RESEARCH PROJECT

PREVALENCE AND ASSOCIATED RISK FACTORS OF

HELICOBACTER PYLORI AMONG PATIENTS AT THE
REGIONAL HOSPITAL BUEA

A Research project submitted to the Department of Biomedical science of Redemption

Higher Institute of Biomedical and management Sciences in partial fulfilment of the

Requirement for the award of a Higher National Diploma in Medical laboratory sciences

By

Mr. AKEM LAZARE.A

M.Sc. Pharmacology
MARCH, 2024

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 ABSTRACT

Introduction: Helicobacter pylori infection is a global public health problem affecting over 50%

of the population worldwide the fourth most common cancer is gastric cancer caused by

Helicobacter pylori and it is the second cause of mortality due to cancer in the world reason why

this study seeks to determine the prevalence and associated risk factors of Helicobacter pylori

infection among the patients at the Regional Hospital Buea. Method: Using a cross-sectional

study design where a convenient sampling technique was use to recruit 340 patients this study

ran from November 2023 to March 2024. Questionnaires and blood analysis were used as a

source of data collection. Results: The prevalence of this study is 62.9% were most of the

participants 56% were within 27-35 age range, 72.88% were females, 69.07% were single and

62.25% were university students. Risk factors of H. pylori were 52.76% normal housing

condition, 45.34% drink borehole water, 65 (27.54%) eating commercial food. 78 23.93% eating

vegetables once a week 30.67% eating spicy food. majority 27.12% of the participants with H.

pylori were within the 22-26 age range, 40.68% females in this study had H. pylori, 58.47%

singles tested positive for H. pylori. Conclusion: The prevalence of H. pylori amongst youths in

the Molyko community is 53% which is relatively high. Factors such as water source, food

source and spicy food are associated with H. pylori as most infected either consume borehole

water, eat commercial food or eat spicy food. H. pylori are most prevalent amongst single,

females between the ages 27-35 years old. These people are viewed as high consumers of street,

spicy food which is also highly associated to H. pylori infection. Recommendations: Screening

and testing for Helicobacter pylori infection campaign, Provide education on risk factors,

transmission routes, and preventive measures for H. pylori infection

Key words: Prevalence, Helicobacter pylori, Buea regional Hospital, Determine, Community

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TABLE OF CONTENT

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 CHAPTER ONE

INTRODUCTION

1.0 BACKGROUND

Helicobacter pylorus was first discovered in 1983, and eleven years later in 1994 the

International Agency for Research on Cancers (IARC) classified H. pylori as a definite class 1

carcinogen (J.R. Warren. et al, 1983). It is a small, spiral, gram-negative bacillus which inhabits

the mucus layer overlying the gastric epithelial cells in humans. It produces a potent urease. The

isolation of H. pylori from the human gastric mucosa and the demonstration of its involvement in

gastritis, peptic ulcer disease and gastric cancers have radically changed our perception of these

diseases. Development of atrophy and metaplasia of the gastric mucosa are strongly associated

with H. pylori infection (Mahalanabis, M. et al., 1996).

Helicobacter pylori (H. pylori) are a ubiquitous gram-negative bacterium that selectively

colonizes the gastric epithelium and infects over half of the global population (E. Roma et al.

2015.). Its prevalence varies between countries and among racial groups resident within the same

country. It presents with non-specific dyspeptic symptoms with a varying range of severity. In

general, children and adults in developing countries are more infected than developed countries

(B. A. Salih, et al. 2013.). This may be because of factors such as poor sanitation and lack of

potable water supply in developing countries.

Helicobacter pylori (H. pylori) is commonly acquired during childhood. Its long-term

persistence might lead to gastric adenocarcinoma and mucosa-associated lymphoid tissue

lymphoma in adulthood (E. Hestvik, et al. 2010). Thus, H. pylori is one of the most important

leading infectious causes of cancer worldwide, as 8 in 10 gastric cancers in adults are attributable

1
to this infection (Van D et al. 2001). Several factors which contribute to the discrepancies in

terms of prevalence were reported to increase the risk of H. pylori infection, such as older age,

hygiene conditions, a large number of family members, having a mother, a sibling or siblings

infected with H. pylori, room or bed-sharing, drinking unboiled or non-treated water, and low

socioeconomic status (Forman D, et al. 2019).It was also hypothesized that prenatal

transmission from infected mothers or the transmission during delivery might also contribute to

the increased H. pylori prevalence in paediatric patients (Kobayashi, H et al. 2016).

Nevertheless, most of the studies proved that this route of transmission is unlikely since no traces

of H. pylori DNA were encountered in the placenta of pregnant women who tested positive for

this infection (Kodama, M et al. 2004).

Helicobacter pylori infection was analysed in 21 291 adults by 14C-urea breath test,

and H. pylori antibody were detected in 9183 serum samples by latex immunoturbidimetric

method. The correlation of H. pylori infection with demographic–economic, lifestyle factors and

medical history among the participants was determined by questionnaire. The antibodies

against H. pylori urease, VacA and CagA in serum were determined by dot immunobinding

assay. And results shows that the infection rate of H. pylori was 53.0%, and 90.1% of strains

were type I strains (Ivi, M., et al. 2003).

