HEPATITIS IS A SILENT KILLER IN PAKISTAN.



HEPATITIC LIVER



A person may have hepatitis virus while not being aware of it as sometimes in the case of HBV infection, the primary cause of the disease, has no symptoms at all. The newborns are at particular risk as they can get HBV at birth. The failure of the government to include hepatitis B in the immunization programme and the absence of creating the public awareness that the situation demands, is putting millions of new born at high risk. This is more fearful as Pakistan already has a high infant mortality rate of 88 per 1000 and under-five mortality rate of even higher as 123 per 1000. While children are at particular risk, the huge majority of adult population is also at the risk due to lack of public awareness in Pakistan. Even the medical profession, which should have played its due role to create the public awareness, has failed to fulfil its obligations to a great extent. For instance, a fairly educated father of a new born baby was given a vaccination card by the doctor at the clinic where his son was delivered. While the card listed six fatal diseases— poliomyelitis, neo-natal tetanus, pertussis, diphtheria, tuberculosis and measles, included on the Extended Programme of Immunization (EPI) of the government, it only mentioned hepatitis B vaccination as optional. This is also the case with the majority of the maternity hospitals as the government has not officially included the hepatitis B vaccination in the EPI. The majority of population, not only the vast number of illiterates but also many in the fairly educated group, are thus unaware that hepatitis B vaccination is no more optional but a must. The mass unawareness and the lack of concern on the part of the government are putting the lives of the majority of newborns at grave risks. Sources in the medical profession, who chose to remain anonymous, blamed the indifference of the government to include hepatitis B in the national immunization programme on account of non-allocation of funds. As is, the health sector has been allocated a meagre Rs 2.7 billion in the Budget 1999-2000 which translates into just 2.3 per cent of the funds allocated for the development expenditure only a part of which will go the existing EPI. Sources blamed the reluctance on the part of the government to officially include the hepatitis B in the national immunization programme as it would mean making provisions for funds. As hepatitis B vaccination is fairly expensive the inclusion would mean an allocation of Rs 3.25 billion to vaccinate about 5 million babies every year. However, the economic justification is medically and morally unacceptable as it put the lives of babies at great mortal risk. The cost of hepatitis B vaccination, which is administered in three doses over two months, is high for a poor country like Pakistan where many find it unaffordable. Unlike developed countries where hepatitis vaccines cost no more than buying a bottle of mineral water in a restaurant, the cost of the vaccination in Pakistan, which is totally dependent on imported vaccine, is highly expensive. Hepatitis B vaccination in Pakistan costs Rs 645 for children and almost Rs 1,100 for adults for all three doses. While the government has chosen not to play a role in the vaccination of hepatitis B, the Pakistan Medical Association (PMA) has been trying to create public awareness on the issue for the last two years. However, it was only recently that the PMA initiated a media campaign to set up hepatitis B vaccination centres in the country.

The PMA has established 12 centres in Karachi offering hepatitis B vaccination for both, adults and children, at a ‘discounted rate’. PAGE visited one of the twelve centres, at PMA House, on two consecutive days and found not a single administration of the vaccination. The attendant, however, claimed that the campaign, started two weeks ago (to end on August 15), vaccinated some 30-35 persons per day initially and some 65 persons a day in its finishing phase. Half of those administered vaccination were children, he added.

The multinational pharmaceutical company, SmithKline Beecham, is providing the hepatitis B vaccine, imported from its parent company in Belgium, at a discounted rate for the PMA campaign. Beecham is providing the two dosages of the Vaccine— 10 mcg for person’s up to 19 years of age and 20 mcg for all those above— at four per cent discount. While the vaccine is available for Rs 205 and Rs 340 at the designated vaccination centres as compared to Rs 214 and Rs 354 in the open market, the centres does not charge for disposable syringes and the fee, a saving of about Rs 30. Sources told PAGE that while the PMA awareness drive, over the last two years, has been able to create a greater awareness about the hepatitis B, much remains to be done as not even one per cent population of Pakistan is vaccinated against the deadly disease. Though the awareness has grown somewhat in the urban centres, the bulk of population still remains oblivious to the risk that hepatitis B poses to their health. The situation in the rural areas, which houses the majority of Pakistan’s population, is worse.

Even in the urban centres, such as Karachi, the campaign has elicited diametrically opposite response from basically two segments of the populace, those who can afford it and those who cannot. Sources told PAGE that the lower income group has shown much greater interest in the campaign as compared to those who could easily afford it. However, despite the overwhelming response the former are finding it difficult to afford. On the other hand only a small portion of those who can afford it, has chosen to get vaccinated, PAGE was informed.

HEPATITIS CAN BE PREVENTE AND CONTROL IF…

1. Government should established Screening / diagnosis centres for hepatitis at Teaching & DHQ level Hospitals free of cost, that every one 
2. Government and NGOs provide Counselling and treatment facilities of chronic liver diseases at Provincial, District and Tehsil level hospitals in a phased manner.
3. Establishment of Reference water quality control laboratories at National institute of health (NIH) and at Provincial level.
4. Improvement of health care provider’s knowledge for prevention of Hepatitis through focus on injection safety.
5. Safe blood transfusion practices.
6. Hospital Waste Management System.
7. Introduction of lab based surveillance system for evidence based policy decisions and creating opportunity for epidemiological research studies mainly community based and establishment of provincial satellite offices of the Provincial Coordinator.
8. Advocacy and Behaviour Change Communication (BCC) Strategy development and execution on persistent basis for prevention of Hepatitis by creating awareness among general masses for adoption of healthy practices.
9. Strengthening of routine immunization services of Hepatitis B vaccine for infants through provision of immunization against Hepatitis B in children below one year of age by using Expanded Program of immunization infrastructure.
10. Reduction of vulnerability to Hepatitis in medical staff of public sector and other High Risk Group.

In addition to receiving vaccinations against hepatitis A and B, here's how to protect yourself against hepatitis virus infection:

Ø  Don't have unprotected sex.

Ø  Avoid intravenous drug use and sharing of drug paraphernalia.

Ø  Wash your hands before handling food and after using the bathroom.

Ø  Be sure tattoo or piercing shops sterilize needles and other equipment properly.

Ø  Don't share toothbrushes or razors. Hepatitis can be transmitted through sores or cuts.

Ø  Avoid eating raw shellfish (such as clams or oysters). You could put yourself at risk for hepatitis A if the shellfish was harvested from contaminated water.

Ø  Hepatitis infection can be serious, but knowing what puts you at risk can help protect you.