The National Burden of Hepatitis B Among Blood Donors in Pakistan: A Systematic Review and Meta-Analysis (1991-2025)

Abstract

Introduction: Hepatitis B virus (HBV) infection remains one of the most significant global health challenges, capable of causing both acute and chronic liver disease.

Objective: This systematic review and meta-analysis aim to assess the burden of HBV among blood donors in Pakistan from 1991 to 2025, offering insight into the epidemiology and regional disparities in the prevalence of the virus.

Methodology: The protocol for this systematic review was registered with PROSPERO under the registration CRD420251183056. A comprehensive literature search was carried out across multiple electronic databases, including PubMed, Scopus, ScienceDirect, Web of Science, Embase, PakMediNet, Google Scholar, and the Cochrane Library. The search covered the period from January 1991 to November 2025. A standardized data extraction form was developed to ensure uniformity.

Results: A total of 137 records representing 139 unique studies were included in the review. The overall pooled prevalence of HBV among blood donors in different provinces and regions of Pakistan, based on the 35 years of data from 1991 to 2025, was 1.10% (110,126 positives out of 10,015,962 samples). Among the 139 studies, 132 (94.96%) screened for HBsAg, while 7 (5.04%) screened for HBV DNA. There was a consistent decline in HBV seroprevalence from above 4% in the 1990s to around 1% in recent years (2021-2025). Marked regional disparities persist across Pakistan, with Gilgit-Baltistan (3.63%) and Khyber Pakhtunkhwa (2.07%) exhibiting higher HBV prevalence.

Conclusion: The collective evidence from 139 studies indicates a steady epidemiological transition from intermediate toward a low endemicity of HBV among Pakistan’s donor population.