1.1 STATEMENT OF PROBLEM

A recent global systematic review of the prevalence of H. pylori estimated that approximately

4.4 billion individuals suffered from H. pylori infection in 2015 (Kawahara, T., et al. 2001).

Globally, Africa has the highest prevalence of H. pylori (79.1%), while Ghana has the lowest

prevalence (24.4%). In Asia, the prevalence of H. pylori is 54.7% (Ismail, H. et al. 2015).

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Epidemiological studies have revealed that the prevalence of H. pylori infection among

Cameroon adults ranges from 41.4% to 72.3% (Uesca, M. et al. 2018). Various factors,

including age, gender, education, lifestyle, health condition, number of family members and

financial status and area of residence, could affect the prevalence of H. pylori in the

population. Gastric cancer is the fourth most common cancer worldwide and the second most

common cancer in China (Heuermann, D, et al. 2018). Although the global prevalence

of H. pylori infection is high, only a small proportion of carriers develop severe gastric disease

1.2 OBJECTIVES

1.2.1 GENERAL OBJECTIVES

To determine Prevalence and associated risk factors of Helicobacter pylori infection among

patients at the Regional Hospital Buea

1.2.2 SPECIFIC OBJECTIVES

- To determine the prevalence of Helicobacter pylori infection among patients at the

Regional Hospital Buea

- To identify the associated risk factors of Helicobacter pylori infection among patients at

the Regional Hospital Buea

- To determine the prevalence of Helicobacter pylori infection in relation to

sociodemographic factors among patients at the Regional Hospital Buea

1.3 RESEARCH QUESTIONS

- What is the prevalence of Helicobacter pylori infection among patients at the Regional

Hospital Buea?

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 - What are the associated risk factors of Helicobacter pylori infection patients at the

Regional Hospital Buea?

- What is the prevalence of Helicobacter pylori infection among y patients at the Regional

Hospital Buea in relation to socio-demographic factors?

1.4 Scope of the Study

This study title "The Prevalence and associated risk factors of Helicobacter pylori infection

patients at the Regional Hospital Buea” and will involve screening of youths for Helicobacter

pylori at the Molyko community located at the foot of mount Fako situated between the mile 17

and the Bonduma along the highway to the Governor’s office. The research will be conducted

between the periods of November 2023 to April, 2024. Using a cross sectional quantitative study

design where participants will be selected using convenient sampling techniques and using

questionnaire and laboratory results to collect data.

1.5 SIGNIFICANCE OF STUDY

To the participants

- It will create awareness to the participants and help them know their Helicobacter pylori

status since screening of Helicobacter pylori antigen will be carried out

To the community

- It will increase their awareness on Helicobacter pylori thereby reducing the number of

people who get infected thereby reducing mortality rate.

- It will also help the government develop better strategies in managing this problem and

provide resources whenever necessary.

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To the researcher

- It will also widen her way of reasoning and understanding of this pathology. This

research will be a contribution to the body of literature in the area of the effect of

personality trait on student’s academic performance, thereby constituting the empirical

literature for future research in the subject area

`1.6 Justification of study

This study is intend to discuss on the prevalence of Helicobacter pylori among youths in the in

the Molyko community. In justifying why the current study is important, it is vital to mention

that researchers have this area of study very important to the development of science especially

in developing countries and their contribution to the development of awareness of this virus in

our society. This study will benefit a number of groups among them are the patients. This study

will help to educate the client patients more about hepatitis B, and the necessary measures to take

in order to avoid been infected

1.7 Definition of terms

1.7.1 Operational definition of terms

Helicobacter pylori: is a ubiquitous gram-negative bacterium that selectively colonizes the

gastric epithelium (CDC, 2019)

Associated risk factors: Condition that when exposed to will prone you to acquire a disease

(WHO. 2020)

Prevalence: prevalence is the proportion of a particular population found to be affected by a

medical condition (WHO, 2019)

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Youths: persons within the ages of 15 to 35 years (Cameroon youth policy)

1.7.2 Conceptual definition of terms

Helicobacter pylori: it is a bacteria that causes most gastritis

Associated risk factors: Condition that when exposed to will prone you to acquire Helicobacter

pylori infection

Prevalence: prevalence is the proportion of individuals leaving with Helicobacter pylori

infection

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 CHAPTER TWO

LITERETURE REVIEW

2.0 Introduction

This chapter focuses more on the historical Review, Contextual Review, Conceptual Review and

Empirical Review

2.0 HISTORICAL REVIEW

The discovery of H. Pylori, by Warren and Marshall, was preceded by nearly a hundred years of

inconspicuous publication relating to spiral bacteria, achlorhydria, gastritis, gastric ureases, and

antimicrobial therapy for ulcers (Marshall B.J. 1988). Investigation of gastric bacteria properly

began in the latter half of the 19th century when microscope resolution had sufficiently advanced

(Kidd M et al. 1998) Bottcher and Letulle firstly hypothesized that bacterial caused ulcer

diseases in 1875, after they discovered bacteria in the floor and margins of gastric ulcer. In 1884

Walery Jaorski describe spiral organism (vibrio regula) in gastric washings. He suggested that

these organisms might be implicated in causation of gastric diseases. Similar spiral organisms

were found in stomach of humans and other species by several scientist between then and the

20th century. For instance, in 1893 Bizzozero noted spirochete in gastric mucosa of dogs which

were named Helicobacter bzzozeroni. Kasai and Kobayashi in 1920 isolated spirochetes in cats

and then to rabbits to produce ulcer (Kidd M et al. 1998).

