The Indian Journal of Pediatrics

, Volume 76, Issue 12, pp 1247–1257 | Cite as

Calculating prevalence of hepatitis B in India: Using population weights to look for publication bias in conventional meta-analysis

  • Ashish Batham
  • Manoj Anand Gupta
  • Pallav Rastogi
  • Shubham Garg
  • V. Sreenivas
  • Jacob M. Puliyel
Special Article

Abstract

Publication bias can result from the propensity of researchers to document what is unusual. This can distort the inferences drawn in systematic reviews. To measure the distortion, it has been suggested that a second analysis be done; using weights proportional to the size of the population from which the samples are drawn. We re-evaluate data from a published meta-analysis on prevalence of hepatitis B in India, to see how this approach alters the results. Prevalence of hepatitis B among tribal and non-tribal populations in different States was analyzed. Weights were then assigned according to population of the State. The overall country prevalence was then calculated. Using population-weights it is estimated that the point-prevalence of hepatitis B among non-tribal populations is 3.07% [95% CI: 2.5–3.64]. Among tribal populations it is 11.85% (CI 10.76–12.93). Overall prevalence was 3.70 (CI: 3.17–4.24) (corresponding to a chronic carrier rate of 2.96%). The present analysis using population-weights has resulted in the estimated prevalence among non tribal populations increasing by 24% and that among tribal populations decreasing by 25.5% when compared to figures of the meta-analysis published earlier. The advantages and drawbacks of this procedure are discussed.

