Hepatitis C: frequency and risk factors associated with sero-positivity among adults in Larkana City.

BACKGROUND: Viral hepatitis is a major public health problem. Infection with Hepatitis C virus (HCV) leads to chronicity and there are about 170 million people infected with HCV. Up to 70% of chronically infected individuals develop active liver disease. The Objective of the study was to find out the frequency of Anti-HCV seropositivity and risk factors of Hepatitis C Virus (HCV) transmission in people of Larkana city. METHOD: The study was conducted at Larkana from April 2006 to April 2007. Camps were established in the main general practitioners' clinics. A questionnaire about knowledge of HCV and risk factors of its transmission was administered to subjects. Descriptive statistics were done by SPSS-10. RESULT: Total 450 cases were enrolled into this study. They were divided into 3 age groups. Eighty-nine (19.8%) cases were in age group <20 years, 262 (58.2%) were in age group 20-40 years and 99 (22.0%) were in age group >40 years. There were 353 (78.4%) male and 97 (21.6%) female subjects, out of these 450 cases 30 (6.6%) were positive for Anti-HCV. A number of risk factors of HCV transmission were present in these cases. History of therapeutic injections was present in 72 cases and 35 cases used public barber services. CONCLUSION: History of therapeutic injections and use of barber services for shave were the most frequent risk factors in our study.

Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial.

INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described. METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis. RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year. Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A. CONCLUSION: The private sector plays a major health-care role in Pakistan. Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building. Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings.