Role of Islamic teachings in prevention of chronic Hepatitis B and C
Prof. Najib ul Haq
MRCP(UK ),FRCP (Edin),FRCP (Glasg), MACG (USA
GLOBAL EPIDEMIOLOGY
Viral Hepatitis is one of the major global problems of health. According to the WHO reports about 350 million people are carrying hepatitis B virus in their blood and 170 million suffer from hepatitis C which comprise 3% of the World population.1 The number of people exposed to hepatitis B at some stage of their life may be two billion2
Their effects on humans range from sub-clinical infections and acute hepatitis to chronic liver diseases like cirrhosis liver and hepatocellular carcinoma. Inspite of recent advances in their detection and treatment, they continue to be a major public health problem. Both viruses cause the same type of clinico-pathological syndromes of liver disease and although fulminant hepatic failure is relatively common in HBV infections, chronic liver disease is much common in HCV infections.
SPREAD AND TRANSMISSION
There are many types of viruses causing hepatitis and these can be grossly grouped into the following;
a: Transmitted through foeco oral route (hepatitis A and E )
b: Parentally transmitted (Hepatitis B, C, D and G)
Hepatitis A and E are usually self-limiting and sometimes lead to acute serious sequellae in certain clinical situation but there are no chronic sequellae. However Hepatitis B and C virus can carry on in the body after an acute episode and in many cases become chronic with major serious clinical complications like cirrhosis and hepatocellular carcinoma. These chronic problems are the man cause of concern for health professional today. Ironically the transmission of these viruses can be prevented by understanding and thus avoidance of the factors responsible for transmission. I shall concentrate only on transmission factors of hepatitis B and C and the role of Islamic teachings in their prevention.
Research on routes of spread has revealed the percutaneous exposure as the most important mean of acquisition of Hepatitis B and C viruses. Transfusion of contaminated blood and blood products3, use and sharing of contaminated needles by injecting drug users and tatooists4, surgical procedures and use of non-disposable syringes by local practitioners5,6, have all been implicated as risk factors for transmission. Non-percutaneous routes such as perinatal2 and sexual transmission7 are more important in HBV than HCV transmission. However there is a definite risk of HCV infection by perinatal transmission and through sexual exposure8. The risk of HCV acquisition in this way is also supported by finding of HCV RNA in the semen of infected men9 and HCV RNA sequence homology in sexual partners and spouses10.
The risk factors for transmission of Hepatitis B and C depend on the social behavior and cultural norms of a society and thus vary from one country to another. In Muslim countries like Pakistan the major risk factor is repeated use of injections11 for common illnesses, while addiction and sexual transmission may be very important risk factors in USA, where sexual behavior indicates more than 10 partners in 30-34% all age groups and more than 50 partners in 4%12 Similarly blood transfusion is a major risk factor in developing countries because of the poor blood screening programs while it has become almost insignificant in Western countries and USA due to effective blood screening prior to transfusion.13 Addiction may not be very significant risk factor in our society while it may be very important in Western and particularly American society where overall Cocaine use at some stage of life is about 14% and may be still higher (22%) in the younger age group of 25-29 years and use of Marijuana 45% at some stage of life while more than 100 times in 17% population in the age group of 30-39 years12.
The overall factors of transmission of hepatitis B and C can be summarized as under14
Repeated use of injections (particularly addicts)
Blood transfusion
Tattooing
Accidental exposure to contaminated blood through sharps (needles, knives etc)
Sexual transmission (specially sexual promiscuity and homosexual behavior)
These risk factors can be grouped under two main headings.
Parental transmission. Primarily from exposure of skin or mucosa to contaminated blood through sharps including needle stick injuries and sharps (contaminated dental / surgical instruments and barbers blades/knives etc) sharing tooth brushes, vertical transmission and tattooing etc.
Sexual transmission through exposure of mucosa to contaminated secretions or blood from infected Individuals.
PREVENTION
Vaccination plays a measure role against prevention of hepatitis B but till this time vaccine could not be developed against hepatitis C, because of the structural characteristics of this virus. However adopting measures to void risk factors of transmission can be of utmost importance in the prevention of these viruses.