Key words

Hepatits B 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Puliyel JM, Sreenivas V. Meta-analysis can be statistically misleading. EBM 2005. 10;130.Google Scholar
  2. 2.
    Batham A, Narula D, Toteja T, V Sreenivas, Puliyel JM. Systematic Review and Meta-analysis of Data on Point Prevalence of Hepatitis B in India. Indian Pediatr 2007;44:663–675PubMedGoogle Scholar
  3. 3.
    Biswas SC, Gupta I, Ganguly NK, Chawla Y, Dilawari JB. Prevalence of hepatitis B surface antigen in pregnant mothers and its perinatal transmission. Trans Royal Soc Trop Med Hyg 1989;83:698–700.CrossRefGoogle Scholar
  4. 4.
    Choudhury N, Ramesh V, Saraswat S, Naik S. Effectiveness of mandatory transmissible disease screening in Indian blood banks. Indian J Med Res 1995;101:229–332.PubMedGoogle Scholar
  5. 5.
    Elavia AJ, Banker DD. Prevalence of hepatitis B surface antigen and its subtypes in high risk group subjects and voluntary blood donors in Bombay. Indian J Med Res 1991;93:280–285.PubMedGoogle Scholar
  6. 6.
    Gupta I, Sehgal A, Sehgal R, Ganguly NK, Vertical transmission of hepatitis B in North India. J Hyg Epid Microbiol Immunol 1992;36:263–267.Google Scholar
  7. 7.
    Irshad M, Joshi YK, Acharya SK, Tandon BN. Prevalence of hepatitis B virus infection in healthy persons in North India. Natl Med J India 1994;7:210–212.PubMedGoogle Scholar
  8. 8.
    Joshi SH, Gorakshakar AC, Mukherjee M, Rao VR, Sathe MS, Anabhavane SM et al. Prevalence of HBsAg carriers among some tribes of Madhya Pradesh. Indian J Med Res 1990;91:340–343.PubMedGoogle Scholar
  9. 9.
    Khatri JV, Kulkarni KV, Vaishnav PR, Merchant SM. Vertical transmission of hepatitis B. Indian Pediatr 1980;17:957–962.PubMedGoogle Scholar
  10. 10.
    Makroo RN, Hassain G, Koul A, Shah GN. Prevalence of Hepatitis B surface antigen in Kashmiri blood donors. Indian J Med Res 1989;89:310–313.PubMedGoogle Scholar
  11. 11.
    Mohite JB, Urhekar AD. Prevalence of HBsAg positivity in staff and patients at MGM Medical College and Hospital, Navi-Mumbai. Indian J Med Sci 1999;53:434–438.PubMedGoogle Scholar
  12. 12.
    Nandi J, Bhawalkar V, Mody H, Elavia A, Desai PK, Banerjee K. Detection of HIV-1, HBV and HCV antibodies in blood donors from Surat, western India. Vox Sang 1994;67:406–407CrossRefPubMedGoogle Scholar
  13. 13.
    Nayak NC, Panda SK, Zuckerman AJ, Bhan MK, Guha DK. Dynamics and impact of perinatal transmission of Hepatitis B virus in North India. J Med Virol 1987;21:137–145.CrossRefPubMedGoogle Scholar
  14. 14.
    Nijhawan S, Rai RR, Sharma D, Saxena HB. HBsAg prevalence in blood donors in Jaipur. Indian J Gastroenterol 1997;16:155PubMedGoogle Scholar
  15. 15.
    Panda SK, Ramesh R, Rao KVS, Gupta A, Zuckerman AJ, Nayak NC. Comparative evaluation of the immunogenicity of yeast derived (recombinant) and plasma derived Hepatitis B vaccine in infants. J Med Virol 1991;35:297–302.CrossRefPubMedGoogle Scholar
  16. 16.
    Prasad SR, Rodrigues FM, Dhorje SP, Ramamoorthy CL. Prevalence & subtypes of hepatitis B surface antigen in the tribal population of Arunachal Pradesh, India. Indian J Med Res 1983;78:300–306.PubMedGoogle Scholar
  17. 17.
    Singhvi A, Pulimood RB, John TJ, Babu PG, Samuel BU, Padankatti T et al. The prevalence of markers for Hepatitis B and human immuno-deficiency viruses, malarial parasites and microfilaria in blood donors in a large hospital in South India. J Trop Med Hyg 1990;93:178–182.PubMedGoogle Scholar
  18. 18.
    Sumathy S, Thyagarajan SP, Latif R, Madanagopalan N, Raguram K, Rajasambandam P et al. A dipstick immunobinding enzyme-linked immunosorbent assay for serodiagnosis of hepatitis B and delta virus infections. J Virol Methods 1992;38:145–152.CrossRefPubMedGoogle Scholar
  19. 19.
    Tandon BN, Irshad M, Raju M, Mathur GP, Rao MN. Prevalence of HBsAg and anti HBsAg in children and strategy suggested for immunization in India. Indian J Med Res 1991;93:337–339.PubMedGoogle Scholar
  20. 20.
    Thakur TS, Sharma V, Goyal A, Gupta ML. Seroprevalence of HIV antibodies, Australia antigen and VDRL reactivity in Himachal Pradesh. Indian J Med Sci 1991;45:332–335.PubMedGoogle Scholar
  21. 21.
