THERE are 15 million persons suffering from hepatitis in Pakistan. This means one out of 13 Pakistanis. Much has been said and written to highlight the causes of hepatitis and their prevention. However, two major reasons are rarely if ever mentioned: 1) drug-induced hepatitis, and 2) unnecessary use of injections.

According to medical research, between 25 per cent and 50pc of all hepatitis cases and even hepatic failure may be due to adverse drug effects, whereas almost 15pc of patients with autoimmune hepatitis have drug-induced liver disease. Drugs linked with hepatitis include anti-TB drugs, anti-convulsants, paracetamol, anabolic steroids, erythromycin, oestrogens, combined oral contraceptives and many more. All such drugs are available over the counter in Pakistan.

Paracetamol (acetaminophen) is the most important pharmacological cause of acute liver failure.

In 2014, the Federal Drug Authority imposed a ban on the manufacture of high-dose versions of acetaminophen — doses higher than 325mg — because the drug caused severe liver failure in some patients.

In Pakistan, doctors continue to prescribe and patients on their own continue to consume 1,000mg of paracetamol two to three times a day. During the dengue epidemic, millions of paracetamol tablets were consumed, without any research on their health impacts.

All the articles and advertisements on hepatitis in Pakistan emphasise the use of clean unused injections, but there is hardly any debate on the unnecessary use of injections. A household-based survey by the Aga Khan University, WHO and Kuwait University found the injection rate use in Karachi and Mirpurkhas district to be 13.6 injections per person per year. This is one of the highest rates in the world.

Health professionals need to highlight these causes of hepatitis and educate the public.

Rafiq Jaffer
Lahore

Published in Dawn, January 1st, 2020