Strategies and Interventions for the Prevention of Hepatitis B in the Pakistani Population

Running head: SYSTEMATIC REVIEW 1
Strategies and Interventions for the Prevention of Hepatitis B in the Pakistani Population
Name
Institutional Affiliation

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The strategies and intervention effective for the prevention of Hepatitis B in the
Pakistani population: a systematic review
Abstract
Introduction. Hepatitis B is one of the sub-types of Hepatitis caused by the Hepatitis B virus.
Hepatitis B is one of the leading causes of chronic liver disease in the population. The
lifestyle has been predicted to increase the incidence and prevalence of Hepatitis B among the
citizens of Pakistani. As an important public health strategy, it’s imperative to understand the
social, economic, political and environmental dimensions impacting on the incidence,
prevalence, spread and prevention and or management of Hepatitis B in the Pakistani
population.
Methods. A systematic search of peer-reviewed literature was performed on the Pakistani
population on the percentages of incidence, prevalence, spread, lifestyle and policies of the
Pakistani population since 1968. The results were analysed and discussed to explain the
strategies and interventions that would be effective for the prevention of Hepatitis B in the
population.
Results. In the systematic review, 481 papers were reviewed and analysed of which 11 were
relevant to the strategies and interventions effective for the prevention of Hepatitis B in the
Pakistani population. Majorly, most of the papers discuss the interventions on the American
and European populations and as such, the papers were excluded in the systematic review
analysis. Mostly cross-sectional studies, the peer-reviewed papers are reports comparing the
strategies and interventions effective in populations with low and high Hepatitis B
prevalence. The peer-review papers were obtained from Scopus, PubMed and Web of
Science databases.

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Conclusion. Current studies have largely focused on developed nations and their populations
to generate strategies effective for the prevention of the spread of viral diseases such as
Hepatitis B. the studies focus on preparedness rather than primary care interventions to curb
the spread and reduce the prevalence of Hepatitis B in the Pakistani population.
Introduction
A major global disease causing most of the chronic liver disease. Hepatitis B is a
problem facing the populations in Asia, Africa and Latin America. The World Health
Organization approximates that about 2 billion human beings are suffering from hepatitis B
infection with right over a half billion people suffering from the chronic form of the disease.
In the countries endemic for the hepatitis b infection, Pakistani ranks high because of the poor
health facilities, low socioeconomic status of the population and less awareness among the
public concerning most communicable diseases Hepatitis B included.
In the studies conducted by the Pakistani Medical Research Council in determining
the prevalence for HBV infections, the study approximated the prevalence at 3.2% and
incidence rate representing new transmissions at 4.8%. According to the studies,
approximately 15 million Pakistanis were suffering from an active form of Hepatitis B
infection, which was highly attributed to the rampant use of injectable drugs in the population
using syringes. The clinical presentation of HBV infection varies among the different
individuals however, the range of clinical signs and symptoms tend to overlap among the
same individuals. The infection following hepatitis B virus follows three different clinical
courses depending on several factors in the environment or the infected person, which are:
 A carrier state that remains asymptomatic with the ability to transmit the infection
horizontally or vertically to other individuals.

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 An acute infection that is self-limited over a period of a few days to weeks, with the
infected individuals able to transmit the virus through their body fluids.
 Chronic hepatitis B infection with a fulminant liver failure clinical sequel that can
progress to liver cirrhosis or hepatocellular carcinoma.
Considering the size and population of Pakistani as a country, the information at
national level concerning the prevalence and incidence rates of hepatitis B remain very
scanty. However, studies into the field have provided for a lot of data and information
concerning the risk factors and systems in place already to curb the spread of the Hepatitis B
virus in the country and how the health policies and structures put in place increase or
decrease the awareness levels and prevalence of hepatitis B. The current systematic review of
peer-reviewed literatures therefore provides the information on the risk factors, current health
structures and policies and the lifestyle of the Pakistani population. In addition, it gives
account of how these factors together increase the spread of the infection and lastly will
provide the mitigations and solutions to intervene effectively the spread of HBV considering
the socioeconomic, political, development and financial situation of the country.
Methods
Search items
Using the PRISMA guidelines, the peer-reviewed literatures were collected for the systematic
review of the strategies and interventions that would be effective in the prevention of the
spread of hepatitis B virus in Pakistani. Using the key terms developed from the research
question(see appendix 1) and the informal pilot searches, the search design was created and
used to identify the most relevant publications. The search terms used to develop the content
of the systematic review from the online peer-reviewed literature in the databases were

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hepatitis, hepatitis B, hepatitis B prevalence, hepatitis B in Pakistani and prevention of
Hepatitis B in Pakistani.
Information sources
Four databases containing information on science were used in the search for the peer-
reviewed literature. The databases were;
 Scopus, a database that offers comprehensive information and knowledge through
articles from the fields of science, sociology and literature.
 PubMed, is a free database containing full texts articles of biomedical and life
sciences.
 Web of science, providing multiple databases through a subscription based system
concerning topics in the fields of science, sociology, arts and literature.
 Google scholar, a free search engine providing full texts of academic articles in every
field such as medicine, technology, law and humanities.
Eligibility
Publications between the years of 1968 to 2017 on the topics of Hepatitis B, Hepatitis B risk
factors, Hepatitis B in Pakistani and Intervention and prevention of Hepatitis B in Pakistani.
All these factors were reviewed as the primary peer-reviewed articles to analyse the data and
provide a discussion for the strategies and interventions effective for the prevention of
hepatitis B virus infections in the Pakistani population.
All publications available in English were systematically reviewed in this paper. I
considered and therefore analysed all the papers provided from the databases that provided

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information and knowledge on the health status of the Pakistani population in regards to
socioeconomic conditions and practices. Articles on the other sub types such as hepatitis A, C
and D were excluded however, some interventions are applicable across the same. In the
systematic review, I excluded articles and studies providing information on the clinical
progression, symptomatology and prognosis of hepatitis B infections in the general or
specific for the Pakistani population. Studies that determined the prevalence and incidence
rates among the medical professionals in Pakistani as occupational health hazards were
included in the systematic review as the focus of this article was the interventions effective in
prevention of spread of HBV. Grey literature was not searched for nor reviewed in the
systematic review however, data sources regarding the prevalence, incidence rates and
mortality rates on hepatitis B in Pakistani from the World Health Organization and the Centre
for Disease Control were included and discussed.
Selection of the study papers
A three-layer screening process was applied in the identification of the papers to be used in
this systematic review. Using the relevance criteria, the titles to the articles were vetted then
the selected papers were screened after reading the abstract for relevance to the study
question. Lastly, the quality and quantity of information provided in the remaining papers
was analysed to determine the 11 publications used in this systematic review.
Quality assessment and bias analysis
Bias was assessed using the checklist provided by the formal Critical Appraisal Skills
Programme tool and therefore due to the nature of the infections and spread, deliberately
caused infections, infections due to randomized trails and intervention studies regarding the
issues were not found as expected.
Summary measures