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Epidemiology of viral hepatitis B and C in Punjab, Pakistan: a multicenter cross-sectional study, 2017-18 [version 1; peer review: 2 approved with reservations]
July 1, 2025
Healthcare-Related Exposures
- Unsafe Injections: 60% of HBV/HCV cases are linked to reused needles .
- Dental Procedures and Surgery: Poor sterilization practices increase transmission .
- Barber Practices: Circumcision and shaving by untrained barbers contribute to 20% of infections .
Sociocultural Practices
- Hijama (Cupping Therapy): Traditional bloodletting without sterilized tools .
- Gender Disparities: Men face higher HBV risks (4.4% vs. 3.55% in women) due to occupational exposures .
Demographic Trends
- Age: HBV peaks in youth (16–30 years), while HCV dominates older adults (>61 years) .
- Geography: Muzaffargarh district has Punjab’s highest HBV (26%) and HCV (65.2%) rates .
Table 2: Key Risk Factors and Odds Ratios
| Risk Factor | Adjusted Odds Ratio (OR) | Significance (p-value) |
|---|---|---|
| Intravenous Injections | 3.2 | <0.001 |
| Barber Shaving | 2.8 | <0.05 |
| Hospitalization | 2.5 | <0.01 |
| Hijama Therapy | 1.9 | <0.05 |
Source: Multivariable analysis from Punjab clinics .
Geographical Hotspots: Mapping the Crisis
- HBV Hotspots: Muzaffargarh (26%), Rajanpur (20.3%) .
- HCV Hotspots: Shujabad (66.4%), Muzaffargarh (65.2%) .
- Rural vs. Urban: Northern rural Punjab reports 24.8% HCV prevalence, higher than central (23.1%) and southern (17%) regions .
Table 3: District-Wise Prevalence in Punjab
| District | HBV Prevalence | HCV Prevalence |
|---|---|---|
| Muzaffargarh | 26% | 65.2% |
| Shujabad | – | 66.4% |
| Rahim Yar Khan | 8% | – |
Source: Multicenter study (2017–18) .
Challenges in Diagnosis and Treatment
- Diagnostic Limitations: ELISA alone misses 20.79% of HBV cases; PCR improves accuracy .
- Cost Barriers: HCV treatment costs $1,000, but NGOs provide subsidized options at $10 .
- Awareness Gaps: 80% of infected individuals are unaware of their status .
Hope on the Horizon: The Punjab Model
Launched in 2021, the Punjab Hepatitis Control Programme aims to eliminate HCV by 2030 through:
Decentralized Care: Telehealth and rural clinics expand access .
Free Testing and Treatment: Over 250,000 treated, with 93% cure rates .
Vaccination Drives: HBV vaccination coverage improved via EPI since 2008 .
Conclusion: A Call to Action
Punjab’s hepatitis crisis demands urgent, multi-sectoral action:
Strengthen Healthcare Protocols: Enforce sterilization and safe injection practices.
Community Education: Target high-risk groups like transgender communities and barbers.
Sustainable Funding: Prioritize hepatitis programs in public health budgets.
With science-backed strategies and political will, Punjab can turn the tide against this silent epidemic.