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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Open Access  Full Text Article                                                                                                                                                     Research Article

Assessment of Helicobacter pylori Infection and Associated Risk Factors in Asymptomatic Patients Attending Muhoza Health Center

ISHIMWE Alain Prudence *, TUYISHIME Jean de Dieu, UWAMAHORO Consolée, NZEYIMANA Godefroid, MIGABO Hiberte

Ines-Ruhengeri, Faculty of Applied Fundamental Sciences, Department of Biomedical Laboratory Sciences, Rwanda

 

 

INTRODUCTION

Helicobacter pylori, is a bacterial pathogen that colonizes the gastric mucous lining and the epithelial tissue of the stomach. The bacterium is known to cause gastric cancer 50% of the world’s population is infected by H. pylori and the frequent cause of chronic bacterial infection is blamed on H. pylori1¹. Diseases such as duodenal ulcers, gastric ulcers, adenocarcinoma of the distal stomach, mucosa-associated lymphoid tissue (MALT) lymphoma, diabetes mellitus, cardiovascular disease and autoimmune disease can be caused by H. pylori ². The organism can be transmitted through poor sanitation, which is one of potential risk factors with house flies transmitting the infection mechanically. Use of water contaminated with faeces, use of endoscope tubes and person to person transmission have been reported to predispose people to Helicobacter Pylori³.   H. pylori can be diagnosed through invasive and non-invasive techniques such as using stool to detect antigen and serological test to detect antibody. The fact that Helicobacter pylori differ genetically, it develops antibiotic resistance to several antibiotics and can survive in acidic environment⁴. Globally Helicobacter pylori infection is one of the major public health problems causing chronic gastritis and peptic ulcers, gastric ulcers and associated carcinoma. Despite of the measures taken, H. pylori remain a common bacterial pathogen infecting 70–90% of the population in developing countries, and 50% in developed countries⁵. In Rwanda, the overall prevalence of H. pylori infection was 77.5% between 2016 and 2018 and 80% of these, had chronic gastritis while 76% had gastric adenocarcinoma cases⁶. Studies regarding Helicobacter pylori infection based on stool antigen among asymptomatic patients in Rwanda are scarce to none. Additionally, people may asymptomatically be carrying H.pylori infection and this can prevent early treatment before advancement and spreading of the infection. This study was attempted to assess Helicobacter pylori infection and associated potential risk factors in asymptomatic patients at Muhoza health center, Rwanda.

METHODS

Study Setting and Design

A cross-sectional study, was carried out at Muhoza health center, in Musanze District, Muhoza sector and was restricted in immunoserology section at Muhoza health center.

Data Collection

The study involved both male and female patients with no history of Helicobacter pylori infection who are above 5 years old attending Muhoza health center. 60 study participants who had no symptoms of gastritis, or not having gastric ulcers and/or duodenal ulcers were included. Children below 5 years of age and Patients who were on treatment for ulcers, using drugs like proton pumps inhibitory and antibiotics within the last seven days before the study were excluded. During the study period, patients without gastritis symptoms were given clean, dry, stool containers without any preservatives and instructed to put stool sample for H. pylori testing and also not to contaminate the sample.  Stool samples from study participants were directly taken to the laboratory to be analysed immunoserologically.

Helicobacter pylori stool antigen detection  

The H.pylori Ag rapid test cassette (faeces) is lateral flow chromatographic immunoassay based on the principle of the double antibody-sandwich technique.  The test cassette consists of 1; a burgundy colored conjugate pad containing H.pylori antibodies conjugated with color particle , a nitrocellulose membrane strip containing a test band (T band) and a control band (C band). The T band is pre-coated with non-conjugated H. pylori antibodies. When an adequate volume of test specimen is dispensed into the sample well of the cassette, the specimen migrates by capillary action across the cassette.  The antigen of H. pylori if present in the specimen will bind to the H. pylori antibodies conjugates. The immunocomplex is then captured on the membrane by the precoated H. pylori antibodies, forming a burgundy colored T band, indicating H.pylori antigen positive test results. To serve as a procedural control, a colored line will always appear in the control line region indicating that proper volume of specimen has been added and membrane wicking has occurred. Otherwise, the test is invalid and the specimen must be retested with another device⁷.  

Testing procedure

A liquid in the testing kit was mixed with a small portion of the stool and once there is a thorough mixture, it was poured to the sample hole on the rapid test.  The test device has “T” (Test Line) and “C” (Control Line). Both the Test Line and the Control Line in the result window are not visible before applying any samples.  “T’’ window coated with monoclonal anti-H. Pylori formed a line after the addition of the stool specimen⁸.

Ethical Considerations

An official approval letter to conduct the study was provided by Muhoza health center Director. An informed consent form was then given to the patients who were willing to participate in the study after receiving explanations about the relevancy of the study.  The information of the study participants was only used for academic purpose.

RESULTS

Socio-demographics and socio-economic characteristics of the study participants

Socio-demographic and socio-economic characteristics of the population were established in order to characterize the population (Tab.1). Out of 60 asymptomatic patients attending Muhoza health center the majority were females, with 34 (57%) and the age ranged from 5 to 70. Most study participants were in the age group of [10-20], with 32%   and the age group of >50 had the least number of participants with 5%. For education, most participants 23(38%) were in secondary school. Only 4 participants were attending university with 6.60%. Those who were attending kindergarten and primary were 5, 8% and 18, 30% respectively. According to socio-economic level, most participants were in level 1 with 22, (36 %.) A few participants (3) were in 4^th socio-economic level with 5%.  Profession wise, most of the study participants were farmers (32, 53%). The least number of participants were the students with 6.6%.

