A case-control study of risk factors associated with serological evidence of Hepatitis C virus infection in Islamabad Rawalpindi
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Hepatitis C virus (HCV) infection is a serious health hazard in the developing countries. HCV infection often leads to fatal liver cirrhosis and hepatocellular carcinoma. In the absence of any vaccine against the HCV infection, a prevention program based on the knowledge of risk factors for HCV infection seems to be the only strategy available to control its spread. The objective of this case-control study was to identify risk factors associated with serological status of the study subjects against HCV infection in Islamabad-Rawalpindi. We enrolled 113 cases and 216 controls from various departments of the nine major hospitals of the twin cities during July-September 1998. Cases were enzyme linked immune sorbent assay (ELISA) positive for antibodies to HCV (anti-HCV), aged 20-70 years, and residents of Islamabad or Rawalpindi division. Controls essentially were anti-HCV ELISA negatives, also of the same age range and residents of Islamabad and Rawalpindi division. A structured questionnaire was administered to study subjects to collect data on demographic variables and potential risk factors, after they consented to participate in the study. Of 113 cases, 29 (25.7%) were residents of Islamabad, 52 (46%) of Rawalpindi and 23 (28.3%) of other towns. Of 216 controls, 64(29.6%) were from Islamabad, 77 (35.6%) from Rawalpindi and 75 (34.7%) from other towns. The mean (SD) age (years) for cases and controls was 44.54 (12) years and 32.31 (10) years respectively. Final multivariate logistic regression model revealed that after adjusting for age, cases compared to controls were more likely to have received injections in the past with a glass syringe (adjusted odds ratio - aOR) = 11.38; 95% CI 3.04 - 42.57). Cases were twice as likely to be hospitalized in the past (aOR = 1.97; 95% CI 1.13 - 3.43). A separate multivariate logistic regression model for males showed that cases compared to controls were significantly more likely to have had their daily facial shave (aOR = 4.31; 95% CI: 1.22 - 15.18) and armpit shave (aOR = 2.85; 95% CI: 1.26 - 6.48) done by the barbers. The male cases were also significantly more likely to have received one or more therapeutic injections in the past ten years. There is a need of strict compliance for the use of disposable syringes and needles by health care personnel. Public health education programs about the known routes of transmission including instructions to avoid facial and armpit shave from barbers by males, should be initiated to minimize the risk of acquiring HCV infection. Further studies are needed to identify risk factors for HCV infection at the household level in different communities.
Bari, A. (1999). A case-control study of risk factors associated with serological evidence of Hepatitis C virus infection in Islamabad Rawalpindi (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.