Warren in 1979 identified campylobacter pylori as the putative causative of human

gastritis (Kidd M et al 1998). Culture of the organism (H. pylori) was obtained by Barry

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Marshall (Marshal B.J. 1988). Earlier attempts to culture the organism proved abortive because

incubation was usually limited to 48 hours. Success at culture was incidental, as one of them

spanned a holiday period and hence lasted for 5 days, there by yielding a growth. History was

then made in April 1982 at Royal Perth Hospital in Australia where H. Pylori was cultured.

Examination at the plate showed a pure growth of 1mm transparent colonies. Gram stain of the

colonies show slightly curved organism and not spiral as in the smear of the specimen which

made Marshal to doubt whether it was the organism in question that was grown. Armstrong and

Wee produce electron micrograph scans from the culture obtained which showed that the

bacterium was a spiral organism having five flagella.

Further studies on the organism and its RNA sequence in ribosome helped correct the earlier

misconception that the organism belonged to the campylobacter family (Initially called

campylobacter pyloridis). At the 5th international campylobacter workshop in Mexico in

February, 19898 the campylobacter taxonomy committee agreed that Helicobacter Pylori should

no longer be included in the campylobacter group. There was initial difficulty in the

nomenclature before Steward Goodwin who was head of the microbiology department at Royal

Perth Hospital at that time reportedly suggested Helicobacter and this was published in 1989

The World Health Organization classified H. Pylori as a class 1 (definite) carcinogen

implicated in the etiopathogenesis of gastric malignancies in 1994 (Houghton J et al. 2005).

Parsonnet et al. also describe an association between H. Pylori and gastric lymphomas

(Parsonnet. J et al. 1994). Tomb et al. completed sequencing of the entire l; 667,867 base pairs of

Helicobacter pylori genome in 1997 (Tom JF et al. 1997). In 2005, Warren and Marshal were

awarded the Nobel Prize in physiology or Medicine for their work on H pylori and PUD (The

Nobel Prize 2005)

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2.2 CONCEPTUAL REVIEW

2.2.1. DEFINITION

Helicobacter pylori (H. pylori) are gram-negative, spiral-shaped bacteria and transmitted

from humans to humans that colonize the human stomach, causing chronic gastritis, gastric

malignancy and peptic ulcer disease, which have been recognized as a major public health

concern all over the world (Marshall, BJ, et al. 2019).

Types of Helicobacter pylori

- Type I strains (highly virulent)

- Intermediate strain

- Type II stain (reduce virulent) (Covacci A., et al 1997)

Types of infection

- Peptic ulcer

- Gastric ulcer

Gastric Helicobacter species.

Gastric Helicobacter species have adapted to the inhospitable conditions found at the gastric

mucosal surface, and it is currently thought that the stomachs of all mammals can be colonized

by members of the genus Helicobacter. All known gastric Helicobacter species are urease

positive and highly motile through flagella (Choi J, et al. 2011). Urease is thought to allow short-

term survival in the highly acidic gastric lumen, whereas motility is thought to allow rapid

movement toward the more neutral pH of the gastric mucosa; this may explain why both factors

are prerequisites for colonization of the gastric mucosa (McNulty CA, et al. 2011). Upon entry,

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gastric Helicobacter species display urea- and bicarbonate-mediated chemotactic motility toward

the mucus layer (Megraud F, et al. 2007). The spiral morphology and flagellar motility then

assist in penetration into the viscous mucus layer, where the more pH-neutral conditions allow

growth of the gastric Helicobacter species.

(i) Helicobacter felis.

The spiral-shaped Helicobacter felis was first isolated from the stomach of a and was later also

found in dogs. Subsequently designated H. it was probably also the Helicobacter species

originally described by Bizzozero in 1893. H. felis is one of the Helicobacter species with

zoonotic potential It has a helical morphology with typical periplasmic fibers, which can be used

for microscopic identification. H. felis requires high humidity and can only poorly, if at all, be

cultured on standard growth media used for the culture of H. pylori. H. felis is highly motile; on

agar plates it does not really form colonies but rather grows as a lawn (El-Zimaity HM, et al.

2016).

(ii) Helicobacter mustelae.

The ferret pathogen H. mustelae was isolated shortly after H. pylori and was originally classified

as Campylobacter pylori subsp. Mustelae. It was subsequently shown to have characteristics

different from H. pylori and was later classified as H. mustelae H. mustelae a is relatively small

rod, which has multiple polar and lateral sheathed flagella. Interestingly, H. mustelae is

phylogenetically closer to the enterohepatic Helicobacter species based on its 16S rRNA gene

sequence, urease sequences, and fatty acid profile but to our knowledge H. mustelae has not been

implicated in enteric colonization in ferrets. The ferret stomach resembles the human stomach at

both the anatomical and physiological levels and gastritis, gastric ulcer, gastric adenocarcinoma,

and MALT lymphoma in ferrets have all been described (Christensen AH, et al. 2012).

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(iii) Helicobacter acinonychis.