    Kaur U, Sahni SP, Bambery P, Kumar B, Chauhan A, Chawla YK et al. Sexual behaviour, drug use and hepatitis B infection in Chandigarh students. Natl Med J India 1996;9:156–159.PubMedGoogle Scholar
  22. 22.
    Mukherjee M, Joshi SH, Rao VR, Gorakshakar AC, Sathe MS. Prevalence of hepatitis b surface Antigen among some tribes of Madya Pradesh, Rajasthan, and Maharastra. J Indian Antrop Soc 1990;25;68–72.Google Scholar
  23. 23.
    Nanu A, Sharma SP, Chatterjee K, Jyoti P. Markers for transfusion-transmissible infections in north Indian voluntary and replacement blood donors: prevalence and trends 1989–1996. Vox Sang 1997;73:70–73.CrossRefPubMedGoogle Scholar
  24. 24.
    Prakash C, Sharma RS, Bhatia R, Verghese T, Data KK. Prevalence of North India of hepatitis B carrier state amongst pregnant women. Southeast Asian J Trop Med Public Health 1998;29:80–84.PubMedGoogle Scholar
  25. 25.
    Satoskar A, Ray V. Prevalence of hepatitis B surface antigen (HBsAg) in blood donors from Bombay. Trop Geogr Med 1992;44:119–121.PubMedGoogle Scholar
  26. 26.
    Sharma R, Malik A, Rattan A, Iraqi A, Maheshwari V, Dhawan R et al. Hepatitis B virus infection in pregnant women and its transmission to infants. J Trop Pediatr 1996;42:352–354.CrossRefPubMedGoogle Scholar
  27. 27.
    Werner GT, Frosner GG, Sareen DK. Prevalence of serological markers for viral hepatitis and AIDS in rural Punjab. J Commun Dis 1989;21:139–141.PubMedGoogle Scholar
  28. 28.
    Abass F, Thomas RD, Rajkumar A, Gupta N, Puliyel JM. Controlling perinatally acquired hepatitis B. Indian J Pediatr 2001;68:365.CrossRefPubMedGoogle Scholar
  29. 29.
    Ahmad B, Grover R, Ratho RK, Mahajan RC. Prevalence of hepatitis B virus infection in Chandigarh over a six year period. Tropical Gastroenterol 2001;22:18–19.Google Scholar
  30. 30.
    Banerjee A, Chakravarty R, Mondal PN, Chakraborty MS. Hepatitis B virus genotype D infection among antenatal patients attending a maternity hospital in Calcutta, India: assessment of infectivity status. Southeast Asian J Trop Med Public Health 2005;36:203–206.PubMedGoogle Scholar
  31. 31.
    Bhagyalaxmi A, Lala MK, Jain S, Sunderam S, Nayak S, Kalia M, Patel N. HBsAg carrier status in urban population of Ahmedabad city. Indian J Med Res 2005;121:203–204.PubMedGoogle Scholar
  32. 32.
    Chakravarti A, Rawat D, Jain M. A study on the perinatal transmission of the hepatitis B virus. Indian J Med Microbiol 2005;23:128–130.CrossRefPubMedGoogle Scholar
  33. 33.
    Chandra M, Khaja MN, Farees N, Poduri CD, Hussain MM, Aejaz Habeeb M et al. Prevalence, risk factors and genotype distribution of HCV and HBV infection in the tribal population: a community based study in south India. Trop Gastroenterol 2003;24:193–195.PubMedGoogle Scholar
  34. 34.
    Chandrasekaran S, Palaniappan N, Krishnan V, Mohan G, Chandrasekaran N. Relative prevalence of hepatitis B viral markers and hepatitis C virus antibodies (anti HCV) in Madurai, south India. Indian J Med Sci 2000;54:270–273.PubMedGoogle Scholar
  35. 35.
    Chowdhury A, Santra A, Chakravorty R, Banerji A, Pal S, Dhali GK et al. Genotype, phylogenetic analysis, and transmission pattern of occult hepatitis B virus (HBV) infection in families of asymptomatic HBsAg carriers. J Med Virol 2006;78:53–59.CrossRefPubMedGoogle Scholar
  36. 36.
    Ganju SA, Goel A. Sero-surveillance of HIV, HBV and HCV infections in antenatal and STD clinic attendees. J Commun Dis 2004;36:60–62.PubMedGoogle Scholar
  37. 37.
    Garg S, Mathur RD, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in western India. Indian J Pathol Microbiol 2001;44:409–412.PubMedGoogle Scholar
  38. 38.
    Gupta N, Kumar V, Kaur A. Seroprevalence of HIV, HBV, HCV and syphilis in voluntary blood donors. Indian J Med Sci 2004;58:255–257.PubMedGoogle Scholar
  39. 39.
    Joshi RM, Gupta V, Jain B, Kumar S, Basu S. Screening for HBsAg, anti-HIV, anti-HCV and syphilis amongst blood donors in a teaching hospital. J Commun Dis 2002;34:157–159.PubMedGoogle Scholar
  40. 40.
    Kaur H, Marshalla R. Seroepidemiology of HIV, HBV, HCV and treponemal infections. J Commun Dis 1998;30:29–31.PubMedGoogle Scholar
  41. 41.
    Kaur R, Berry N, Mittal SK, Mathur MD, Baveja U. Hepatitis B virus in a select pediatric population in Delhi, India. J Commun Dis 2002;34:146–148.PubMedGoogle Scholar
