A case-control study of risk factors associated with Hepatitis C infection among pregnant women in hospitals of Karachi- Pakistan

Hepatitis C virus infection (HCV) prevalence has increased worldwide but dramatically in developing countries including Pakistan. HCV is responsible for serious consequences owing to its high risk of chronicity potentially leading to liver cirrhosis and hepatocellular carcinoma. Protective methods, such as the use of vaccination to reduce the risk of transmission have not yet been established. A better knowledge of the risk factors of HCV transmission is needed for the adoption of preventive measures by those at risk especially implies to pregnant women because of the additional health care visits due to childbearing and risk of vertical transmission. The objective of this case control study was to identify risk factors for HCV infection among pregnant women seeking antenatal care in two tertiary care hospitals of Karachi, Pakistan. We enrolled 119 cases and 238 controls from October 2005 to February 2006. Cases were enzyme linked immunosorbent assay (ELISA) III positive for antibodies to HCV (anti-HCV), controls were anti HCV Elisa negatives. A structured questionnaire was administered to collect history of exposures to potential risk factors of HCV infection among patients, after they consented to participate in the study. Of 119 cases, 97% and of 238 controls 96% were residents of Karachi. The mean age of cases was 27 years (SD 6) ranged from 17 years to 50 years and of control was 25 years (SD 5) ranged froml5 years to 37 years. The mean number of gestation for cases was 4 (SD 3) and for controls was 3 (SD 2). Final multivariable logistic regression model revealed that after adjusting for past hospitalization history and household contact with jaundice/hepatitis, cases as compared to controls were more likely to receive on average atleast one injection (aOR=2.33; 95% CI=1.38, 3.91) in a month. Cases were more likely to have one hospitalization as compared to controls (aOR=2.03; 95% CI=1.19, 3.46) after adjusting other variables. Household contact with jaundice/ hepatitis was independently associated with HCV, as the cases were more likely to have household member who had jaundice/hepatitis previously (a0R=3.32; 95% CI=1.89, 5.83) as compared to controls. There is an urgent need to gear up activities of the hepatitis prevention and control program to reduce the transmission of HCV. Awareness interventions for injection use at practitioner and patient levels should be implemented. Health care setup needs strict compliance for the use of sterilization techniques. Further researches are required to identify factors at household level for HCV seropositivity to initiate preventive measures