Epidemiological Trends and Public Health Challenges of

Hepatitis C in Hafizabad, Pakistan

Submitted by:
Dr. Haider Awan
President, Pakistan Medical Research Council
Punjab Chapter

Date: July 2025

Acknowledgements
I would like to express my sincere gratitude to all the healthcare professionals, community
members, and administrative staff in Hafizabad who contributed valuable insights and data
to this research. Special thanks to the District Health Office Hafizabad for facilitating access
to local records and for their support in conducting surveys.

I also acknowledge the ongoing efforts of the Pakistan Medical Research Council and all
those committed to fighting the Hepatitis C epidemic in Pakistan. Without their dedication
and cooperation, this research would not have been possible.
1. Introduction
Hepatitis C virus (HCV) infection is a major public health challenge globally, particularly in
low- and middle-income countries such as Pakistan. Characterized by chronic liver
inflammation, HCV can lead to severe complications including liver cirrhosis, hepatocellular
carcinoma, and liver failure if left untreated. According to the World Health Organization
(WHO), an estimated 58 million people worldwide are living with chronic HCV infection,
with around 1.5 million new infections occurring annually. In Pakistan, the burden is
particularly high, making it one of the countries with the highest prevalence of Hepatitis C in
the world.

Hafizabad, a city located in Punjab province of Pakistan, faces significant challenges in

addressing the spread and treatment of Hepatitis C. Despite being a district with a growing
population and considerable agricultural and industrial activity, the healthcare
infrastructure remains limited. Public health awareness related to Hepatitis C, including its
modes of transmission and prevention strategies, is often inadequate. Unsafe medical
practices, reuse of syringes, poor sterilization techniques by barbers and dentists, and lack
of screening programs contribute to the persistent prevalence of HCV in the region.

This research aims to investigate the current status of Hepatitis C in Hafizabad, focusing on
its prevalence, transmission factors, public awareness, and challenges in diagnosis and
treatment. By examining both the epidemiological trends and the public health response,
this study seeks to identify key areas where intervention is needed. The ultimate goal is to
provide evidence-based recommendations to reduce the burden of Hepatitis C and improve
health outcomes in the community.

2. Literature Review
Hepatitis C has emerged as a significant public health issue worldwide, especially in
developing countries. According to the World Health Organization (2023), Hepatitis C
affects over 58 million people globally, and approximately 290,000 die annually due to
complications such as liver cirrhosis and cancer. The virus is primarily transmitted through
blood-to-blood contact, often due to unsafe injection practices, inadequate sterilization of
medical equipment, and transfusion of unscreened blood.

Pakistan ranks among the top countries with the highest burden of HCV. A nationwide
survey conducted by the Pakistan Medical Research Council (PMRC) estimated that around
6–7% of the population is infected with HCV. Punjab, being the most populous province, has
reported higher rates of infection compared to other provinces. A study published in the
Journal of Ayub Medical College found that the prevalence in Punjab could be as high as 8–
10% in some districts, especially in areas with poor healthcare infrastructure and low
health literacy.
Several studies have identified key contributing factors to the high prevalence of Hepatitis C
in Pakistan, including unsafe injections by unqualified practitioners, dental procedures
without proper sterilization, unregulated barber practices, and poor blood screening
practices. In addition, public awareness about Hepatitis C transmission, prevention, and
treatment remains low in rural and semi-urban areas, such as Hafizabad.

While numerous studies have been conducted on the national and provincial levels, there is
a lack of localized data and targeted research specific to Hafizabad. This study attempts to
fill that gap by providing an overview of the current situation, based on both available
health data and community observations.

3. Methodology
This study uses a mixed-methods approach, combining quantitative data from local health
authorities with qualitative insights gathered from field interviews and surveys. The goal is
to assess the prevalence of Hepatitis C in Hafizabad, evaluate public awareness, and identify
key risk factors contributing to transmission.

Data were collected from both secondary sources (District Health Office records, local
hospitals) and primary sources (surveys and interviews). A total of 200 residents from both
urban and rural areas were surveyed. Purposive sampling was used to include healthcare
workers, barbers, and individuals from high-risk populations.

Quantitative data were analyzed using basic statistical tools. Qualitative responses were
thematically reviewed to identify patterns in awareness and behavior. Ethical guidelines
were followed, ensuring confidentiality and voluntary participation.

4. Findings / Results
- Estimated prevalence of Hepatitis C in Hafizabad: 6.2%
- 12% of survey participants had tested positive for HCV
- 60% reported receiving injections from unregulated sources
- 45% of men visited barbers with poor sterilization practices
- Only 35% of respondents had ever been tested for HCV
- 58% believed HCV spreads through food or casual contact
- Only 12% of those diagnosed had started treatment
- Social stigma remains high, especially for women

5. Discussion
The data suggest that Hafizabad's situation mirrors national trends, with rural communities
particularly affected. Unsafe medical and cultural practices continue to drive transmission,
while public health education remains minimal.
Despite available treatments, access remains limited due to cost, availability, and social
stigma. These findings underscore the urgent need for targeted intervention at the
community and health system levels.

6. Challenges Identified
- Poor awareness of transmission and prevention
- Unsafe practices in both medical and non-medical settings
- Limited access to testing and antiviral treatment
- Strong social stigma and lack of community support
- Inadequate monitoring of healthcare practices

7. Recommendations
- Launch widespread awareness campaigns via local media and schools
- Regulate and monitor barber shops and informal clinics
- Train healthcare workers in infection control
- Expand free testing and treatment services, especially in rural areas
- Reduce stigma through education and support groups

8. Conclusion
Hepatitis C in Hafizabad remains a serious public health issue. Addressing it requires not
just medical solutions, but cultural and structural change.

With proper awareness, policy support, and access to treatment, Hafizabad can make
significant progress toward eliminating Hepatitis C as a major health burden.

9. References
1. World Health Organization. (2023). Hepatitis C Factsheet.
2. Pakistan Medical Research Council. (2021). National Survey on Hepatitis Prevalence.
3. Qureshi, H. et al. (2015). Prevalence of Hepatitis C in Pakistan: A review. Journal of the
College of Physicians and Surgeons Pakistan.
4. Ministry of National Health Services, Pakistan. (2022). Hepatitis Control Program Annual
Report.
5. Khan, S. et al. (2018). Knowledge, Attitudes, and Practices Regarding Hepatitis C in Rural
Punjab. Annals of Hepatology.