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

Abstract

Background: <i>Helicobacter pylori</i> infection has been reported to affect more than half of the global population. The persistence of <i>H. pylori</i> infection results to chronic gastritis and peptic ulcer disease. Despite this burden there is limited published studies regarding proportion of <i>Helicobacter pylori</i> 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 <i>Helicobacter pylori </i>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 <i>H. pylori </i>infection as evidence by positive stool antigen test. Independent factors associated with <i>H. pylori</i> 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 <i>H. pylori</i> 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 <i>H. pylori</i> infection was 105 (24.9%). More than half of the participants (56.4%) were males. The risk of <i>H. pylori</i> 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 <i>H. pylori.</i> 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 <i>H. pylori</i> infection. Increase in age and abdominal pain were independently associated with <i>H. pylori</i> infection. Most <i>H. pylori</i> stool antigen test positive children had endoscopic lesions that warranted treatment. Therefore every <i>H. pylori</i> stool antigen test positive child needs eradication therapy.