Table 1: Socio-demographics and socio-economic characteristics of the study population

The prevalence of H. pylori infection in asymptomatic patients

In this study, the prevalence of H. pylori infection was determined   and the overall prevalence was 37% (Fig. 1). The prevalence was further determined in males and females with 25% and 12% respectively.

 

 

Figure 1:  Prevalence of H. pylori among asymptomatic participants

 

Risk factors associated with H. pylori in asymptomatic participants

Risk factors associated with Helicobacter pylori infection were studied among asymptomatic patients at Muhoza health center. The risk factors were further classified into sociodemographic-socioeconomic (Tab.2) and living conditions risk factors (Tab.3).

 

 

Table 2:   Sociodemographic-socioeconomic risk factors and their association with Helicobacter pylori infection 

Socio-demographic and -economic risk factors		Number	H. Pylori positive (%)	p-value
Gender	Male	26	7(11.7)	0.171
	Female	34	15(25)
Age groups	[ 5-10 [	15	6(10)	0.019
	[ 10-20 [	19	10(16.7)
	[ 20-30 [	5	4(6.7)
	[ 30-40 [	12	2(3.3)
	[ 40-50[	6	0(0)
	>50	3	0(0)
Education	No	10	1(1.7)	0.027
	Kindergarten	5	0(0)
	Primary	18	6(10)
	Secondary school	23	12(20)
	University	4	3(5)
Socioeconomic level	1	25	10(16.7)	0.195
	2	19	9(15)
	3	16	3(5)
	4	0	0(0)
Profession	Farmer	32	13(21.7)	0.195
	Civil servant	8	2(3.3)
	Private	15	4(6.7)
	Student	4	3(5)

Table 3: Living conditions risk factors and their association with Helicobacter pylori infection.

 

 

DISCUSSION

H. pylori, is a serious pathogen that colonizes the gastric mucous lining and the epithelial tissue of the stomach leading to a range of several diseases. The prevalence for H. pylori infection was low compared to the prevalences 75% and 67.7% prevailed in the studies conducted at University Teaching Hospital of Butare, Rwanda and in Harare, Zimbabwe respectively^9,10. Difference in prevalences might be due to different study period, study area, study population, environment and testing method used. The above studies used rapid urease test while in the present study, stool antigen test was used. This study showed that the prevalence of H. pylori was higher in females than in males with 25% and 12% respectively. This is supported by the study conducted in Nigeria which revealed the higher prevalence in females than in males with 31% and 20% respectively¹¹.  This could be due to the fact that most females are usually with children who may get infected while coming in contact with infected area and also due to almost constant contact with household items that may be contaminated with H. Pylori infection. These findings are in contradiction with the study reported among Nigerian patients with dyspepsia, in Badani¹².  

Age was significantly associated with Helicobacter pylori infection (p-value 0.019). The most affected age groups were [11-20[and [5-10[. This might be influenced by the fact that children and adolescents are more exposed to contaminated food and drinks. Additionally, these children are school aged, and after commencing school, the poor hygiene and concentration at schools increase the chance of person-to-person transmission of H. pylori infection, while adolescents are active travallers and may come in contact with contaminated food in restaurants and shops selling fast foods.  These findings are similar to the results reported among asymptomatic patients at surgical outpatients department, in Harare, Zimbabwe¹⁰. Education was significantly associated with Helicobacter pylori infection with p-value 0.027. Secondary school goers were more infected than others, and this is probably due to poor hygiene and concentration at the schools, contributing to transmission of H. pylori infection. Similar results were reported in an oilfield Community in Hebei, China¹³.    

Source of water was significantly associated with H. pylori infection (p value 0.045). The highly affected participants were those who used river water. This is because river water can be contaminated with Helicobacter pylori, whose active, spiral form of H. pylori can survive in river water for at least a week, and coccoid form can survive for a year or more. This is in comparison with the study about Helicobacter pylori in the drinking water in Peru⁷. 15 Household population was significantly associated with H. pylori infection (p value= 0.001).  Higher percentage of the infection was observed in household of above 6 people in the house (30%) while lower percentage of infection (5%) was in households with 1 - 3. This was due to close interpersonal contacts and that family members share a genetic predisposition to H. pylori, making them exposed to a common source of infection and share the socio-economic status¹². Similar findings were observed among children aged 1 to 15 years at holy Innocents children’s hospital, Mbarara, south western Uganda¹⁴. 

CONCLUSION

The prevalence of Helicobacter pylori infection was high among the asymptomatic patients. Only age, education level, source of water and household population were significantly associated with having   the infection. Education of the population about prevention of the infection, clean source of water for drinking and home usage is recommended to the local government authorities  in Musanze. Screening for H. pylori infection, good adherence on antibiotics against H. pylori,proper hand washing,   and proper household settings to reduce crowding issue is recommended to the citizens. Carrying out country wide research about H. pylori infection would be very useful in order to establish  new epidemiologic data.

Acknowledgments

Our gratitude is extended to Ines Ruhengeri and Ruhengeri Muhoza health center administration for facilitating this study at their health facilities.

Conflict of interest

Authors declare no conflict of interest

Availability of raw data and material

Raw data and information on material should be obtained from the corresponding author upon request.

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