H. acinonychis, a pathogen of cheetahs and other big cats (formerly named Helicobacter

acinonyx is currently the closest known relative to H. pylori and has been suggested to have

diverged from its last common ancestor (H. pylori) only relatively recently The presence of H.

acinonychis is associated with chronic gastritis and ulceration, a frequent cause of death of

cheetahs in captivity Furthermore, eradication treatment of H. acinonychis led to the resolution

of gastric lesions in tigers similar to the effect of antibiotic treatment of H. pylori infection H.

acinonychis is susceptible to antibiotic therapy, as used for H. pylori infection, and utilizes

similar mechanisms for antimicrobial resistance (de Martel C, et al. 2010).

(iv) Helicobacter heilmannii.

The diverse species H. heilmannii was originally designated Gastrospirillum hominis and is

a Helicobacter species with a wide host range. It has been isolated from several domestic and

wild animals, including dogs, cats, and nonhuman primates, and is also observed in a small

percentage of humans with gastritis. In the latter, colonization may reflect a zoonosis, as there is

an association between colonization with this bacterium and close contact with dogs and cats

carrying the same bacterium. Its morphology resembles that of H. felis, but H. heilmannii lacks

the periplasmic fibers. Human H. heilmannii infection may result in gastritis and dyspeptic

symptoms, and in sporadic cases even in ulcer disease, but the inflammation is usually less

marked than in H. pylori-positive subjects and may be spontaneously transient (Warren, JR, et l,

2017).

2.2.2 Prevalence and Geographical Distribution

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The prevalence of H. pylori shows large geographical variations. In various developing

countries, more than 80% of the population is H. pylori positive, even at young ages (Marshall,

BJ, et al. 2014). The prevalence of H. pylori in industrialized countries generally remains under

40% and is considerably lower in children and adolescents than in adults and elderly people

(Chey, WD et al. 2017). Within geographical areas, the prevalence of H. pylori inversely

correlates with socioeconomic status, in particular in relation to living conditions during

childhood. In Western countries, the prevalence of this bacterium is often considerably higher

among first- and second-generation immigrants from the developing world (Uemura, N, et al.

2001). While the prevalence of H. pylori infection in developing countries remains relatively

constant, it is rapidly declining in the industrialized world (Choi, IJ et al. 2020). The latter is

thought to be caused by the reduced chances of childhood infection due to improved hygiene and

sanitation and the active elimination of carrier ship via antimicrobial treatment. In developing

countries, H. pylori infection rates rise rapidly in the first 5 years of life and remain constantly

high thereafter, indicating that H. pylori is acquired early in childhood (Pacifico, L, et al. 2014).

However, in industrialized countries the prevalence of H. pylori infection is low early in

childhood and slowly rises with increasing age. This increase results only to a small extent

from H. pylori acquisition at later age. The incidence of new H. pylori infections among adults in

the Western world is less than 0.5% per year; the higher prevalence of infection among the

elderly thus reflects a birth cohort effect with higher infection rates in the past (Zabala T et al.

2017). The active elimination of H. pylori from the population and improved hygiene and

housing conditions have resulted in a lower infection rate in children, which is reflected in the

age distribution of this lifelong-colonizing bacterium (Kotilea, K, et al. 2019). Overall, new

infection more commonly occurs in childhood and lasts for life unless specifically treated.

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2.2.3 PATHOGENESIS OF INFECTION

H. pylori-Associated Pathogenesis

The primary disorder, which occurs after colonization with H. pylori, is chronic active gastritis.

This condition can be observed in all H. pylori-positive subjects. The intragastric distribution and

severity of this chronic inflammatory process depend on a variety of factors, such as

characteristics of the colonizing strain, host genetics and immune response, diet, and the level of

acid production. H. pylori-induced ulcer disease, gastric cancer, and lymphoma are all

complications of this chronic inflammation; ulcer disease and gastric cancer in particular occur

in those individuals and at those sites with the most severe inflammation. Understanding of these

factors is thus crucial for the recognition of the role of H. pylori in the ethology of upper

gastrointestinal pathology. (UNICEF. 2017)

Acute and chronic gastritis

Colonization with H. pylori virtually always leads to infiltration of the gastric mucosa in both

antrum and corpus with neutrophilic and mononuclear cells. This chronic active gastritis is the

primary condition related to H. pylori colonization, and other H. pylori-associated disorders in

particular result from this chronic inflammatory process.

(i) Acute gastritis.

Data on the acute phase of infection are scarce and largely come from reports of subjects who

deliberately or inadvertently ingested H. pylori or underwent procedures with contaminated

material (Nguyen, TVH, et al. 2022). Recently, a human challenge model for H. pylori infection

was introduced; it allowed controlled studies of the acute phase of infection with deliberate

infection of healthy volunteers with a well-characterized laboratory strain of H. pylori (Che, TH,

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et al. 2011). Together, these reports showed that the acute phase of colonization with H.

pylori may be associated with transient nonspecific dyspeptic symptoms, such as fullness,

nausea, and vomiting, and with considerable inflammation of both the proximal and distal

stomach mucosa, or pangastritis. This phase is often associated with hypochlorhydria, which can

last for months. It is unclear whether this initial colonization can be followed by spontaneous

clearance and resolution of gastritis and, if so, how often this occurs.

(ii) Chronic gastritis.

