Newly Diagnosed Hepatitis-B and Hepatitis-C during Surgical Pre-operative Assessment of Patients from Lower Socioeconomic Class; Frequency, Risk Factors and Vaccination Status

OBJECTIVE: To see the frequency of newly diagnosed Hepatitis-B and Hepatitis-C cases during pre-operative surgical assessment of patients from lower socioeconomic class and to study the possible risk factors. STUDY DESIGN: Descriptive Cross Sectional study. SETTING: Department of Surgery, Sir Syed College of Medical Sciences and Hospital, Karachi. STUDY DURATION: From July 2012 to July2013. MATERIAL AND METHODS: Total 107 patients (>= 18 years) of both genders from lower socioeconomic class planned for elective surgical procedure were included after ethical approval. Previously diagnosed cases of Hepatitis-B and C were excluded. After history and clinical examination, Hepatitis-B & Hepatitis-C serology was performed (ELIZA technique). History of blood transfusion, previous dental or surgical procedures, intravenous injections, intravenous drug abuse, tattooing, piercing, circumcision, shaving by barbers, unprotected sex and Hepatitis-B vaccination status obtained. Data was analyzed by SPSS version 17. RESULTS: Among 107 cases (42% males & 58% females) with mean age 39 +/- 14 years, HepatitisB infection was present in 6(6%) cases, Hepatitis-C in 11(10%) and Hepatitis-B and C serology was negative in 90 (84%) cases. Frequency of Hepatitis-B was 3% (in males) versus 9% (in females); Hepatitis-C 6.4% (in males) versus 15.5% (in females). Among those with Hepatitis-B or C, history of previous surgical procedure present in 47% cases (vs. 21% in Hepatitis-B and C negative cases), dental procedure in 29.4% (vs. 7.7 %), intravenous injections in 94% (vs. 43%), intravenous drug abuse in 5.8% (vs. 0 %), blood transfusion in 35% (vs. 12%), tattooing in 0% (vs. 2%), unprotected sex in 5.8% (vs. 1%), piercing in 64.7% (vs. 39%), circumcision by barbers in 83.3% of males (vs. 80%), shaving by barbers in 66.6% of males (vs. 27%). Hepatitis-B and C was found to be associated with history of blood transfusion, intravenous injections, dental procedures, shaving by barbers, piercing and intravenous drug abuse (p< 0.05). Clinical stigmata of liver disease were present in 3% cases. Among all cases 9% were previously vaccinated for Hepatitis-B. CONCLUSION: Preoperative determination of Hepatitis viral markers is a good clinical practice to limit transmission from asymptomatic carriers and to diagnose new cases. Pakistan has high prevalence of Hepatitis-B and C and poverty and low literacy rate are the main determinants of its spread. Those who are negative for Hepatitis-B should be encouraged to get vaccinated. There is need for measures to create awareness about preventive measures and affective control of transmission of Hepatitis-B and C in community as well as at health care facilities.