Prevalence of Hepatitis B and C in prisons worldwide: A meta-analysis during the years 2005-2015

Biomed Press An Open Access Publisher Background: Viral hepatitis is still considered as a major cause of burden of disease in the world, and is the most common cause of cirrhosis and liver cancer. Prisoners are one of the groups most at risk for hepatitis. This study aimed to investigate the prevalence of hepatitis B and C in prisons worldwide during the years 2005-2015. Method: In order to find relevant articles published from 2005 to 2015, two members of the research team searched the databases of PubMed, Scopus, and Web of Science. The study was conducted using the random effects model and the fixed effects model. In order to examine heterogeneity, Cochran Q test was used at an error level of less than 10%; its quantity was estimated using the I2 indicator. The publication bias was measured using Begg’s rank correlation test and Egger’s linear regression method. After extracting the required data, the meta-analysis was performed using the software Stata 12. Results: A total of 43 studies which met the inclusion criteria were analyzed. The results showed that the overall prevalence of hepatitis B in prisoners was 5.17% (95% CI: 2.19-9.30). The highest prevalence, that is, 13.14% (95% CI: 11.99-14.36), was observed in Africa. According to the World Health Organization (WHO) classification, the highest prevalence, that is, 5.04% (95% CI: 4.45-5.67), was observed in the Western Pacific region. The prevalence of hepatitis B in men and women were, respectively, 6.70% (95% CI: 6.52-6.88) and 4.34% (95% CI: 3.98-4.79). The results showed that the overall prevalence of hepatitis C in prisoners was 13.22% (95% CI: 8.958.16). The highest prevalence, that is, 26.4% (95% CI: 25.05-27.87), was observed in Australia. According to the WHO classification, the highest prevalence of hepatitis C, that is, 24.26% (95% CI: 21.6-27.02), was observed in the Southeast Asia region. The prevalence of hepatitis B in men and women were, respectively, 9.33% (95% CI: 1.56-1.98) and 6.25% (95% CI: 5.78-6.74). Conclusion: The prevalence of hepatitis B and C in prisoners was greater than that in the general population, and the prevalence in men was greater than that in women. Appropriate and effective interventions to reduce transmission of hepatitis B and C in the prisons worldwide is essential. Abstract Received: 30 December 2017 Accepted: 07 April 2018 Published: 30 April 2018

prevalence of infection in correctional centers could aid in proper prevention, management and planning of infectious diseases. Since one of the high-risk groups of individuals is prisoners and since viral hepatitis is one of the most important health issues for prisoners, the aim of this study was to obtain an estimate of the prevalence of viral hepatitis among prisoners in the world.

(b) Study selection
The data extracted from the articles are shown in Figures 1 and 2. A final total of 43 articles were eligible and included in the study. All the articles (during the three stages) were evaluated by two independent researchers and, in case of any disagreement, a third examiner to arrive at the final analysis. With respect to the articles included in the data analysis phase, all information related to type of study, first author's name, year of study, year of publication, participants' gender, country of study, number of participants, and hepatitis type (B and C) by sex, were entered on the spreadsheet forms designed in the software Excel. The data, after the cleaning phase, were transferred from Excel to the Stata 12 software program.

(c) Statistical analysis
In this study, the pooled weighted average (derived from results of individual studies) were used in the evaluations. The weighted average for each study was calculated based on the sample size and variance. In this study, the random effects model (the DerSimonian and Laird method) and the fixed effects model (the Mantel-Haenszel method) were used; the indicator under study was "prevalence", which was calculated as the ratio of (p) with a 95% CI. In order to examine heterogeneity, Cochran's Q test was used at an error level of less than 10%; its quantity was estimated using the I 2 indicator (I 2 is the percentage of total variation across studies due to heterogeneity rather than chance). A value of 0% indicates no heterogeneity among the studies. If p < .01 and I 2 > 50%, the random effects model was used; otherwise, the fixed effects model was used.
The publication bias was measured using Begg's rank correlation test and Egger's linear regression method. After extracting the required data, the meta-analysis was performed using the software Stata 12.

Results
Of the 43 articles that were evaluated in our study, these were the following countries which were represented: Iran, Brazil, Azerbaijan, Indonesia, England, Scotland, Italy, France, Ghana, Spain, America, Croatia, Lebanon, Pakistan, Mexico, Nigeria, Ukraine, Australia, and Macedonia. The sample size in these studies varied from 200 to 17084 people Table 1     history of injection were obtained Table 3. Analysis of these studies indicated that, overall, the prevalence of hepatitis C in prisoners worldwide was 13

Discussion
The population of prisoners consists of groups facing greater health problems influenced by unstable economy, history of drug abuse, and other instances of risk behavior. One of the main health-related concerns among prisoners is blood-borne infections, including hepatitis B and C [59]. This study aimed to investigate the prevalence of hepatitis B and C in prisons worldwide. In the present study, 43 studies were evaluated to examine the prevalence of hepatitis B and C in prisons around the world. In the final meta-analysis, 31 articles were included in the investigation   [60]. Overall, the prevalence of hepatitis C in prisons around the world was estimated to be 13.22% (95% CI: 8.95-18.16). The highest prevalence of hepatitis B, according to continent, was seen in Africa, at 13.14% (95% CI: 11.99-14.36), and the lowest was in Europe, at 1.16% (95% CI: 1.03-1.30). However, the highest prevalence of hepatitis C in prisons, according to the WHO's classification of regions, was in Australia, at 26.4% (95% CI: 25.05-27.87), and the lowest was seen in the Americas, at 3.68% (95% CI: 3.5-3.87). Health organizations should, therefore, seek to modify the existing patterns and halt the growing trend of hepatitis infection by implementing proper vaccination programs and/or preventative education to lower risk and prevalence.
According to the results, it could be argued that the prevalence of hepatitis among male prisoners is greater when compared with that among female prisoners. Given the higher prevalence of risk behavior and drug injection among men, these findings affirm the greater need for training in this group. Drug use is currently a global problem; indeed, nearly 5% of the world's population (200 million people) use drugs [61]. Injection is one of the most harmful ways of drug use. It is estimated that there are 13 million injection drug users in the world, 75% of which live in developing countries [59]. Drug injection and needle sharing in closed environments, such as prisons, could exacerbate the transmission of blood-borne diseases. The results of the present study showed that the prevalence of hepatitis B among the people with a history of injection was 12.68% (95% CI: 4.65-23.9), and the prevalence among those without a history of injection was 7.4% (95% CI: 0.06-29.9). With respect to the prevalence of hepatitis C and the history of injection, the results showed that the prevalence for those with such a history was 19.32% (95% CI: 3.51-43.65), and the prevalence among those without a history of injection was 12.99% (95% CI: 1.03-35.24).

Conclusion
The results suggest that the prevalence of hepatitis B and C, in general, and that of hepatitis C, in prisons, are of particular concern. The prevalence of hepatitis is higher among men than women