Muslim can play a major role in preventing the spread of hepatitis by preaching and practicing the teachings of Islam. Most of the major risk factors listed above are preventable. If we ask our public to practice Islamic principles it will have a tremendous impact on prevention of these deadly diseases. It will not only help us in this world but Allah will also reward us for this on the day of judgment. Allah loves his creation (human beings) so much that he declared in Quran;
-----وَمَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَا النَّاسَ جَمِيعًا
----and if any one saved a life, it would be as if he saved the life of the whole people15.
This Ayah does not mention of saving a Muslim only but saving a human being, be a Muslim or a Non Muslim. We should propagate our message about preventing hepatitis. If this message reaches to some people and practiced by only few of them, it will prevent hepatitis and save at least few human lives. Allah will reward us for this act of saving His creatures. The Prophet Muhammad (SAW) also said,
" Whosoever removes the pain and trouble of another believer, Allah will remove his trouble on the Day of Judgment.” 16 He also said " Whosoever makes things easier for a poor and a needy person, Allah will make things easier for him in this world as well as in the Hereafter." 17
If we work with this spirit and save human life, Allah will reward us in both the Worlds.
In the following lines I will discuss the risk factors of transmission of hepatitis and the importance of Islamic principles in their prevention. This will be discussed under two main headings of parental and sexual transmission.
A: Parental Transmission
1: Repeated use of injections or reuse of injections. Even when small amount of blood from an infected individual on a used needle is injected into another person (by injecting him with that needle or syringe) hepatitis can be transmitted to him. It may be as little as one thousand part of a blood drop. Repeated use of injections obviously increases this risk 18. Our prophet Muhammad (SAW) has s forbidden the use of excessive medications. He (SAW) said, "Leave aside medicines as long as you can manage without it." 19
When compared to the oral medication, injectible route would delivers maximum amount of medicine to the body. One should therefore try to use oral medications as much as possible and injections should only be used in unavoidable clinical situations where oral medications cannot be given due to the seriousness or urgency of situation. This clinical practice would be in line with the guideline set in the above Hadith of the prophet where the prophet advised to use the minimum amount of medication.
He has also forbidden the use of Khabith medicines
" The Holy Prophet has prohibited people from using Khabith (i.e. expired and prohibited)
medicines." 20
“Khabith” medicine is any substance that is used for treatment having a significant potential to harm the individual using it. It may be a toxic medicines or a contaminations e.g. from reuse of contaminated syringes and blood or blood products infected with hepatitis B or C.
2: Tattooing: One other important factor in transmission is tattooing because a contaminated needle or instrument from an infected person can transmit the disease to healthy person getting tattooed with the same needle or instrument. The prophet has forbidden tattooing and declared it “Haram.” There are many sayings (Ahadiths) of the Holly prophet in this regard and some are quoted as reference below from “Sahih Bukhari,” which is considered to be the most authentic book of the Sayings (Ahadith) of the prophet Muhammad (SAW)
Narrated Abu Huraira 21
A woman who used to practice tattooing was brought to 'Umar. 'Umar got up and said, "I beseech you by Allah, which of you heard the Prophet saying something about tattooing?" l got up and said, "O chief of the Believers! l heard something." He said, "What did you hear?" I said, "I heard the Prophet (addressing the ladies), saying, 'Do not practice tattooing and do not get yourselves tattooed.'"
Narrated 'Abdullah 22Allah has cursed those women who practice tattooing
Narrated Abu Juhaifa 23
The Prophet forbade the use of the price of blood and the price of a dog, the one who takes (eats) usury the one who gives usury, the woman who practices tattooing and the woman who gets herself tattooed.
Narrated Abu Huraira 24
The Prophet said, "The effect of an evil eye is a fact." And he prohibited tattooing
3. Addiction Main line addicts have very high prevalence of Hepatitis B and C and they significantly contribute to the pool of chronic hepatitis n the West and America
يَا أَيُّهَا الَّذِينَ آمَنُواْ إِنَّمَا الْخَمْرُ وَالْمَيْسِرُ وَالأَنصَابُ وَالأَزْلاَمُ رِجْسٌ مِّنْ عَمَلِ الشَّيْطَانِ فَاجْتَنِبُوهُ لَعَلَّكُمْ تُفْلِحُونَ
O ye who believe! Intoxicants and gambling, (dedication of) stones, and (divination by) arrows, are an abomination, of Satan's handwork: eschew such (abomination) that ye may prosper.