When colonization does become persistent, a close correlation exists between the level of acid

secretion and the distribution of gastritis. This correlation results from the counteractive effects

of acid on bacterial growth versus those of bacterial growth and associated mucosal

inflammation on acid secretion and regulation. This interaction is crucial in the determination of

outcomes of H. pylori infection. In subjects with intact acid secretion, H. pylori in particular

colonizes the gastric antrum, where few acid-secretory parietal cells are present. This

colonization pattern is associated with an antrum-predominant gastritis. Histological evaluation

of gastric corpus specimens in these cases reveals limited chronic inactive inflammation and low

numbers of superficially colonizing H. pylori bacteria. Subjects in whom acid secretion is

impaired, due to whatever mechanism, have a more even distribution of bacteria in antrum and

corpus, and bacteria in the corpus are in closer contact with the mucosa, leading to a corpus-

predominant pan gastritis (Kotilea, K, et al. 2016). The reduction in acid secretion can be due to

a loss of parietal cells as a result of atrophic gastritis, but it can also occur when acid-secretory

capacity is intact but parietal cell function is inhibited by vagotomised or acid-suppressive drugs,

in particular, proton pump inhibitors (PPIs) (Yuan, C, et al. 2018). Although colonization

with H. pylori is almost invariably associated with the presence of gastritis, and gastritis is

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mostly due to H. pylori colonization, other causes of gastritis include infections such as

cytomegalovirus, chronic idiopathic inflammatory and autoimmune disorders such as Crohn's

disease and pernicious anaemia, and chemical damage due to alcohol abuse or nonsteroidal anti-

inflammatory drug (NSAID) use.

2.2.4 Peptic ulcer disease

(i) Definitions.

Gastric or duodenal ulcers (commonly referred to as peptic ulcers) are defined as mucosal

defects with a diameter of at least 0.5 cm penetrating through the muscularis mucosa. Gastric

ulcers mostly occur along the lesser curvature of the stomach, in particular, at the transition from

corpus to antrum mucosa (E. Hestvik, et al. 2013). Duodenal ulcers usually occur in the

duodenal bulb, which is the area most exposed to gastric acid. In Western countries, duodenal

ulcers are approximately fourfold more common than gastric ulcers; elsewhere, gastric ulcers are

more common. Duodenal ulcers in particular occur between 20 and 50 years of age, while gastric

ulcers predominantly arise in subjects over 40 years old.

2.2.5 Diagnostic method of Helicobacter pylori

Rapid urease test

The RUT was performed using a non-commercial validated test. This test was performed with a

homemade solution with 1 ml distilled water, one drop of 1% phenol red, and 100 mg urea,

prepared just before endoscopy. One antral sample was placed in the solution and maintained at

room temperature. The test was considered positive when the colour changed from yellow to red

within 24 hours (Che, TH, et al. 2022).

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Histopathology

Biopsies from the antrum and the corpus were obtained for histology and were fixed in 10%

formalin and sent to the laboratory. Paraffin embedded and multiple 4 mm-thick histological

sections were obtained from each biopsy. Preparations were stained with haematoxylin and

eosin, and Giemsa evaluated by several pathologists blinded to the results of the other tests. The

presence of H. pylori was determined but not graded (Che, TH, et al. 2022).

Polymerase Chain Reaction (PCR)

DNA was extracted from biopsies using DNeasy Blood & Tissue Kit (Qiagen, Hilden,

Germany). A sequence of 294 bp in the ureC (glmM) gene was amplified as described previously

(13).Primer pair used for ureC amplification had the nucleotide sequence as follows: forward

primer,(5′-AAGCTTTTAGGGGTGTTAGGGGTTT-3′) and reverse primer (5′-

AAGCTTACTTTCTAACACTAACGC-3′). The PCR conditions consisted of 1 cycle of 5 min at

93°C, followed by 35 cycles of 1 min at 93°C, 30 s at 55°C, 30 s at 72°C, and a final cycle of 10

min at 72°C. Amplified products were visualized on 2% agarose gel under UV light. All assays

were performed at least twice (Che, TH, et al. 2022).

Stool antigen test

Stool samples were analysed using a polyclonal ELISA stool antigen test (Astra s.r.l, Milan,

Italy), according to manufacturer’s instructions. Briefly, diluted faecal samples and peroxidase-

conjugated polyclonal antibodies were added to the wells. After 90 minutes of incubation at

room temperature, sample wells were washed to remove unbound samples and enzyme-labelled

16
antibodies. The results were read at 450/620nm by spectrophotometry. To determine H.

pylori antigen concentrations in test samples, a cut-off value of OD 0.2 was used. Samples with

OD values < 0.150 were considered negative. Samples with OD values within 0.150-0250 were

considered borderline and samples with OD values > 0.250 were considered positive (Che, TH,

et al. 2022).

