In the present study we have attempted to evaluate the effects of the earthquake of 2005, in the afflicted community residing in the Northern areas of Pakistan. We analyzed the prevalence, and any potential rise thereof following the disaster, of blood borne infections in the earthquake-afflicted communities HIV and HCV infections were used as indicators of blood-borne infections. We report here that no cases of HIV were found in the earthquake-affected areas immediately or 11 months following the disaster. We, however, recorded a 3.26% prevalence of HCV in the same population immediately following the disaster. Slightly higher (5.51%), albeit statistically non-significant, prevalence of HCV was recorded 11 months after the disaster.
Disasters are considered a major public health concern. They may cause an unexpected number of deaths, injuries, or illness in the affected community; may destroy local health infrastructures, or have adverse effects on the environment and the population, increasing the potential risk for communicable diseases and environmental hazards that will increase morbidity, premature death, and diminished quality of life in the future [14
The October 8, 2005 Kashmir earthquake caused massive devastation and a considerable loss of human life. The healthcare services were hit particularly hard, with most of the hospice centers being either completely destroyed or seriously damaged. The affected population comprised mainly rural inhabitants, where health facilities were already lacking [23
]. The quality of healthcare provided to the earthquake affectees was severely compromised. It has been reported that, the seven major hospitals in the area, only three had a functional blood transfusion service [25
]. Quality assurance was very much lacking. Therefore, the risk of transmission for blood-borne infections in the after-care became an imminent threat.
Prevalence of Hepatitis C and HIV for the Northern parts of Pakistan is relatively unknown. No study has been conducted in the earth-quake affected region that gives us an idea of the status-quo regarding these two infections in particular, and blood-borne infections in general. Therefore, we undertook to investigate the baseline prevalence of these infections and then chart out any change that could be a potential consequence of the earthquake.
The reported Hepatitis C seroprevalence in Pakistan, determined from a sample over 47,000 individuals from the city of Islamabad, has been estimated 5.31% [26
]. The only serological study in this direction, published in 2002, that involved the Northern areas of Pakistan revealed that 4% of healthy voluntary adults were positive for anti-HCV antibodies [27
]. This issue is important because the risk factors for the spread of blood-borne infections are more common in the rural, under-developed Northern areas. The situation concerning HIV is also very similar. After the incidence of isolated outbreaks amongst the high-risk populations beginning in 2004, the need for demographic surveys has become all the more critical in Pakistan [28
]. The only survey conducted amongst the people of the Northern areas reports the HIV sero-positivity 0.007% [27
The purpose of this study was to establish a baseline first for the prevalence of Hepatitis C and HIV in the earthquake-affected population. Our analysis of the first batch of sampling revealed 3.26% of the population positive for HCV antibodies, and none for HIV. This incidence for HCV does not vary much from that reported earlier for other areas of Pakistan. The risk factors for the spread of HCV in this region; including unsafe injection practices, poverty, low literacy rate and poor health-seeking behavior have been charted out in the past [30
]. The prevalence of HCV, therefore, was anticipated in these communities even before the advent of the earthquake.
We found no HIV prevalence in the second batch of samples collected 11 months after the earthquake, but the percentage of HCV positive samples was still found to be 5.51%. This rise in HCV prevalence was, however, not found statistically significant.
Pakistan has not as yet started experiencing the HIV epidemic [31
]. Risk factors for HIV spread, particularly unawareness, low literacy rate, and practice of homosexuality, have been recorded in the Northern areas of Pakistan [32
]. Moreover, the major bulk of HIV cases in Pakistan is comprised of deported migrant workers from the Gulf States, a significant proportion of whom are residents of Northern Pakistan [34
]. A complete absence of HIV cases in our studied population was, therefore, surprising. The fact that our study was not able to detect any HIV infection may well be a result of the limited populace that was sampled. More expanded analysis is needed to truly chart the dynamics of HIV in these areas.
In contrast to HIV, a considerable prevalence of Hepatitis C was recorded in the earthquake-affected Northern areas. This observed HCV prevalence may be attributed to a varied mix of factors. The issue of unscreened blood transfusion ranks definitely as the most important contributory factor. Other factors may include the use of unsterilized equipment, lack of awareness and widespread illiteracy in Northern Pakistan. It may be speculated that compromised healthcare and other afore-mentioned factors related to earthquake will aggravate the transmission and prevalence scenario in these areas. The slight increase observed in the two batches studied may be attributed to the variation in the population samples studied in the two instances. The two sample populations indeed were significantly different according to most of the measured parameters (Table ).
At this time, proper guidelines and procedures, implemented urgently, could play a significant role in reducing the spread of blood-borne infections. Mandatory screening of blood and blood products before transfusion, proper sterilization of surgical and dental instruments, and appropriate disposal of infected materials and disposable syringes are among the issues that need to be emphasized [21