However the prophet Muhammad has clarified, that all intoxicants are Haram (absolutely forbidden). He said: " Every intoxicant is khamr, and every khamr is haram." Umar, the second Khalifah of the Prophet, declared from the pulpit of the Prophet: "Khamr is that which befogs the mind."
This issue has been decisively addressed in the following Ahadith of the prophet (SAW) Narrated Aisha: 26
The Prophet said, "All drinks that produce intoxication are Haram (forbidden to drink).
Narrated Abi Burda 27
That Abu Musa Al-Ash'ari said that the Prophet had sent him to Yemen
B: Sexual Transmission:
Prostitutes and homosexuals are important sources of carrying hepatitis B and C viruses and transmitting it to others. Although this may not be very important cause of transmission in our society but it is a major cause in West and America .
1. Prostitution: Prostitutes are one of the main source of spreading the disease because they have one of the highest. 28, 29 carrier rate of Hepatitis B and C and also HIV. It varies from 9-12%30. Islam does not allow prostitution and strongly condemns it as clearly evident from the following Hadith.
Narrated Aun bin Abu Juhaifa 31
“……. He replied, "Allah's Apostle prohibited taking money for blood, the price of a dog, and the earnings of a slave-girl by prostitution; he cursed her who tattoos and her who gets tattooed, the eater of Riba (usury), and the maker of pictures."
Islam forbids sex with a women other than wife and discourages and warns not even to get indulge in activity which might lead to abnormal sexual temptations and thus a risk of involvement in adultery.
Sexual contact with a person other than wife is forbidden in Islam.
In Quran it is stated 32
وَلاَ تَقْرَبُواْ الزِّنَى إِنَّهُ كَانَ فَاحِشَةً وَسَاء سَبِيل
Nor come near to adultery: for it is a shameful (deed) and an evil, opening the road (to other evils).
In another Surah the good sexual behavior of people is described as a standard of human “success” in the eyes of Allah and those who cross the prescribed limits, are labeled as transgressors
1. قَدْ أَفْلَحَ الْمُؤْمِنُون The believers must (eventually) win through,
5 وَالَّذِينَ هُمْ لِفُرُوجِهِمْ حَافِظُون َ Who abstain from sex
6. إِلَّا عَلَى أَزْوَاجِهِمْ أوْ مَا مَلَكَتْ أَيْمَانُهُمْ فَإِنَّهُمْ غَيْرُ مَلُومِينَ
Except with those joined to them in the marriage bond, or whom their right hands possess, for (in their case) they are free from blame,
7. فَمَنِ ابْتَغَى وَرَاء ذَلِكَ فَأُوْلَئِكَ هُمُ الْعَادُون.َ
But those whose desires exceed those limits are transgressors
The prophet Muhammad (SAW) also stresses on the issue. In Sahih Bukhari, Ibn Abbas quoted a Hadith from the prophet (SAW) 33
“I have not seen a thing resembling 'lamam' (minor sins) than what Abu Huraira 'narrated from the Prophet who said "Allah has written for Adam's son his share of adultery which he commits inevitably. The adultery of the eyes is the sight (to gaze at a forbidden thing), the adultery of the tongue is the talk, and the inner self wishes and desires and the private parts testify all this or deny it."
2. Homosexuality. It is well known that homosexual behavior is a major risk factor in transmission of hepatitis B and C. Chronic hepatitis B and C are more common in Guy men when compared with general population.34 This behavior also, leads to transmission of other diseases including STDs and HIV 35
Islam strongly condemns homosexuality. In Quran it is stated 36
وَلُوطًا إِذْ قَالَ لِقَوْمِهِ أَتَأْتُونَ الْفَاحِشَةَ مَا سَبَقَكُم بِهَا مِنْ أَحَدٍ مِّن الْعَالَمِين- إِنَّكُمْ لَتَأْتُونَ الرِّجَالَ شَهْوَةً مِّن دُونِ النِّسَاء بَلْ أَنتُمْ قَوْمٌ مُّسْرِفُونَ
"We also sent Lut : He said to his people : "Do ye commit lewdness such as no people in
creation (ever) committed before you? For ye practice your lusts on men in preference to women: ye are indeed a people transgressing beyond bounds.
