Prevalence of Helicobacter pylori infection during pregnancy and influence on the pregnancy anemia intervention package in Uganda among mothers at Kawempe Health Centre
Baingana, Rhona Kezabu
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The National Anemia Policy (2002) specifies an intervention package for anemia in pregnancy which consists of iron and folic acid supplementation, and malaria and hook worm control. However, the prevalence of anemia in pregnant women in Uganda at 31% remains a public health problem. Evidence suggests that Helicobacter pylori infection should be considered together with malaria, gastrointestinal parasites and other infections as a cause of anemia. This study aimed to determine the impact of H. pylori infection on the efficacy of the intervention package for anemia in pregnancy in Uganda. Study 1 used a cross-sectional design to describe the epidemiology of H. pylori infection in pregnant women in Uganda. The prevalence of H. pylori infection assessed by the stool antigen test among 447 pregnant women attending antenatal care clinics in Apac, Mbale, Mbarara and Rakai Districts and at Kawempe Health Centre (KHC) was 45% but varied from 18% in Apac to 60% at KHC. H. pylori infection was independently associated with enrolment at clinics not in Apac (OR=5.68; 95% CI: 3.02-10.7) and with using water from public wells, boreholes or springs (OR=3.20; 95% CI: 1.19-8.61) and from rivers, lakes or streams (OR=5.20; 95% CI: 1.58-17.05). Rural residence (OR=0.60; 95% CI: 0.4-0.92) and education (OR=0.51; 95% CI: 0.27-0.97) each had an independent negative association with H. pylori infection. The unexpected variation of H. pylori infection by geographical location calls for further study of the epidemiology of H. pylori infection in the region and offers an opportunity to study the transmission dynamics of H. pylori infection. Study 2 used a longitudinal design to determine the impact of H. pylori infection on the efficacy of the maternal anemia control package. A total of 151 primi-and secundi gravidae attending antenatal care at KHC were enrolled in their first trimester of pregnancy; 76 and 52 mothers returned for follow-up assessments in the 2nd and 3rd trimesters. At baseline, the prevalence of H pylori infection was 70.2% (95% CI: 62.9, 77.5) and was not associated with anemia. Of the mothers with anaemia at baseline (N=44), 32 (73%) did not have iron deficiency (ID) and 32 (73%) had raised C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP). H. pylori infection did not influence the response to the maternal anemia control package in this sample of pregnant women who were not severely anaemic. Over the study period mean hemoglobin reduced by 1.73 g/dL (95% CI: -2.94, -0.53) among women with malaria parasites relative to women without malaria parasites, and increased by nearly 1g/dL (95% CI: 0.10-1.82) among women with adequate iron stores compared to those with inadequate iron stores. These findings underscore the continuing need to prevent and control malaria and to address iron deficiency during pregnancy. The finding that over half of the mothers with anaemia did not have iron deficiency has implications for current strategies to prevent and control anaemia in pregnancy with infection/inflammation being a major consideration. A possible role for Helicobacter pylori in severe anemia should be explored.