**2. Literature review**

A cross-sectional study was conducted in Karachi, Pakistan, to assess the knowledge and awareness of HBV infection, its prevalence, transmission, and perception of HBV vaccine and vaccination status among young females. Descriptive statistics were used and out of 550 survey questionnaires, only 434 were returned. Response rate was 78.9%. More than 90% had knowledge of HBV infection. Only 17% had received HBV vaccination during childhood. Only 24% had been tested for HBV in adulthood. Majority of respondents had some awareness of HBV and related consequences [11].

A comparative cross-sectional facility-based survey between HCV-positive and negative respondents at Taluka Hospital (OPD) Rural district of Sindh was conducted to assess the knowledge regarding risk factors of HCV transmission and options to prevent the risk factors associated with HCV transmission. Out of 520 respondents, only 66% having HCV infection were interviewed. Highest infection was present among 21–30 years of ages (39%). About 75.6% of urban population and 52.9% illiterate group were

#### *Awareness and Prevalence of Hepatitis B and C in Rural Areas of Lahore, Pakistan DOI: http://dx.doi.org/10.5772/intechopen.109192*

infected. Majority of HCV infected population had the misconception of water, food, heat, and mosquitoes as factors of HCV transmission [12].

A cross-sectional study was done in Nigeria, antenatal clinics in six different geopolitical zones recruited 159 pregnant women who agreed to undergo antihepatitis C virus testing, which was then validated using the polymerase chain reaction method. Out of 159, 99 pregnant women in Nigeria are not well informed about hepatitis C virus infection, and those 77, who are informed, are more likely to be young and highly educated. High hepatitis C virus infection rates serve as early support for the need for routine prenatal screening [13].

Eliminating the hepatitis C virus (HCV) requires an understanding of its obstacles and overcoming them. The current study set out to look into the prevalence of HCV disease awareness, linkage to care, and treatment uptake in a Taiwanese hyperendemic area. Residents in Tzukuan, between the years 2000 and 2018, were invited to take part in the questionnaire-based HCV interviews. Anti-HCV-seropositive participants' rates of disease knowledge, accessibility, and anti-HCV therapy were assessed. Even in the early days of direct-acting antiviral agents, found out significant gaps in disease awareness, link-to-care, and treatment uptake in the HCV care cascade in an HCV-hyperendemic area. It is critical to overcome these obstacles to achieve HCV eradication [14].

By using survey results, hepatitis B free campaign was conducted to eliminate HBV in San Francisco by increasing awareness, testing, and vaccination. The campaign conducted 306 street intercepts and telephone interviews of San Francisco patients for assessment. One-third of respondents ranked HBV as a key health issue in Asian community, second to diabetes. General HBV awareness is high. The campaign used survey results to focus efforts on more intensive provide outreach and to create messages for public media campaign [15].

A general population-based study was carried out in Nawabshah Sindh, Pakistan, to evaluate the epidemiological rate and risk factors of hepatitis B and hepatitis C. In count, 523 people were tested for hepatitis B and C, with 232 being female and 291 being male. Hepatitis C and B were found in 14.3% and 6.7% of the population, including both. Public health issues are being raised by the higher numbers of hepatitis B surface antigens and hepatitis C virus in Nawabshah. Precautionary action must be taken immediately [16].

This study aims to examine cost-effectiveness of community-born screening and early treatment with antiviral therapy for HBV in The Gambia. In Gambia, the prevalence of HBsAg is 8.8% in people older than 30 years. Adult community-born screening and treatment for HBV in The Gambia is likely to be a cost-effective intervention [17].

In the United States, a community-born study was conducted to assess attitudes about HCV screening and knowledge about HCV disease at several sites that serve high-risk populations. 140 participants were surveyed. Baseline hepatitis C knowledge was poor. However, brief educational intervention improved knowledge and raised acceptability of testing [18].

The study regarding HIV and hepatitis C viral screening practices in a geographic disease sample of American community Health Centers. It involves the complete survey of their attitudes and beliefs about HIV and HCV testing. Statistics were generated to describe the prevalence of HIV and HCV and associated demographics by CHCs. HCV prevalence ranged from 0.1–3.7%. Additional education and counseling may facilitate increased screening rates [19].

A prospective community-wide screening was conducted to assess rates of chronic HBV and HCV infections among Somali, Liberian, and Kenyan immigrants in Minnesota. Out of 853 participants, 13.5% had chronic HBV

infection while 7% of them had HCV infection. Chronic HBV and HCV are major health problems among African immigrants. Community-based screening is effective to identify and provide health education for those who are at risk of viral hepatitis [20].

A street outreach study was conducted to assess the prevalence of HCV infection among many homeless PWUDs in Tel Aviv, detect risk factors for HCV infection, evaluate knowledge of the disease status, and measure the probability of connection to care. Data showed that HCV infection is very common in PWUDs who are homeless. Importantly, it was discovered there was startlingly limited access to care in this cohort despite relatively high awareness of HCV status. To stop the spread of HCV, these findings inspire new therapeutic strategies aimed at enhancing accessibility and conformity among homeless PWUDs [21].

A study conducted an evidence review to determine the burden of hepatitis C information in the immigrant population and to assess effectiveness of screening and treatment programs for chronic hepatitis C infection in Canada for the Canadian collaboration for immigrant and refugee's health. Immigrants had a high prevalence of chronic hepatitis C infection as compared to the Canadian-born population. They are also at increased risk of mortality from complications of Cirrhosis and hepatocellular carcinoma. Treatment of chronic HCV in those with Cirrhosis eliminated the risk of liver failure [22].

A cross-sectional survey-based study was conducted among healthcare workers of the Federal Medical Center Bida, Nigeria to assess knowledge, awareness, and prevalence of viral hepatitis. About 248 individuals participated in this study. Overall awareness of the various types of hepatitis was 70.6% with a marked trend over educational level. There is a need to provide education to raise awareness and knowledge among this group [23].

A cross sectional study was conducted to assess awareness and knowledge of hepatitis B infection in selected areas of Puchong, Malaysia. Out of 400 subjects, 48.5% were not aware, and 66.5% had never taken vaccine for hepatitis B. Overall, the level of awareness and knowledge was low. This low level should be improved through health education and frequent vaccination program for hepatitis B among public, especially in Puchong, Malaysia [24].

A cross-sectional study was done in Nigeria, antenatal clinics in six different geopolitical zones recruited 159 pregnant women who agreed to undergo antihepatitis C virus testing, which was then validated using the polymerase chain reaction method. Out of 159, 99 pregnant women in Nigeria are not well informed about hepatitis C virus infection, and those 77, who are informed, are more likely to be young and highly educated. High hepatitis C virus infection rates serve as early support for the need for routine prenatal screening.
