This study evaluated risk factors of hepatitis infection among the pregnant group of females and association with the seropositivity of infection. These pregnant women had higher risk with a house hold contact, past history of admission in a hospital, past abortion and past experience of surgical intervention done. The HBV and HCV prevalence was 28.9% and 61.9% respectively with 9.5% women co-infected with both types. Hepatitis- C was more common among this vulnerable group, as compared with the other.
A recent Pakistani study on pregnant viral infections prevalence found hepatitis- B as 1.16% with highest percentage (1.69%) in the month of January whereas hepatitis- C had 1.42% with highest figures as 2.2% in the month of March in Peshawar district. Ten thousand two hundred eighty-eight pregnant women participated in this study. Although present study was not large enough to this in term of sample size plus the area, but still findings of prevalence of these infections do correlate to each other among pregnant women and same area as well 5. A Cameron based study among the pregnant women found high statistics of hepatitis- B infection, which is contrary to the present study findings 6.
A facility based study in Ghana, described high prevalence of Hepatitis- B infection i. e 7.7% among educated, unemployed and multiparous antenatal patients with no significant association of sociodemographic characteristics and hepatitis- B infection. This study recruitment protocols resembled the present study however they did not take into account the risk factors and their association which was explained clearly in the present study with significance as well 12. A retrospective Brazilian study of hepatitis screening among pregnant women, found 1.9% and 1.3% seroprevalance of Hepatitis B and C respectively. They found no significant association of age with these viral infections among pregnant females, but a high frequency of hepatitis infection according to the results. These results are not in association with the present study and further they only took prevalence whereas risk factor evaluation was missing in their study 13.
An Egyptian Case Control study of Hepatitis- B Infection calculated mean age of the study participants as 32 years and 62% males in the study contrary to the present study. Their sample size was calculated with 95% confidence interval, 80% power of the study and 1: 2 ratios among cases and controls, in association with this study. The results revealed prisons and military facilities (OR: 19.2; CI 2.7- 135.6) with increased risk of HBV infection; with intravenous drug users, contact with any hepatitis infected family member and invasive procedures exposures as risk factors. Multivariate analysis showed (OR: 19.2; CI 2.7- 135.6) in military areas; (OR = 8.7; 95% CI: 1.1–72.1) in intravenous drug users and (OR = 5.6; 95% CI: 1.1–27.2) among the persons going through unsafe invasive techniques 14.
A very unique study regarding status of HBV and HCV infection was studied in 306 transgender community of Rawalpindi with a mean age of 27 Years. The results showed predominance of HCV infection among the group with HBV as an insignificant infection. The ones who were going to Barbers were found to be 34.61% HCV positive. Bisexuality was the factor leading to sexually transmitted diseases among them, number of sexual partners with frequency of sex without safe equipment, unsafe razors used for body cleaning, low budget barber shops for hair cutting, unsafe street dentists visits, poverty, stress and economic crisis were the driving forces behind higher disease burden among these groups. The present study was similar in case of both infections and risk factors evaluated in it but completely different in the group being tested so cannot be compared with each other 15.
The prevalence of hepatitis – B infection only was studied among antenatal patients and showed high seropositivity of the infection, with older aged women as the most infected. No association of sociodemographic variables and risk factors identified with the infection revealed 16. These findings are not in association with the present study, as both infections were studied and found significant associations of risk factors with the HBV and HCV infections. Both infections when studied among pregnant women, hepatitis- B was found to be in higher prevalence as compared with hepatitis- C. Multiple sex partners (OR = 11.6; 95% CI: 5.1- 26.7; P < 0.001) was the only significant risk factor associated with hepatitis- B infection, rest were not 17. These findings are not correlated with present study because of the norms of an Islamic state and risk factors involved were different as well.
A retrospective analytical study among pregnant women of Swat, concluded HBV and HCV as the commonest infections with highest frequency of HCV in females. The recommended antenatal screening before delivery and surgical interventions. They compared HBV infection in urban (39.02%) and rural (60.98%) as well as HCV in urban (27.40%) and rural (72.60%), showing high seropositivity of HCV in rural sector. Although results correlate with the present study but it is a case control and with no comparison of urban and rural women. Re use of contaminated syringes, instruments and blood products were the listed risk factors, however present study revealed past history of infection, abortion and admission in hospital with any surgical intervention as risk factors 18. A descriptive study upon pregnant females visiting Gynaecology and Obstetrics department of Shaikh Zayed Hospital of Lahore also concluded more frequency of HCV infection in multigravida and previous exposure to surgery, blood transfusion and hospital admission were the risk factors. All the findings are in association with the present study except for the case control study design 19. Similarly, another Pakistani study at Karachi also revealed same high frequency of HCV infection in pregnant women and no association of any risk factors with the both infections. These findings recommended universal antenatal screening for the females, in order to lower down its burden. This study was similar to the present study in terms of frequency however sexually transmitted infections and delivery mode was found to be significant in the present study 20.
Limitations of the study included as under;
- It was an unmatched case control study. Although study was conducted in tertiary care hospitals, but the data cannot be extrapolated.
- A selection bias can never be excluded from such studies.
- The core antibodies were not tested, that could have an effect upon the results.