title: Epidemiologic study of chronic hepatitis B virus infection in male volunteer blood donors in Karachi, Pakistan.
abstract: BACKGROUND
  The magnitude of chronic infection with hepatitis B virus (HBV) varies substantially between the countries. A better understanding of incidence and/ or prevalence of HBV infection and associated risk factors provides insight into the transmission of this infection in the community. The purpose of this investigation was to estimate the prevalence of and to identify the risk factors associated with chronic infection with HBV, as assessed by HBV surface antigen (HBsAg) positivity, in asymptomatic volunteer male blood donors in Karachi, Pakistan.
  
  
  METHODS
  Consecutive blood donations made at the two large blood banks between January 1, 1998 and December 31, 2002 were assessed to estimate the prevalence of HBsAg positivity. To evaluate the potential risk factors, a case-control study design was implemented; cases (HBsAg positives) and controls (HBsAg negatives), were recruited between October 15, 2001 and March 15, 2002. A pre-tested structured questionnaire was administered through trained interviewers to collect the data on hypothesized risk factors for HBV infection. Sera were tested for HBsAg using commercially available kits for enzyme linked Immunosorbant assay-III.
  
  
  RESULTS
  HBsAg prevalence in the male volunteer blood donors was 2.0 % (7048/351309). Multivariate logistic regression analysis showed that after adjusting for age and ethnicity, cases were significantly more likely than controls to have received dental treatment from un-qualified dental care provider (adjusted odds ratio (OR) = 9.8; 95% confidence interval (CI): 2.1, 46.1), have received 1-5 injections (adjusted OR = 3.3; 95% CI: 1.1, 9.6), more than 5 injections (adjusted OR = 1.4; 95% CI: 1.4, 12.7) during the last five years or have received injection through a glass syringe (adjusted OR = 9.4; 95% CI: 2.6, 34.3). Injury resulted in bleeding during shaving from barbers (adjusted OR = 2.3; 95% CI: 1.1, 4.8) was also significant predictor of HBsAg positivity.
  
  
  CONCLUSIONS
  Prevalence of HBsAg positivity in the male volunteer blood donors in Karachi was 2%. Infection control measures in health-care settings including safe injection practices and proper sterilization techniques of medical instruments and education of barbers about the significance of sterilization of their instruments may reduce the burden of HBV infection in this and similar settings. There is also an urgent need of developing locally relevant guidelines for counseling and management of HBsAg positive blood donors.
authors.affiliation: Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University PO Box 24923, Safat 13110, Kuwait. saeed.akhtar@hsc.edu.kw
authors.forename: Saeed
authors.initials: S
authors.lastname: Akhtar
authors.forename: Muhammad
authors.initials: M
authors.lastname: Younus
authors.forename: Salman
authors.initials: S
authors.lastname: Adil
authors.forename: Farrukh
authors.initials: F
authors.lastname: Hassan
authors.forename: Sarffraz Hussain
authors.initials: SH
authors.lastname: Jafri
mesh_terms: D000328:Adult; D001461:Barbering / Q000706:statistics & numerical data; D001782:Blood Donors / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003729:Dental Care / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000209:etiology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D006801:Humans; D007267:Injections / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D011787:Quality of Health Care; D012307:Risk Factors; D012867:Skin / Q000293:injuries; D014950:Wounds, Penetrating / Q000150:complications
chemical_list: D006514:Hepatitis B Surface Antigens