2018;8(1):150.
Chemaitelly H, Mahmud S, Rahmani AM, et al. The epidemiology of hepatitis C virus in Afghanistan: systematic review and meta-analysis. International Journal of Infectious Diseases. 2015;40:54-63.
Mousawee SMR, Moossavi M, Bahrami A, et al. The prevalence of hepatitis B, hepatitis C and human immunodeficiency viral infections among a large population of Afghans. Hepatitis Monthly. 2020;20(7).
Janjua NZ, Kuo M, Chong M, et al. Assessing hepatitis C burden and treatment effectiveness through the British Columbia Hepatitis Testers Cohort (BC-HTC): design and characteristics of linked and unlinked participants. PloS one. 2016;11(3):e0150176.
Sostre SO, Tiu G. Strategies for treating depression in patients with hepatitis C. Current Psychiatry. 2013;12(4):33.
Hajarizadeh B, Wallace J, Richmond J, et al. Hepatitis B knowledge and associated factors among people with chronic hepatitis B. Australian and New Zealand Journal of Public Health. 2015;39(6):563-568.
Khuwaja A, Qureshi R, Fatmi Z. Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi. Eastern Mediterranean health journal. 2002;8(6):787.
Dong C, Huang ZJ, Martin MC, et al. The impact of social factors on human immunodeficiency virus and hepatitis C virus co-infection in a minority region of Si-chuan, the people's Republic of China: a population-based survey and testing study. PloS one. 2014;9(7):e101241.
Machado SM, Almeida Neto Cd, Pinho JRR, et al. Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up. Revista de Saúde Pública. 2017;51:40.
Mumtaz Z, Salway S, Bhatti A, et al. Improving maternal health in Pakistan: toward a deeper understanding of the social determinants of poor women’s access to maternal health services. American journal of public health. 2014;104(S1):S17-S24.
Chu CJ, Lee SD. Hepatitis B virus/hepatitis C virus coinfection: epidemiology, clinical features, viral interactions and treatment. Journal of gastroenterology and hepatology. 2008;23(4):512-520.
Zoratti M, Organization WH. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection: web annex 3.1: adult hepatitis C virus treatment systematic review. 2018.
CDC A. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 1998;47(RR-19):1-39.
Lim AG, Walker JG, Mafirakureva N, et al. Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis. The Lancet Global Health. 2020;8(3):e440-e450.
Lee M-H, Yang H-I, Yuan Y, et al. Epidemiology and natural history of hepatitis C virus infection. World journal of gastroenterology: WJG. 2014;20(28):9270.
Smith A, Sabidó M, Camey E, et al. Lessons learned from integrating simultaneous triple point‐of‐care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala. International Journal of Gynecology & Obstetrics. 2015;130:S70-S72.
