Epidemiology of and Factors Associated with Helicobacter Pylori Infection and Proportion Requiring Treatment Among Symptomatic Children in Northwestern Tanzania

Abstract

Background: Helicobacter pylori infection has been reported to affect more than half of the global population. The persistence of H. pylori infection results to chronic gastritis and peptic ulcer disease. Despite this burden there is limited published studies regarding proportion of Helicobacter pylori infected children that require treatment in many settings in low and middle-income countries (LMICs). Therefore this study aimed to determine the epidemiology of and factors associated with Helicobacter pylori infection and proportion requiring treatment among symptomatic children in northwestern Tanzania. Methodology: This was a hospital based cross-sectional study conducted at BMC hospital in Northwestern Tanzania from December 2021 and April 2022 among outpatient children aged 1 to 15 years with gastrointestinal symptoms. The main study outcome (event) was presence of H. pylori infection as evidence by positive stool antigen test. Independent factors associated with H. pylori infection were determined by logistic regression model. The significance level was set at p-value of <0.05. Oesophagogastroduodenoscopy (OGD) was performed to the randomly serially selected representative sample of symptomatic children with positive H. pylori stool antigen test to determine the proportion of children requiring treatment. Results: A total of 422 symptomatic children were included in the study. The median age was 7 [IQR 3 – 10] years. The prevalence of H. pylori infection was 105 (24.9%). More than half of the participants (56.4%) were males. The risk of H. pylori infection was significantly associated with increase in age (OR= 1.09; 95%CI; 1.03 – 1.15; P= 0.002), and abdominal pain (OR=2.2; 95%CI 1.2 – 4.0; P= 0.01). About 55 participants were randomly selected for OGD among 100 children above or equal 2 years of age with positive stool antigen for H. pylori. The majority were found to have lesion warranting treatment. These lesions included gastritis 47 (85.5%), duodenal ulcers 2 (3.6%) and gastric ulcers 1 (1.8%). Conclusion: About a quarter of the enrolled children had H. pylori infection. Increase in age and abdominal pain were independently associated with H. pylori infection. Most H. pylori stool antigen test positive children had endoscopic lesions that warranted treatment. Therefore every H. pylori stool antigen test positive child needs eradication therapy.