Seroprevalence and risk factors associated with Helicobacter pylori infection among children aged less than 18 years old in Duhok Province, Iraq
Prevalence and risk factors for H. pylori infection
Keywords:H. pylori, seroprevalence, risk factors, children, Duhok, Iraq
Objectives: Helicobacter pylori infection is predominantly acquired in early childhood and persists for decades before causing disease. This study aimed to detect the prevalence of H. pylori infection and identify potential factors associated with infection in Duhok province, Iraq.
Methods: This cross-sectional study was conducted in Duhok Province, Kurdistan Region, Iraq. Over a four-year period from 2016 to 2020, a total of 381 children aged four to 18 years who attended the hospitals and were evaluated for specific IgG antibodies against H. pylori using serological tests were included. A questionnaire was completed at the start of the study. H. pylori serology data were analyzed using the chi-square test.
Results: The seroprevalence of H. pylori IgG-specific antibodies among the study participants was 31%. The infection rate significantly increased with increasing age of the participants (p<0.001), from 19.8% among four to five-year-olds to 42.9% among 16 and 18-year-olds. The infection rate was significantly higher in girls (35.9%) than that in boys (26.5%) (p<0.047). Infections were also higher among university students (41%; p<0.001), children from the country-side population (41%; p<0.001), children from crowded households (67.3%; p<0.001), and children with a history of gastrointestinal pain (44.4%; p>0.001).
Conclusion. The prevalence rate of H. pylori infection among children in Duhok province is quite similar to that reported in previous studies in the Kurdistan region, Iraq, and increases with age. University attendance, history of gastrointestinal pain, countryside population, and overcrowding were risk factors associated with H. pylori infection. Valuable approaches to improve sanitary purposes and educational and socioeconomic status should be emphasized and promoted to reduce the risk of H. pylori infection among children.
2. Hussein NR, Saleem ZS, Balatay AA, Abd KH, Daniel S, Taha AA, et al. Seroprevalence of Helicobacter pylori Infection in Renal Transplant Recipient Attending Duhok Kidney Disease Center. Transplantation proceedings. 2016;48(1):92-5.
3. Ishaq S, Nunn L. Helicobacter pylori and gastric cancer: a state of the art review. Gastroenterology and hepatology from bed to bench. 2015;8(Suppl 1):S6-s14.
4. Atherton JC. The pathogenesis of Helicobacter pylori-induced gastro-duodenal diseases. Annual review of pathology. 2006;1:63-96.
5. Hussein NR, Robinson K, Atherton JC. A study of Age-Specific Helicobacter pylori Seropositivity Rates in Iraq. Helicobacter. 2008;13(4):306-7.
6. Mitchell H, Megraud F. Epidemiology and diagnosis of Helicobacter pylori infection. Helicobacter. 2002;7 Suppl 1:8-16.
7. Malaty HM, El-Kasabany A, Graham DY, Miller CC, Reddy SG, Srinivasan SR, et al. Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood. Lancet (London, England). 2002;359(9310):931-5.
8. Kivi M, Johansson AL, Reilly M, Tindberg Y. Helicobacter pylori status in family members as risk factors for infection in children. Epidemiology and infection. 2005;133(4):645-52.
9. Al-Shamahy HA. Seroprevalence of Helicobacter pylori among children in Sana'a, Yemen. Annals of Saudi medicine. 2005;25(4):299-303.
10. Kim JH, Kim HY, Kim NY, Kim SW, Kim JG, Kim JJ, et al. Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea. Journal of gastroenterology and hepatology. 2001;16(9):969-75.
11. Go MF. Review article: natural history and epidemiology of Helicobacter pylori infection. Alimentary pharmacology & therapeutics. 2002;16 Suppl 1:3-15.
12. Hussein NR, Mohammadi M, Talebkhan Y, Doraghi M, Letley DP, Muhammad MK, et al. Differences in virulence markers between Helicobacter pylori strains from Iraq and those from Iran: potential importance of regional differences in H. pylori-associated disease. Journal of clinical microbiology. 2008;46(5):1774-9.
13. Hussein NR, Napaki SM, Atherton JC. A study of Helicobacter pylori-associated gastritis patterns in Iraq and their association with strain virulence. Saudi J Gastroenterol. 2009;15(2):125-7.
14. Salih AM, Goreal A, Hussein NR, Abdullah SM, Hawrami K, Assafi M. The distribution of cagA and dupA genes in Helicobacter pylori strains in Kurdistan region, northern Iraq. Annals of Saudi medicine. 2013;33(3):290-3.
