Prevalence and associated risk factors for Helicobacter pylori infection using stool antigen test among children presenting to the outpatient clinic of a tertiary hospital in Nigeria
Authors: Ikobah Joanah Moses , Uhegbu Kelechi , Ikwuagwu Elekwachi , Adedokun Funke , Akpan Francis Michael , Okwong Emem Esio , Asuquo Edet Bassey , Ekanem Emmanuel Eyo 
Published: August 2024

Objectives:
Helicobacter pylori is a ubiquitous Gram-negative spiral, flagellate bacillus organism that infects about 50% of individuals globally. The distribution of H. pylori infection is influenced by age, sex, geographical location, ethnicity, and socioeconomic factors. Due to the geographic variations, which include intra-country variations and different epidemiologic factors associated with infections with H. pylori, local studies are imperative to assess the prevalence and risk factors of H. pylori as this could assist in marking out preventive measures for the locality. There are no studies on H. pylori infection in children presenting to the University of Calabar Teaching Hospital (UCTH), Calabar, South-south Nigeria. This study aimed to determine the prevalence and associated factors of H. pylori infection in Nigerian children aged 3–18 years of age using the stool antigen test.

Material and Methods:
This was a cross-sectional study of 169 children aged 3–18 years presenting to the children’s outpatient clinic of the UCTH. Semi-structured questionnaire was used to obtain information on socioeconomic and demographic characteristics, source of drinking water, personal and household hygiene, and social class. Fresh stool samples were collected and analyzed using lateral flow immune-chromatographic assay for the qualitative detection of H. pylori antigen in a fecal specimen. Adjusted odds ratio (AOR) with its 95% confidence interval (CI) was used to assess the strength of the association. To identify the associated factors of H. pylori, multivariable logistic regression models were built. In the multivariable analysis, variables with P < 0.05 were considered statistically significant.

Results:
The prevalence of H. pylori among the study participants was 27.2%. The infection rate increased with an increase in the age of the participants, from 25.4% among 6–10-year-olds to 30.6% among 11–15-year-old adolescents. At univariate analysis, mother’s level of education (P = 0.002), father’s level of education (P = 0.02), social class (P = 0.002), place of residence (P = 0.009), number of rooms in the house (P = 0.001), method of domestic waste disposal (P ≤ 0.001), and past history of diarrhea (P = 0.007) were significantly associated with H. pylori infection. After multivariable logistic regression analysis, living in a house with less than three rooms (AOR 0.38, 95% CI 0.16–0.89; P = 0.026), domestic waste disposal in the bush (AOR 0.18, 95% CI 0.06–0.50; P = 0.001), residence in urban areas (AOR 4.64, 95% CI 1.47–14.65; P = 0.009), and past history of diarrhea (AOR 2.88, 95% CI 1.23–6.74; P = 0.015 were independently associated with H. pylori infection).

Conclusion:
The study showed a high prevalence of H. pylori infection among children presenting to the UCTH. Living in a house with less than three rooms, poor disposal of household waste, poor source of drinking water in schools, and a past history of diarrhea were risk factors for H. pylori infection. Public health education and the provision of potable water in schools are therefore advocated to curb H. pylori infection.