Prevalence studies are not always easily undertaken in the developing countries including Bangladesh due to high cost, we made efforts to prospectively estimate Prevalence of anti-HBC total positivity among a population living at Kalyanpur, a densely populated community in Dhaka, the capital city of Bangladesh.The results of our study suggest a high HBV exposure among our study population.
In this study, 384 respondents were tested for the Hepatitis B core antibody. Among them 183(47.7%) were positive and 201(52.3%) were negative. The anti HBC positive group consisted almost of equal number of male (24.2%) and female (23.4%). The prevalence of Hepatitis B core antibody (anti-HBc) was 47.7% among our study population. It was higher to that reported from previous study of healthy adult and children in Bangladesh (21.1%)16
but within the range of previous studies from selected population of Dhaka; 24.1% in non-Intravenous Drug Users (NIDUs) and 31.8% in Intravenous Drug Users(IDUs)17
; 35.2% among women at a Sexually Transmitted Disease (STD)clinic18
; 48.1% among truck drivers and helpers19
; 49.3% among women living near a truck stand20
; and 73% among Commercial Sex Workers(CSWs).21
The higher rates among our study population could be attributed to the general lack of proper health care because of deprived socio-economic status (monthly household income of US $ 50) and less public health awareness about the transmission of Hepatitis B Virus infection as well as the lack of hepatitis B vaccination in the community.
The varied prevalence of the anti HBc, a marker for exposure to HBV infection has been reported from different parts of India, ranging between 8%-18% of total donor population.22
In the study from Behrampur, Ganjam in Orissa, about 30.1% of total donations (220 of 729) was anti HBc positive indicating a very high rate of exposure to HBV infection among the blood donors from this region. Studies from other parts of India reported that the prevalence of anti HBV core antibody ranging from 21% in Kolkata (Eastern India), 20.9% in New Delhi (Northern India) to 8.4% in Chandigarh (Northwestern India).23,24
The socio-demographic analysis of the 183 responded who were positive for anti- HBc antibody showed that it had a higher preponderance in female (7.3% in males Vs 8.6% in females). A study was conducted in India by Asim et al. which showed a difference in the sero prevalence of the core antibody between the male and the female donors (19.3% Vs 18%), but as in our study, the difference was statistically not significant.25
We observed a significantly increasing prevalence of the core antibody was among young adults and middle age individuals. Almost equal percent of anti HBc positive cases was observed in the illiterate males and females. This favors horizontal transmission in early childhood as the principal mode of transmission of the virus, contrary to vertical transmission, which is popularly assumed. Similar observations have also been made in Nepal26
Overcrowding and poor levels of sanitation may be responsible for such early horizontal spread of the virus.
The risk factors for exposure to HBV as revealed by this study, include History of Dental procedure (OR .433; p
=.003), History of Blood Transfusion (OR .187; p
=.015), Ear-nose-body piercing (OR .453; p
=.044) and Circumcision by Hajam (OR .322; p
=.004).The most important risk factor for HBV as revealed by the study, include dental procedure and circumcision by Hajam who were unaware of the consequences of unhygienic and unsterilized intervention. Blood transfusion is another important risk factor for HBV transmission revealed by the study. The screening of the blood units for the core antibody adds to the cost, but it is definitely useful in reducing the residual risk of post transfusion hepatitis. The traditional practice of ear and nose piercing by women is also an important route of HBV transmission and thus extra care is warranted before one pierces a tissue.
HBV poses a huge burden on the health of Bangladeshis, being the leading cause of all forms of chronic liver diseases (CLD). HBV is responsible for 76.3% of cases of chronic hepatitis28
and 61.2% of cases of cirrhosis.29
Things have changed very little over the years, as a Bangladeshi study in 1994, found that HBV responsible for 40.5% of cases of CLD in this country.30
In India >60% of cases of CLD is due to HBV.31
The same applies to Pakistan, where HBV is responsible for 60% of cases of CLD.32
In Nepal, 60% of cases of chronic hepatitis and 40% of cases of cirrhosis of the liver are due to HBV.33
HBV also ranks the first as the cause of Hepato Cellular Carcinoma (HCC) in Bangladesh. Studies have shown that HBV is responsible for 33.3% of cases of HCC in Bangladesh.34
The intermediate rate of chronic HBV carriage of around 3% was observed in most general populations (clinics, villagers), suggesting that this population would benefit from universal hepatitis B vaccination.35
In 2004, the Government of Bangladesh and United Nation International Children Emergency Fund (UNICEF) have introduced the hepatitis B vaccine into the Expanded Programme on Immunization (EPI) against six infectious diseases. The successful continuation of the programme is expected to reduce chronic HBV infections in the next generations. Since 90% of the HBV infected older children and adults successfully clear the infection and do not become chronic carriers, the prevalence of HBsAg alone might not describe the total burden of HBV infections.
Therefore, estimation of the prevalence of anti-HBc, in addition to the estimation of the prevalence of HBsAg which is the most reliable biological biomarker of HBV infection, is much more informative about indicator of HBV disease burden among the population.
There are some limitations of our study. First, we did not perform surface Antigen tests for HBV (HBsAg) and HBV DNA the presence of which indicates current status of infection; and anti-HBs that differentiate susceptible persons from those immune persons, which can be due either to natural infection or hepatitis B vaccination. All the above limitations are mainly due to study cost constraints, mostly related to laboratory tests. The second limitation is that the study was conducted in a single population in Dhaka, and may not reflect all of Bangladesh, although the literature we have cited suggests that it should. A final limitation is the relatively short observation window, which may have missed important secular trends in the background prevalence of the hepatitis B viruses.
Based on the findings of the studyj, it may be concluded that high prevalence of Hepatitis B core antibody (47.6%) indicates that the memebers of this urban community are highly exposed to hepatitis B virus.
Authors gratefully acknowledge the financial support of the BMRC for this research work for the benefit of mass population of the country. We also thankful to the study participants for their valuable time, support and cooperation.
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