Prevalence of hepatitis B among Afghan refugees living in Balochistan, Pakistan.
OBJECTIVE
Continued civil war and political instability in Afghanistan have lead to a huge influx of refugees into the neighboring provinces in Pakistan. This study was conducted to estimate seroprevalence of hepatitis B and to identify potential risk factors for hepatitis B virus (HBV) transmission among the refugees living in the camps of Balochistan Province, Pakistan.


METHODS
A cross-sectional survey of hepatitis B surface antigen (HBsAg) was conducted during October 2003. We obtained the registration list to select families randomly from the refugee camps. A husband, wife and one of their children, selected at random, were enrolled in the study. Study subjects with positive laboratory results for HBsAg were compared with those who were negative for HBsAg.


RESULTS
Field workers interviewed 301 families with a total of 903 study subjects. Blood specimens of 75 study subjects (8.3%, 95% CI 6.6-10.3) were positive for HBsAg. There were 37 husbands (12.3%, 95% CI 7.2-14.4) and 21 wives (7.0%, 95% CI 4.5-10.6) positive for HBsAg. Out of 301 children, 17 (5.6%, 95% CI 3.4-9.1) were positive for HBsAg. Receiving more than ten injections during the previous year increased the risk of HBV infection (OR 3.5, 95% CI 1.8-6.7). A child positive for HBsAg was more likely to have a positive parent compared to an HBsAg negative child (OR 5.7, 95% CI 2.0-16.5).


CONCLUSIONS
Hepatitis B is highly endemic among Afghan refugees living in these camps. Unsafe injection practices will continue to cause a steady increase in the magnitude of this health problem until appropriate control measures are taken. The possibility of mother-to-child transmission underscores the need to include vaccination against hepatitis B as part of routine immunization in this population.
Quddus
Arshad
A
WHO, Polio Eradication Initiative, Kandahar, Afghanistan. arshadwho@yahoo.com
Luby
Stephen P
SP
Jamal
Zahid
Z
Jafar
Tariq
T
D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D007223:Infant; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010154:Pakistan / Q000208:ethnology; D012036:Refugees; D012307:Risk Factors; D018454:Spouses
D006514:Hepatitis B Surface Antigens