In another Ayah Allah says, 37
أَتَأْتُونَ الذُّكْرَانَ مِنَ الْعَالَمِين- وَتَذَرُونَ مَا خَلَقَ لَكُمْ رَبُّكُمْ مِنْ أَزْوَاجِكُم بَلْ أَنتُمْ قَوْمٌ عَادُونَ
"Of all the creatures in the world, will ye approach males and leave those who Allah has created for to be your mates, Nay ye are a people transgressing (all limits)
Prophet Muhammad (SAW) also condemns this abnormal behavior. Two Ahadith are quoted below as example;
"When a man mounts another man, the throne of God shakes."
"Kill the one that is doing it and also kill the one that it is being done to." (in reference to the active and passive partners in gay sexual intercourse)
3. Abnormal sexual behavior
Anal sex is also strictly forbidden in Islam and it has been equated to sodomy. Few Ahadith are quoted below to explain this;
Hazima bi Sabit narrated. …from Muhammad (SAW)
“Do not perform anal sex with your wives” (quoted in Althirmizee. Nisaee and Masnad Ahmad)
The one who performs sex with a menstruating woman or did an anal sex it is as if he does not accept the teaching (Shariat) of Muhammad (SAW) (Quoted in Masnad Ahmad)
The risk of transmission is understandably more when there is damage to the normal mucosal linings of an organ or damage to the intact skin. Therefore the risk of transmission will be more in case of intercourse during the menstrual period. Islam has forbidden intercourse during this period. 38
وَيَسْأَلُونَكَ عَنِ الْمَحِيضِ قُلْ هُوَ أَذًى فَاعْتَزِلُواْ النِّسَاء فِي الْمَحِيضِ وَلاَ تَقْرَبُوهُنَّ حَتَّىَ يَطْهُرْنَ فَإِذَا تَطَهَّرْنَ فَأْتُوهُنَّ مِنْ حَيْثُ أَمَرَكُمُ اللّهُ إِنَّ اللّهَ يُحِبُّ التَّوَّابِينَ وَيُحِبُّ الْمُتَطَهِّرِينَ
They ask you concerning women's courses. Say: They are a hurt and pollution: So keep away from women in their courses, and do not approach them until they are clean. But when they have purified themselves, ye may approach them in any manner, time, or place ordained for you by Allah. For Allah loves those who turn to Him constantly and He loves those who keep themselves pure and clean.
These are some of the basic teachings of human behavior in Islam. It is clearly evident from these Islamic teachings that following and propagating these principles can not only protect human beings from deadly diseases like hepatitis B and C but also safeguard them against AIDS and other disease sharing similar routes of transmission.
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4. Seal KH, Edlin SR, Ochoa KC, Tulsky JP, Moss AR San Francisco ; opportunities for intervention. West J Med 2000; 172:16-20.
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8. Rooney G, Gilson RJ. Sexual transmission of hepatitis C Virus. Sex Transm Infect 1998; 74:399-404.
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10. Ackerman S, Ackerman C, Paltiel O. Intrafamilial spread of hepatitis C virus; a systemic review. J Viral Hepat 2000; 7: 93-103.
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hepatitis-an analysis with first and second generation assays N Engl J Med 1991;325:1325-9.
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Rizzetto M. Epidemiological and clinical burden of chronic hepatitis B virus / hepatitis C virus infection. A multicenter Italian study. J Hepatol. 2003 Dec;39(6):1036-41.
