Reassessment of Selected Healthcare Associated Risk Factors for Hbv and Hcv Infections among Volunteer Blood Donors, Karachi, Pakistan

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SUMMARY

Epidemiologic studies conducted in the 1990s identified several independent healthcare associated risk factors for HBV and HCV infections in Pakistan. In 2002, we re-examined healthcare associated HBV and/or HCV infection risk factors in volunteer blood donors.

In this case-control study, we collected data using a structured questionnaire on socioeconomic attributes, putative healthcare related risk factors, and other known factors for HBV and HCV infections in Karachi, Pakistan.

The multivariable logistic-regression model (166 cases, 394 controls) after adjusting for socio-demographic attributes and other known HBV and HCV risk factors revealed that more cases than controls had multiple lifetime hospitalization, adjusted odds ratio (AOR)=2.48; 95% confidence interval (CI) 1.04,5.94, and had received dental treatment from an unqualified provider (AOR=5.90, CI, 1.66,21.02). More cases than controls had received a large number of therapeutic injections during the last 5 years (1-5 injections vs. 0, AOR=2.64, 95% CI 1.06,6.60; 6-19 injections vs. 0, AOR=4.09, 95% CI 1.59,10.51; ≥20 injections vs. 0,AOR=4.34, 95% CI 1.70,11.07), and had their last injection given using a re-usable glass syringe (AOR=3.41 CI 1.13,10.29).

Our data suggest that risk factors for HBV and HCV infections identified in the last decade have remained unchanged in healthcare facilities in Karachi. Additional multi-disciplinary efforts are needed to control healthcare associated HBV and HCV transmission in Pakistan.

Key words: healthcare, hepatitis B virus, hepatitis C virus, risk factors, blood donors, developing countries, Pakistan

INTRODUCTION

Inadequate infection control practices in healthcare settings have been shown by epidemiologic investigations, to contribute significantly to the global burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. This is particularly true in developing countries around the world such as Pakistan (1-3).

Historically hepatitis has been a menace across the world without regards to geographical boundaries, socio-cultural and economic divide. Recognizing this problem, the universal guidelines for infection control were developed in late 1980s (4), and their implementation in the developed nations has led to the application of rigorous infection control practices in healthcare settings. In conjunction with quality assurance systems, higher occupational safety standards, and greater recognition of and respect for patients' rights, the universal precautions have resulted a dramatic improvement in infection control (1, 5). The situation in developing countries such as Pakistan, however, remained unchanged, as standardized infection control did not become widely implemented and/or practiced (6).

Observational studies conducted in the past decade identified parenteral exposures in healthcare settings, including the use of unsterile medical or dental equipment, and intramuscular (IM) and intravenous (TV) therapeutic injections, as major contributors to HBV and HCV infection cases in Pakistan (7-9). In Pakistan, it wasn't until mid 1990s that the efforts were initiated by public health legislators, healthcare providers, and communities towards implementation of several infection control and prevention measures to reduce healthcare associated infections including HBV and HCV An integral part of these efforts were advocacy for campaigns for HB V vaccination. (10).

Several y ears ha ve passed since initiation of these efforts that, common sense dictates, must have had some impact on practices that were previously found to contribute to spread of HBV and/or HCV infections in Pakistan. However, no or minimal efforts have been made to gauge the impact of these efforts, or to quantitatively assess the current magnitude of healthcare associated risk factors for HBV and HCV infections.

The relative importance ofthe modes of transmission of an infectious disease can change over time, particularly when rejuvenated efforts are made to control its spread. …