15. Hussein NR, Mirkhan SA, Ramadhan AA, Issa RS, Naqid IA, Yassin B, et al. Levofloxacin-Based Regimen Versus Bismuth Quadruple Regimen for Helicobacter pylori Eradication in Kurdistan Region, Iraq. Avicenna J Clin Microbiol Infect. 2020;7(3):81-4.
16. Bayati A, Al-Windi A, Ahmad N. Seroprevalence of anti-Helicobacter pylori antibodies in population of Sulaimani governorate/Kurdistan Region/Iraq. Journal Zankoy Sulaimani. 2013;15:175-85.
17. Yahya N. Helicobacter pylori Seropositivity in Children in Duhok City, Iraq. Science Journal of University of Zakho. 2018;6:82-7.
18. Khalifa MM, Sharaf RR, Aziz RK. Helicobacter pylori: a poor man's gut pathogen? Gut pathogens. 2010;2(1):2.
19. Falsafi T, Valizadeh N, Sepehr S, Najafi M. Application of a stool antigen test to evaluate the incidence of Helicobacter pylori infection in children and adolescents from Tehran, Iran. Clinical and diagnostic laboratory immunology. 2005;12(9):1094-7.
20. Salehi M, Ghasemian A, Shokouhi Mostafavi SK, Najafi S, Rajabi Vardanjani H. Sero-prevalence of Helicobacter pylori Infection in Neyshabur, Iran, During 2010-2015. Iran J Pathol. 2017;12(2):183-8.
21. Viet T, Nguyen H, Nguyen V, Thanh T, Phan B, Hoang h, et al. Epidemiology of Helicobacter pylori Infection in Tay Children in Vietnam. Annals of Clinical and Laboratory Research. 2016;04.
22. Frenck RW, Jr., Fathy HM, Sherif M, Mohran Z, El Mohammedy H, Francis W, et al. Sensitivity and specificity of various tests for the diagnosis of Helicobacter pylori in Egyptian children. Pediatrics. 2006;118(4):e1195-202.
23. Salih BA. Helicobacter pylori infection in developing countries: the burden for how long? Saudi J Gastroenterol. 2009;15(3):201-7.
24. Egan BJ, Holmes K, O'Connor HJ, O'Morain CA. Helicobacter pylori gastritis, the unifying concept for gastric diseases. Helicobacter. 2007;12 Suppl 2:39-44.
25. Moayyedi P, Axon AT, Feltbower R, Duffett S, Crocombe W, Braunholtz D, et al. Relation of adult lifestyle and socioeconomic factors to the prevalence of Helicobacter pylori infection. International journal of epidemiology. 2002;31(3):624-31.
26. Yilmaz E, DoÄŸan Y, GÃ¼rgÃ¶ze MK, Unal S. Seroprevalence of Helicobacter pylori infection among children and their parents in eastern Turkey. J Paediatr Child Health. 2002;38(2):183-6.
27. Wu MC, Sung CH, Chang YC, Ho CL, Wu CC, Wu KH, et al. Seroprevalence of Helicobacter pylori and Hepatitis A Virus among Children in Rural Central Taiwan. Jpn J Infect Dis. 2015;68(6):494-503.
28. Malaty HM, Paykov V, Bykova O, Ross A, Graham DP, Anneger JF, et al. Helicobacter pylori and socioeconomic factors in Russia. Helicobacter. 1996;1(2):82-7.
29. Ding Z, Zhao S, Gong S, Li Z, Mao M, Xu X, et al. Prevalence and risk factors of Helicobacter pylori infection in asymptomatic Chinese children: a prospective, cross-sectional, population-based study. Alimentary pharmacology & therapeutics. 2015;42(8):1019-26.
30. Fraser AG, Scragg R, Metcalf P, McCullough S, Yeates NJ. Prevalence of Helicobacter pylori infection in different ethnic groups in New Zealand children and adults. Australian and New Zealand journal of medicine. 1996;26(5):646-51.
31. Nguyen V, Nguyen K, Phung C, Kremp O, Kalach N, Dupont C, et al. Prevalence of and factors associated with Helicobacter pylori infection in children in the North of Vietnam. The American journal of tropical medicine and hygiene. 2006;74:536-9.
32. Etukudo OM, Ikpeme EE, Ekanem EE. Seroepidemiology of Helicobacter pylori infection among children seen in a tertiary hospital in Uyo, southern Nigeria. Pan Afr Med J. 2012;12:39-.
33. Alborzi A, Soltani J, Pourabbas B, Oboodi B, Haghighat M, Hayati M, et al. Prevalence of Helicobacter pylori infection in children (south of Iran). Diagnostic microbiology and infectious disease. 2006;54(4):259-61.