Prevalence of Hepatitis C and its Associated Risk Factors In Pregnant Women of Khyber Pakhtunkhwa, Pakistan

Abstract

In the present study, we analyzed the prevalence of Hepatitis C virus (HCV) infection and its associated risk factors among pregnant women in five selected districts of Khyber Pakhtunkhwa (KP), Pakistan. The prevention of this highly infectious disease that largely remains asymptomatic, and leads to serious damage during pregnancy carries a substantial socio-economic benefit for the health and welfare of this region. The sensitivity and accuracy of the real-time polymerase chain reaction (qPCR) were also evaluated in comparison with the routine diagnostic methods: Immuno chromatographic technique (ICT), and enzyme-linked immunosorbent assay (ELISA). A total of 750 blood samples from five districts of Khyber Pakhtunkhwa namely, Mardan, Kohat, Peshawar, Nowshera, and Charsadda were screened for HCV infection using a combination of three diagnostic procedures: ELISA, ICT, and qPCR. The results showed that out of the 750 blood samples analyzed, the qPCR assay could confirm the presence of HCV RNA only in 10–30% of anti-HCV-positive samples in each district, with an average of 24% in all districts. ELISA was found to be the most sensitive method for detecting anti-HCV antibodies in 70–100% of HCV-positive blood samples in each district, with an average of 92% in all districts. ICT, which detected antibodies in 27–71% of HCV-positive blood samples from different districts with an average of 44%, is clearly less sensitive than ELISA. The overall prevalence rate in the KP, with 48 of the 750 blood samples tested positive for HCV among pregnant women, was estimated to be 6.4%, which falls within the HCV prevalence range of 4.5 to 8%, reported for Pakistan. However, there was a considerable variation in the rate of HCV prevalence at the district level, which are in order of Mardan (9.33%) >Kohat (7.33%) >Peshawar (6.00%) >Nowshera=Charsadda (4.33%). Logistic regression analysis was performed to determine the association of variables of HCV prevalence, like age, education, residential status, travel to abroad, gravidity, dilation and curettage (D&C), blood transfusion, abortion, general and dental surgery, etc., in participants found to be HCV-positive. The logistic regression model was found to be statistically insignificant (χ2 (8) = 8.785, p >0.05). The model explained 49.9% (Nagelkerke R2) of the variance in HCV-positive cases and correctly classified 95.6% of them. People with a marriage duration of 11–20 years were 17.228 times likely to exhibit HCV symptoms than people in other groups of marriage duration. Illiterates were 50.850 times more likely to acquire HCV infection than people with education. Respondents with urban residential status were 5.221 times more likely to be HCV-positive. Gravidity (primigravida) was also found to have a significant impact on HCV prevalence. A history of dental surgery is likely to increase the chances of HCV-positive status by 2.657 times, whereas the use of therapeutic injections is likely to increase the chances of HCV-positive status by 4.474 times. All other variables were found to be non-significant. District wise chi-square analysis showed age, marriage duration, education, residential status, HCV-positive husband, gravidity, dilation and curettage (D&C), blood transfusion, history of abortion, general and dental surgery, ear and nose piercing, awareness about HCV, history of accident, and use of therapeutic injections to be associated with HCV infection to variable extent in different districts. Our findings of a prevalence rate of 6.4% in KP have important health implications for a large number of pregnant women and their families as most of the infected women are ignorant of HCV infection. Since most of them are asymptomatic, they tend to have normal life implying that there exists a considerable potential for the transmission of HCV to the fetus.