GEO-SPATIAL ANALYSIS OF HEPATITIS C IN DISTRICT HAFIZABAD PUNJAB

Abstract

Hepatitis C Virus (HCV) infection is considered to be one of the increasing public health problems in Pakistan as well as in other developing countries. HCV infection leads to chronic hepatitis in 50% to 80% of patients. In 2004, World Health Organization (WHO) estimated that the annual deaths due to liver cancer caused by HCV and cirrhosis were 308,000 and 785,000 respectively. The situation of HCV infection in District Hafizabad is alarming where 12.95% of total population is living with HCV infection. The objectives of this study were mapping spatial and temporal trends of HCV, geographic correlation studies to analyze socio-economic factors effect on disease spread and identifying risk factors using Geographic Information system (GIS). HCV registered patient’s data were acquired from District Headquarter (DHQ) Hospital Hafizabad. Stratified random sampling technique was used to collect patient’s data in all union councils (UCs) and tehsil municipal committees (TCs). A comprehensive spatial database was developed for visited patients. Mapping was done to analyze spatial distribution of patents in whole district for the period of 2007-2009 and then tracking analysis was used to observe daily patient’s registration variation. Standardized morbidity ratio (SMR) was used to predict population at risk. Trend analysis was used to identify SMR trend. Moran’s I spatial statistics was used to analyze spatial autocorrelation among number of patients and different socio-economic factors. XIV Cluster and outlier analysis was used to determine whether cases of HCV infection tend to occur closer in space to other cases and vice versa. Getis-Ord Gi Spatial Statistics was used to analyze hot spots with respect to standardized population. Mapping of expected risk factors was done using Kriging and then weighted sum analysis was used for vulnerable areas detection. Spatio temporal analysis indicated an increasing HCV trend in District Hafizabad. Maximum numbers of patients were recorded in 2008 and it was observed that most of the patients belong to TC Hafizabad. Population lives in vicinity of DHQ and other healthcare centers are at higher risk. It was analyzed that most of the patients belong to age group of 30-39.Reuse of syringes, barber interaction and surgeries are more prominent causes of disease spread throughout the district. Analysis has revealed that whole district is under the threat of HCV infection and this activity is further spreading rapidly towards southern areas of district. A public awareness campaign is essentially needed to educate people regarding HCV spread, risk factors and treatment. Its main causes are connected to poor medical and illegal practices; therefore, a strict action is required against these elements. There should be another HCV center in District Hafizabad near Pindi Bhattian to treat more number of HCV patients. These findings can contribute significantly to understand disease spread behavior in this district and to study other disease using similar methodology.