15 Quran 5:32
16 Abu Daud, Adab Bab al-Muwakhat
17 Abu Daud, Adab Fial-Ma'unah lil Muslim.
18. Yazdanpanah Y, Boelle PY, Carrat F, Guiguet M, Abiteboul D, Valleron AJ
Risk of hepatitis C virus transmission to surgeons and nurses from infected patients: model-
based estimates in France
19 Tibbi Nabawi 18 FF
20. Ibn Maja al-Tibb, Bab al Nahy 'an al-dawa' al-Kabith.
21. Sahih Bukhari 007.072.830-Dress….
22. Sahih Bukhari 007-072-832 Dress - - - -
23. Sahih Bukhari 007.072.829 Dress----
24. Sahih Bukhari 007.071.636- Medicine---
25. Quran 5:90
26. Sahih Bukhari 001-004-243 Ablutions (Wudu') - - - -
27 Sahih Bukhari 005.059.631: Military Expeditions led by the Prophet (pbuh) (Al-Maghaazi) –
28. Othman BM, Monem FS Prevalance of hepatitis C virus antibodies among intravenous drug
abusers and prostitutes in Damascus, Syria Saudi Med J 2003 Jul:24 Suppl 2:S136-S137
29. Helen Ward, Sophie Day, Jonathan Weber. Risky business: health and safefty in the sex
industry over 9 years period Sex Transm Infect 1999,75:340-343
30. Huo TI, Wu JC, Chang AL et al Changing seropositivity of hepatitis B, C and D virus
infections in high risk populations J Med Virol. , 2004; 72:41-45 (Medline PMID: 14635009)
31. Sahih Bukhari 003.034.440- Sales and Trade---
32. Quran 23: 1-7
33. Bukhari 008.074.260 Asking permission----
34. Yee LJ, Rhodes SD. Understanding correlates of hepatitis B virus vaccination in men
who have sex with men: what have we learned. Sex Transm Infect 2002;78:374-377
35. Remis RS, Dufour A, Alary M, et al. Association of hepatitis B virus infection with other
sexually transmitted infections in homosexual men. Omega Study Group. Am J Public
Health 2000;90:1570-4
36. Quran 7:80
37. Quran 26:165
38. Quran 2:222
Note: All translation of Ayah are taken from Quran translation by Abdullah Yousaf Ali
The author is a retired professor of Medicine, sitting president Pakistan Society of Gastroenterology and GI Endoscopy, President Pakistan Liver Foundation, Convener Gastroenterology, Pakistan Medical Research Council Pakistan, Examiner Fellowship examination College of Physician and Surgeons Pakistan and PhD Molecular Biology Punjab University Pakistan.
E mail najib@prime.edu.pk
Fax: 092-91-5200980
Postal Address: Principal Peshawar Medical College
egal sA � s f pT � is therefore one that is equally espoused by Islamic traditions…THE FORM OF AN ISLAMIC FEMINISM: If the goals of Western feminism are
not viable for Muslim women, what form should a feminist movement take to ensure success?
Above all, the movement must recognize that, whereas in the West, the mainstream of the women's movement has viewed religion as one of the chief enemies of its progress and well-being, Muslim women view the teachings of Islam as their best friend and supporter. The
prescriptions that are found in the Qur’an and in the example of the Prophet Muhammad, (Peace and blessings of God upon him), are regarded as the ideal to which contemporary women wish to return. As far as Muslim women are concerned, the source of any difficulties experienced today is not Islam and its traditions, but certain alien ideological intrusions on our societies, ignorance, and distortion of the true Islam, or exploitation by individuals within the society. It is a lack of an appreciation for this fact that caused such misunderstanding and mutual distress when women's movement representatives from the West visited Iran both before and after the Islamic Revolution.
Second, any feminism which is to succeed in an Islamic environment must be one which does not work chauvinistically for women's interest alone. Islamic traditions would dictate that women's progress be achieved in tandem with the wider struggle to benefit all members of
the society. The good of the group or totality is always more crucial than the good of any one sector of the society. In fact, the society is seen as an organic whole in which the welfare of each member or organ is necessary for the health and well being of every other part.
Disadvantageous circumstances of women therefore should always be countered in conjunction with attempt to alleviate those factors which adversely affect men and other segments of the society.