Serology

On the endoscopy day, 5 ml blood was taken from patients and transferred to the laboratory. The

sera were separated and kept until the day of testing at -20°C. A serological assay for IgG

antibodies against H. pylori was performed by a commercial Helicobacter pylori IgG ELISA kit

(IBL, Hamburg, Germany) according to the manufacturer’s instructions. The results were classed

as positive if anti–H pylori immunoglobulin (Ig) G titters were >12 U/ml, negative if they were <

8 U/ml, and equivocal if they were between 8 and 12 U/ml (Che, TH, et al. 2022).

2.2.6 Treatment of Helicobacter pylori.

Although H. pylorus is sensitive to a wide range of antibiotics in vitro, they all fail as

monotherapy in vivo. In infected patients, the most effective single drug is clarithromycin, which

leads to an approximate eradication rate of 40% when given twice daily for 10 to 14 days

(Ahmed, KS, et al. 2019). The lack of efficacy of monotherapy is related to the niche of H.

pylori, residing at lower pH in a viscous mucus layer. Dual therapies, combining twice-daily-

dosed PPI with, in particular, amoxicillin, are still in use in some countries, but dual therapies

have mostly been replaced by triple therapies. These combine two antibiotics with either a

bismuth compound or a PPI. A further alternative is provided by quadruple therapies, which

17
combine the bismuth compound and PPI with two antibiotics. The exact mode of action of

bismuth compounds is unknown, but H. pylori is susceptible to these compounds both in vivo

and in vitro (Che, TH, et al. 2022).. Tetracycline, amoxicillin, imidazole’s (predominantly

metronidazole and tinidazole), and a few selected macrolides (in particular clarithromycin,

sometimes azithromycin) are probably the drugs most widely used for H. pylori eradication

therapy (Nguyen, TVH, et al. 2017). Recently, the use of rifabutin and furazolidone (Kotilea, K,

et al. 2021) has been promoted. However, as their effectiveness is limited and many patients do

not tolerate furazolidone, the primary use of these two antibiotics is a second-line rescue therapy

of patients harbouring metronidazole-resistant isolates (Che, TH, et al. 2012). Occasionally the

use of ciprofloxacin and related fluoroquinolones and other antibiotics, such as rifampin and

streptomycin (Christensen AH, et al. 2019), has been reported, but these drugs seem to have no

serious advantages over the aforementioned ones. The use of these drugs has resulted in effective

therapies against H. pylori, with consistent eradication rates over 80%. Various treatment

durations, doses, and drug combinations have been studied, but none have consistently reached

eradication levels in excess of 90 to 95%. Failures are in particular related to insufficient therapy

adherence, often because of side effects, and to the presence of antimicrobial resistance. Such

resistance is common in patients who have had previous antibiotic treatment, including failed

eradication therapies (Lu JJ, et al. 2020).

2.3 CONTEXTUAL REVIEW

The incidence and prevalence rates of childhood infection with H. pylori vary greatly (). Within

developed nations, prevalence rates of H. pylori infection among children have been shown to

range from as low as 1.8% to as high as 65% (Megraud F, et al. 2019). While in developing

countries the prevalence is generally higher reaching up to 90% in some countries . The mode of

18
transmission for H. pylori is not certainly known; however, epidemiological studies strongly

support person-to-person transmission and faecal-oral and oral-oral routes. School going children

in developing countries are at higher risk of H. pylori infection. Several factors control the

transmission in developing countries including low socioeconomic status, poor quality of

drinking water, overcrowding, poor personal and environmental hygiene, and food

contamination (Christensen AH, et al. 2019).

Recent study performed on Kumba schoolchildren pointed out an H. pylori prevalence rate of

65.7%. Comparable prevalence was reported by other studies from rural Ethiopia (Yuan, C, et al.

2018). Another study also assessed school children, from Kassala city in east Sudan, found a

much lower prevalence of H. pylori, only 21.8%, compared to the previously mentioned areas. A

similar incidence was encountered in children aged between 6 months and 15 years from Nigeria

(E. Hestvik, et al. 2017). Nevertheless, the prevalence in Nigeria was reported to differ

depending on the geographical area. Thus, Ikpeme et al. (2022). reported a prevalence of 30.9%

in children from South-South Nigeria, whereas a much higher prevalence was noticed by

Senbanjo et al. (2019) and Hacombe et al. (2017) in those from Lagos (63.6%) and Maiduguri

(82%), the latter proving that most of them are infected between 5 and 10 years of age. A

systematic review that compared the worldwide distribution of H. pylori prevalence found Africa

to be the continent with the highest rate of this infection, presenting a prevalence of 70.1%,

followed closely by South America (69.4%) and Western Asia (66.6%) (Che, TH, et al. 2022). In

fact, the authors of this meta-analysis concluded that Nigeria has the highest H. pylori prevalence

worldwide, at 87.7%. In Southern Africa, Walker et al. (2020) reported an overall prevalence of

75%, whereas, in Northern Africa, Bounder et al. (L. Tsongo, et al. 2017) found a prevalence of

92.6% in asymptomatic Moroccans and 89.6% in patients complaining of gastric symptoms

19
regardless of age. Another study performed in Egypt revealed a lower prevalence in the general

population of only 54.4% (Che, TH, et al. 2022). A study from Kenya pointed out a higher

prevalence of H. pylori infection in children compared to adults, 73.3% versus 54.8%

(Christensen AH, et al. 2016). Another pediatric study from Uganda reported a prevalence of

44.3% in healthy children aged 0–12 years (Furuta, T., et al 2018). The data from Ethiopia

showed an overall pooled prevalence of 52.2%, with the highest prevalence in Somali (71%) and

the lowest in Oromia (39.9%). Asymptomatic children from Ghana had the lowest prevalence

of H. pylori infection compared to other reports from Africa, at only 14.2% (Gasbarrini, A., et al.

