Taimoor Hussain, Khalida Walizada , John Joyce, Ayema Haque, Tuba Khan, Rajeswari Khan , Adir Noyan, Ghayoor Hussain, Sara Sahar, Zahra Mushtaq, Ghullamullah Shahzad, Denzil Etienne, , Sara
Objective: Hepatitis B and C is a blood borne infection which attacks the liver, causing both acute and chronic liver disease. It is one of the major causes of end stage liver disease including cirrhosis and hepatocelluar carcinoma. Our study is about the knowledge, attitude and perception of Hazara population of Quetta Pakistan regarding hepatitis B and C. Hazaras are the third largest ethnicity in Afghanistan and a minority in Pakistan. Special focus has been given to flagellation practice during "Ashura" in the first Islamic month called "Muharram". The "Mourning of Muharram" marks the martyrdom anniversary of Imam Hussain Ibn Ali at Karbala Iraq by the forces of the second Umayyad caliph “Yazeed”. Imam Hussain was the grandson of Prophet Muhammad, peace be upon him. During flagellation the mourners have open wounds, blood splatters all around. The mourners flagellate their back and head with sharp mourning blades and knives. Thus there is a hypothetical risk of hepatitis B and C transmission from those are already infected to others. Subjects and methods: A cross sectional survey was conducted by a survey questionnaire. The survey questionnaire was generated on google forms and conducted from August 2020 to October 2020. It assessed the knowledge, attitude and perception of Hazara ethnicity of Quetta Pakistan about Hepatitis B and C. The questions were verified and taken from "World Health Organization" and "Center for Disease Control”. We adopted convenience sampling. The responses were collected by interviewers. The interviewers visited the five main hospitals serving Hazara population, local academic institutions, neighborhood homes, and roadside shops. In addition the survey was also forwarded on social media. Both English and Urdu version of the questionnaire in the same form was generated. The questionnaire asked about their knowledge of signs and symptoms, modes of transmission, vaccination status, and other general perception, attitude and practices towards hepatitis B and C. The survey also explored Hazara community’s perception, practices and attitude towards flagellation with mourning blades. The data from the google form was retrieved and transferred to excel spreadsheet for further analysis. Results: A total of 650 responses were collected. After excluding incomplete responses and responses from other ethnicities, the following results were obtained for a total of 603 responses. Among the respondents 58.2 % were aged 18-30, female and male constituted 56.88% and 43.11% of the respondents respectively. 30.67 % had graduate degrees. 27.19 % respondents were students while 25.37 % were housewives. The percentage of respondents who knew the sign and symptoms were as follows: fatigue 50.7 %, Jaundice 46.6 %, nausea and vomiting 37.8%. The percentage aware of the modes of transmission were as follows: Unscreened blood transfusion 66.8%, reused syringes 75.78%, tattoo, ear, nose piercing 55.7 %, sexual transmission 54.22. Only 44.4 % knew that hepatitis B has vaccine available where as 54.5 % had not been vaccinated. 49.5 % did not know that hepatitis B and C is quite prevalent in Pakistan. 62 % expressed flagellation as a risk factor. 28.05 % of male respondents (85 out of 218 male respondents) had flagellated which is a considerable proportion of male Hazara population, 23.5 % of whom had exchanged flagellation blades with each other. 15.09 % of respondents do not believe on protective effects of hepatitis vaccine to those who flagellate. A large proportion of those who had flagellated (55.3 %) declined getting screening test for hepatitis B or C. Conclusion: There is a need of spreading awareness among the Hazara population regarding hepatitis B and C, particularly regarding the flagellation practice, which should also be scientifically investigated as a possible risk factor. Vaccination and avoiding exchange of flagellation blades should be encouraged. Key words: Hepatitis B and C, flagellation with mourning blades, Muharram, Ashura, Quetta, Pakistan.