Third, Islam is an ideology which influences much more than the ritual life of a people. It is equally affective of their social, political, economic, psychological, and aesthetic life. "Din," which is usually regarded as an equivalent for the English term "religion," is a concept which includes, in addition to those ideas and practices customarily associated in our minds with religion, a wide spectrum of practices and ideas which affect almost every aspect of the daily life
of the Muslim individual. Islam and Islamic traditions therefore are seen today by many Muslims as the main source of cohesiveness for nurturing an identity and stability to confront intruding alien influences and the cooperation needed to solve their numerous contemporary problems. To fail to note this fact, or to fail to be fully appreciative of its importance for the average Muslim – whether male or female - would be to commit any movement advocating
improvement of women's position in Islamic lands to certain failure. It is only through establishing that identity and stability that self-respect can be achieved and a more healthy climate for both Muslim men and Muslim women will emerge…”
From “Muslim Women’s Rights in the Global Village: Challenges and Opportunities,”
Azizah Yahia al-Hibri, Fellow, National Humanities Center, University of Richmond Law Professor. This article was reprinted by permission of the Journal of Law and Religion and is posted online on the Karamah Muslim Women for Human Rights web site at http://www.karamah.org
“…Introduction
In this age of information technology that shrank our world into a global village, it is fair to ask how this recent development has impacted Muslim women’s rights across the world. Having just traveled through nine Muslim countries, ranging from Pakistan and Bangladesh to the Gulf States, Egypt, Syria, and Lebanon, I would answer that it is leading, slowly but surely, to reassessment and change. Attempts to accelerate the pace of this change, however, without full understanding of its complex topology, and the deep-rooted commitment by most Muslim women to spiritual and cultural authenticity, could halt or even reverse this process at great cost to women particularly and Muslim societies as a whole. Hence the challenges and opportunities.
Pious Muslim women are generally bewildered by the laws and judicial systems of their societies, which are supposed to be Islamic. It is well understood that the hallmark of Islam is justice. Yet Muslim societies have been dispensing injustices to women in the name of Islam. Some women seeking divorce in Islamic courts have been trapped within the system for years. On the other hand, divorce and remarriage have been rendered much easier for men. Also, various Shari’ah (Islamic law) protections for women in case of an unhappy marriage, divorce, or custody have been ignored even by the women’s own families. While Western feminists have been focusing on such issues as the veil and the perceived gender discrimination in the laws of inheritance, Muslim women I spoke to did not regard these issues as important. They were more interested in re-examining family law and in the proper application of all Islamic laws, including the laws of inheritance as they stand. In short, Muslim women want a more just understanding of and adherence to Islamic principles. They appear to believe that existing laws and practices are not conducive to a happy home life or a just society. Surprisingly, Muslim women have the support of many Muslim male jurists who share their concerns.
Several factors have forced Muslims to reassess the status quo. The colonization experience, wars, Western education and Western modes of communication have been primary among these factors. Colonization exposed the soft underbelly of the indigenous systems of governance, while at the same time challenging and marginalizing the Muslim individual’s religious beliefs and cultural values. Wars dislodged established social structures, especially those relating to the family. Finally, through the twin lenses of Western education and modes of communication such as satellite television and the Internet, Muslim men and women are experiencing instantaneously, though vicariously, the post-colonial Western worldview and Western ways of life. Generally, they like a good part of what they see, such as democratic governance, freedom of speech, independent women, and comfortable technologically advanced societies. There are other things, however, they decidedly do not like, such as sexual permissiveness, the accelerating divorce rate, growing violence in society, especially among the youth, and the treatment of the elderly.
Consequently, many Muslims, male and female, are struggling today with the following questions: How do they introduce progress into their societies, while at the same time protecting their deep-seated spiritual beliefs and cultural identities, two valuable foundations that colonialism tried unsuccessfully to destroy? How can they benefit from the Western experience, including its recognition of the legitimate rights of women, without inadvertently destroying their highly valued familial ties? In this context, the experience of those North American Muslims who have successfully integrated their religious beliefs and ethnic heritage with the American and Canadian ways of life becomes very valuable. It is a living proof of the fact that Islam is not a mere “Oriental” religion, but a world religion which is capable of meeting the needs of Muslims in all historical eras and all geographical locations…”
[Original footnotes can be read at http://www.karamah.org/images/pdf_doc/JLRal-HibriFin.doc]
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