2016).

2.4 EMPERICAL REVIEW

This study was a nationally representative cross sectional survey, using weighted multistage

stratified cluster sampling. All individuals aged ≥18 years in the selected households were

invited to participate in the survey. Ninety two percent (n = 2382) of the households in 55 cities

participated; 4622 individuals from these households were tested with the 13C-Urea breath test.

Helicobacter pylori prevalence and associated factors were analysed by the t test, chi square and

multiple logistic regression with SPSS11.0. and the results shown that the weighted overall

prevalence was 82.5% (95% CI: 81.0-84.2) and was higher in men. It was lowest in the South

which has the major fruit growing areas of the country. The factors included in the final model

were sex, age, education, marital status, type of insurance (social security), residential region,

alcohol use, smoking, drinking water source. While education was the only significant factor for

women, residential region, housing tenure, smoking and alcohol use were significant for men in

models by sex (Borka B, et al. 2022).

20
A study conducted in Mbarara by Phoebe .A et al (2019) after obtaining informed consent from

parents/legal guardians, illegible children who presented with gastrointestinal complaints at Holy

Innocents Children's Hospital were recruited; structured questionnaires were administered to the

parents/guardians to collect information on sociodemographic data and risk factors of H.

pylori infection. Four (4) millilitres of blood was collected from each child and tested

for H. pylori blood Antibody test and stool specimens were used for H. pylori antigen test. Find

the prevalence of H. pylori infection among the study participants was 24.3%. The infection rate

increased with increase in age of the participants, from 16.2% among 1to 5 years old to 27.2%

among 6 to 10 years. Infections were higher among school going children (68/74, p=0.003, OR

3.9; CI: 1.5 to 10.6) and children from crowded households (59/74, p<0.001, OR 2.6, and CI 1.3

to 5.0), unsafe source of drinking water at schools (46/74, p=0.003), and lack of sanitary facility

at homes (57/74, p=0.001, and OR 1.6 CI 0.7 to 3.6) (Hooi, JKY, et al. 2017).

A study conducted in Vietnam by Thai. H et al (2023), with a total of 1,476 pupils aged 6–

15 years were enrolled in this cross-sectional study using multiple-stage sampling method.

Infection status was assessed using stool antigen-test. A questionnaire was used to obtain socio-

demographic, behavioural, and environmental factors. Logistic regression was performed to

assess possible factors related to the infection. Find out that Of the 1,409 children included in the

analysis, 49.2% were male and 95.8% were of Kinh ethnicity. About 43.5% of parents completed

college or university. The overall prevalence of H. pylori was 87.7%. Infrequency of

handwashing with soap after toilet, the use of only water to clean after toilet, crowded living

areas, larger family size, and younger age were independently contributing to an increased

prevalence of H. pylori. (Thai. H et al. 2023),

21
22
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter will contain the research design, study area, study population, target population,

accessible population, sample size, sample calculation, sample technique, inclusion/ exclusion

criteria, instrumentations, validation of instrument, content validation, reliability testing, data

analysis and ethical considerations.

3.1 Research design

This research was a qualitative cross sectional quantitative study design with the use of

questionnaires to collect data. And it ran from November 2023 to April 2024

3.2 Study area

This study was conducted at Buea Regional Hospital specifically at the IWC, Buea population

consisted mainly of the Bakweri people. Buea regional hospital being the study area is situated at

the foot of Mount Fako. It is about 25kilometers away from the mile 17 motor park and it is

bounded to the North by Bokwaongo, South by Clerk's quarter, west by the Wonya Mavoe and

to the East by Buea station. The Buea Regional Hospital comprises of wards such as outpatient

department, surgical ward, maternity ward, medical ward, pediatric ward and the Laboratory.

This study area is being chosen because it is accessible for the researcher to carry on the study

and convenient for the researcher and was less costly and for a reason being those youths

neglects the existence of Helicobacter pylori infection with the notion that it is being suffered

only within the old.

23
3.3 Study population

The study population was made up of patients at the Regional Hospital Buea.

3.3.1 Target population

Patients consulting at the Regional Hospital Buea

3.4 Sample size

The sample size of 350 participants was used

3.4.1 Sample size calculation

The sample size of this study was calculated using the Cochranes formula.

N = population size = 3,000 = n= Z2 P (1-p)

e2
= (1.96)2 x 0.5 (1 – (0.5)
n= sample size (0.05)2

= 384.16
e= margin error =5% (0.05)
384 participants.
z = 95% (1.96)

If the community has a population size of 3,000

n= n0
1+ (n0-1)
N

= 339.964 ~ 340

340 participants corresponded

24
 3.5 Sampling technique

A convenient sampling technique was used. The study participants were selected at least ten to

15 meters away from each other to ensure independence and social distance.

3.6 Inclusive and exclusive criteria

3.6.1 Inclusive criteria

- The study included only patients at the Regional Hospital Buea

- Those who were present during the data collection.

- Youths who signed the consent form.

3.6.2 Exclusive criteria

The study did not include those patients who refused signing the consent form.

