Assessment of self-reported prevalence, vaccination status, knowledge and behavioral determinants of hepatitis B and D in Pakistan: A cross-sectional study

Sajid Ur Rahman¹Yanfei Gao¹Fazal Noor²Munib Ullah³Hanif Ur Rahman²Abdul Qadeer⁴Tariq Ullah⁵Xiumei Chi⁶Junqi Niu⁶Saeed Hamid⁷Zhenfeng Zhang^1*

• ¹Southern University of Science and Technology, Shenzhen, China
• ²The University of Agriculture Peshawar, Peshawar, Pakistan
• ³PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
• ⁴Central South University, Changsha, China
• ⁵Ayub Teaching Hospital, Abbottabad, Pakistan
• ⁶Jilin University, Changchun, China
• ⁷The Aga Khan University, Karachi, Pakistan

In Pakistan, hepatitis B virus (HBV) and hepatitis D virus (HDV) infections remain a major concern. This study assessed the self-reported prevalence, vaccination status, knowledge, risk factors, attitude, and behavioral practices related to both viruses in Pakistan, along with the impact of stigma and cultural norms on disease perception and management. A cross-sectional study was conducted using an online survey, and the data was collected from 980 general Pakistani public (mostly 18-34 age) from January 15 to March 15, 2025. Among respondents, 79.2% were male and 20.8% female, while 58.5% did not know hepatitis (p > 0.05). Only 7.3% reported HBV/HDV self-reported diagnosis, lower than previous studies (16.6%), but 21.3% had a family history, indicating higher self-reported prevalence (p < 0.05). Key risk factors included low vaccination coverage (26.4%, χ² = 41.17, p < 0.001), chronic infection (χ² = 16.57, p < 0.001), needle-sharing (9.2%), unlicensed dental (10.6%) and medical (19.3%) procedures, and poor glove usage (14.8%) (p < 0.05). Limited public awareness (35.1%) was noted as the major barrier, while 38.4% of respondents acknowledged the presence of stigma. Participants lack adequate knowledge, gaps in vaccination, risky practices, and stigma persist. A comprehensive public health approach is essential to curb HBV/HDV in Pakistan.