  42. 42.
    Kurien T, Thyagarajan SP, Jeyaseelan L, Peedicayil A, Rajendran P, Sivaram S. Community prevalence of hepatitis B infection and modes of transmission in Tamil Nadu, India. Indian J Med Res 2005;121:670–675.PubMedGoogle Scholar
  43. 43.
    Mahalakshmi B, Madhavan HN, Pushpalatha R, Margarita S. Seroprevalence of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among eye donors. Indian J Opthalmol 2004;52:61–62.Google Scholar
  44. 44.
    Murhekar MV, Murhekar KM, Arankalle VA, Sehgal SC. Epidemiology of hepatitis B infection among the Nicobarese-a mongoloid tribe of the Andaman and Nicobar Islands, India. Epidemiol Infect 2002;128:465–471.CrossRefPubMedGoogle Scholar
  45. 45.
    Murhekar MV, Murhekar KM, Das D, Arankalle VA, Sehgal SC. Prevalence of hepatitis B infection among the primitive tribes of Andaman & Nicobar Islands. Indian Med Res 2000;111:199–203.Google Scholar
  46. 46.
    Murhekar MV, Murhekar KM, Sehgal SC. Hepatitis B vaccination in a hyper-endemic tribal community from India: assessment after three years. Vaccine 2004;23:399–403.CrossRefPubMedGoogle Scholar
  47. 47.
    Murhekar MV, Murhekar KM, Sehgal SC. Seroepidemiology of hepatitis B infection among tribal school children in Andaman and Nicobar Islands, India. Ann Trop Paediatr 2004;24:85–88.CrossRefPubMedGoogle Scholar
  48. 48.
    Murhekar MV, Murhekar KM, Sehgal SC. Alarming prevalence of hepatitis-B infection among the Jarawas — a primitive Negrito tribe of Andaman and Nicobar Islands, India. J Viral Hepat 2003;10:232–233.CrossRefPubMedGoogle Scholar
  49. 49.
    Qamer S, Shahab T, Alam S, Malik A, Afzal K. Age-specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh, North India. Indian J Pediatr 2004;71:965–967.CrossRefPubMedGoogle Scholar
  50. 50.
    Sahani M, Jindal K, Abraham N, Aruldas K, Puliyel J. Hepatitis B immunization: cost calculations in a community-based study in India. Indian J Gastroenterol 2004;23:16–18Google Scholar
  51. 51.
    Sharma RR, Cheema R, Vajpayee M, Rao U, Kumar S, Marwaha N et al. Prevalence of markers of transfusion transmissible diseases in voluntary and replacement blood donors. Natl Med J India 2004;17:19–21.PubMedGoogle Scholar
  52. 52.
    Singh B, Kataria SP, Gupta R. Infectious markers in blood donors of East Delhi: prevalence and trends. Indian J Pathol Microbiol 2004;47:477–479.PubMedGoogle Scholar
  53. 53.
    Singh H, Aggarwal R, Singh RL, Naik SR, Naik S. Frequency of infection by hepatitis B virus and its surface mutants in a northern Indian population. Indian J Gastroenterology 2003;22:132–137.Google Scholar
  54. 54.
    Singh J, Bhatia R, Khare S, Patnaik SK, Biswas S, Lal S et al. Community studies on prevalence of HBsAg in two urban populations of southern India. Indian Pediatr 2000;37:149–152PubMedGoogle Scholar
  55. 55.
    Vinodkumar CS, Anandkumar H, Kapur I, Ratna AK. Seroprevalence of HBV among people visiting barbers at Gulbarga. J Commun Dis 2002;34:154–156.PubMedGoogle Scholar
  56. 56.
    Varghese RM, Abraham J, James J, Puliyel JM. Determining the point of indifference where costs of selective and universal immunization against hepatitis B are identical, in a cost-minimization exercise. Indian J Gastroenterol 2004;23:154–156.PubMedGoogle Scholar
  57. 57.
    Phadke A, Kale A. HBV carrier rate in India. Indian Pediatr 2002;39:787–788.PubMedGoogle Scholar
  58. 58.
    Indian Association for Study of the Liver (INSAL); 2000 Hepatitis B in India; therapeutic options and prevention strategies — Consensus statement. Indian J of Gastroenterology. 19:C4–C66.Google Scholar
  59. 59.
    Lodha R, Jain Y, Anand K, Kabra SK, Pandav CS. Hepatitis B in India. A review of disease epidemiology. Indian Pediatr 2001; 38:349–371.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2009

Authors and Affiliations

  • Ashish Batham
    • 1
  • Manoj Anand Gupta
    • 1
  • Pallav Rastogi
    • 1
  • Shubham Garg
    • 1
  • V. Sreenivas
    • 2
  • Jacob M. Puliyel
    • 1
    • 3
  1. 1.Department of PediatricsSt Stephens HospitalDelhiIndia
  2. 2.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.St Stephens HospitalTis Hazari, DelhiIndia

Personalised recommendations