Prevalence and factors associated with helicobacter pylori infection among children aged one month to twelve years in Mulago hospital

Abstract

BACKGROUND: Helicobacter pylori infection is currently estimated to affect at least half of the world’s population and is mostly acquired in early childhood. The magnitude of this infection among children in Uganda remains largely unknown. This study was conducted to assess the prevalence of H. pylori infection and to determine the clinical, socio demographic and environmental factors associated with this infection among children admitted to mulago national referral hospital in Uganda. METHODS: This cross-sectional study was carried out in the acute care unit and paediatric wards of mulago hospital. Between December 2007 and February 2008, a total of three hundred ninety six children aged one month to twelve years were randomly selected to take part in the study. Three hundred and ninety of these children whose caretakers gave informed consent were enrolled in the study. Data on socio demographic, environmental and clinical characteristics and physical examination of each participant was collected using a standardized questionnaire. HIV testing was done for children of unknown status and CD4+ cell counted determined for HIV positive children. Stool from each participant was tested for H. pylori antigen using a rapid monoclonal anti-body based enzyme immunoassay (Rapid strip HpSA, Meridian Diagnostic). Three hundred and eighty four of the children whose stool was obtained for testing were included in the final analysis of this study. The primary outcome assessed was the result of the stool test and secondary outcomes assessed were the factors associated with H. pylori infection. Data was analysed using SPSS version 11.5 software. A chi-squared test was performed for bivariate analysis and logistic regression was done to assess factors independently associated with H. pylori infection in the population studied. RESULTS: Out of 384 children, 246 (64.1%) had H. Pylori infection. On multivariate analysis the factors found to be independently associated with H.Pylori infection were; Presence of wasting (AOR 0.57; 95% C1:0.34-0.95); Presence of persistent diarrhoea (AOR 4.44; 95% C1: 1.68-11.71), and the father being alive (AOR 7.17; 95%C1:1.37-37.61). Presence of diarrhoea and recent use of antibiotics effective against H. pylori were only significantly associated with H.pylori infection on bivariate analysis. CONCLUSION: H.pylori infection was highly prevalent (64.1%) among children admitted to ,ulago hospital. Factors independently associated with H. pylori infection were presence of wasting which was associated with lower prevalence of infection and; presence of persistent diarrhoea and the father being alive which were both associated with higher prevalence of infection. RECOMMENDATIONS: H. pylori infection should be considered and looked for among children who present with persistent diarrhoea. Given the high prevalence of H. pylori infection, local studies should be carried our to assess the clinical outcomes and impact of treating H. pylori infection in children in order to provide clinicians with guidelines for screening and treatment of childhood H. pylori infection in Uganda. Population based studies to assess the national magnitude and factors responsible for the high prevalence should be carried out to guide in appropriate prevention measures.