3.7 Instrumentation

Instruments that were used in this study includes the following; laboratory analysis and

questionnaires, design in the following heading,

- Section A: socio demographic factor

- Section B: associated risk factors of Helicobacter pylori

3.8 Validation of instrument

Well- structured questionnaires was presented to my supervisor to effect necessary correction

and a validated copy of this study was designed and pretesting done at District Hospital Buea.

Procedure for Helicobacter pylori determination

PRINCIPLE

The H. pylori Rapid Test Device (Whole Blood/Serum/Plasma) is a qualitative membrane based

immunoassay for the detection of H. pylori antibodies in whole blood, serum, or plasma. In this

25
test procedure, anti-human IgG is immobilized in the test line region of the test. After specimen

is added to the specimen well of the device, it reacts with H. pylori antigen coated particles in the

test. This mixture migrates chromatographically along the length of the test and interacts with the

immobilized anti-human IgG. If the specimen contains H. pylori antibodies, a coloured line will

appear in the test line region indicating a positive result. If the specimen does not contain H.

pylori antibodies, a coloured line will not appear in this region indicating a negative result. To

serve as a procedural control, a coloured line will always appear in the control line region,

indicating that proper volume of specimen has been added and membrane wicking has occurred

SPECIMEN COLLECTION AND PREPARATION

- The H. pylori Rapid Test Device (Whole Blood/Serum/Plasma) can be performed using

whole blood (from venepuncture or finger stick), serum, or plasma.

- To collect Venepuncture Whole Blood specimens: Collect anti-coagulated blood

specimen (sodium or lithium heparin, potassium or sodium EDTA, sodium oxalate,

sodium citrate) following standard laboratory procedures.

- To collect Finger stick Whole Blood specimens:

- Wash the patient’s hand with soap and warm water or clean with an alcohol swab. Allow

to dry.

- Massage the hand without touching the puncture site by rubbing down the hand towards

the fingertip of the middle or ring finger.

- Puncture the skin with a sterile lancet. Wipe away the first sign of blood.

- Gently rub the hand from wrist to palm to finger to form a rounded drop of blood over the

puncture site.

- Add the Finger stick Whole Blood specimen to the test by using a capillary tube:

26
 - Touch the end of the capillary tube to the blood until filled to the line. Avoid air bubbles.

- Place the bulb onto the top end of the capillary tube, then squeeze the bulb to dispense the

whole blood to the specimen well (S) of the test device.

- Separate serum or plasma from blood as soon as possible to avoid haemolysis. Use only

clear, nonhemolyzed specimens.

- Testing should be performed immediately after specimen collection. Do not leave the

specimens at room temperature for prolonged periods. Serum and plasma specimens may

be stored at 2-8°C for up to 3 days. For long term storage, specimens should be kept

below -20°C. Whole blood collected by venepuncture should be stored at 2-8°C if the test

is to be run within 2 days of collection. Do not freeze whole blood specimens. Whole

blood collected by finger stick should be tested immediately.

- Bring specimens to room temperature prior to testing. Frozen specimens must be

completely thawed and mixed well prior to testing. Specimens should not be frozen and

thawed repeatedly.

- If specimens are to be shipped, they should be packed in compliance with local

regulations covering the transportation of etiologic agents

INTERPRETATION OF RESULTS

POSITIVE: Two lines appear. One coloured line should be in the control line region (C) and

another apparent coloured line should be in the test line region (T).

NEGATIVE: One coloured line appears in the control line region (C). No line appears in the

test line region (T).

27
INVALID: Control line fails to appear. Insufficient specimen volume or incorrect procedural

techniques are the most likely reasons for control line failure. Review the procedure and repeat

the test with a new test. If the problem persists, discontinue using the test kit immediately and

contact your local distributor.

3.9 Data Analysis

Data was organized using the MS Excel. Data was processed by use of a computer and statistical

calculator. The processed data was presented in tables, pie- chart and bar graphs.

3.10 Ethical consideration

A clearance form to conduct the study was obtained from the school (Redemption Higher

Institute of Biomedical and Management Sciences). An authorization letter was obtained from

the Regional Delegation and a letter of Authorization was collected from the head of department

for medical laboratory in RHIBMS, to carry out the study in the laboratory. Informed consent

was obtained from the respondents after providing them with all the necessary details about this

study. Confidentiality of the data collected was upheld throughout this study by the use of

numbers to identify participants rather than names.

28
 CHAPTER FOUR

RESULTS

4.0 Introduction

A total of 340 questionnaires were administered at the Buea Regional Hospital and all the

questionnaires were answered giving a 100% success.

4.1 Socio-demographic factors of the participants

Table 1: shows that majority 141 (41.5%) of the participants were within 27-35 age range, 209
(61.5%) were females, 184 (54.1%) were single and 126 (37.1%) were university students, 274
(80.6%) were Christian and 190 (55.9%) came from a medium family income.
Parameters Variables Frequencies Percentages
Age 15-20 75 21.4
21-26 124 35.4
27-35 141 41.5
Total 340 100
Gender Male 131 37.4
Female 209 61.5
Total 340 100
Marital status Single 184 54.1
Married 100 28.57
Divorce 56 16
Total 340 100
Educational level Primary 58 16.57
Secondary 106 30.29
University 126 37.1
No formal education 50 14.29
Total 340 100
Religion Christian 274 80.6
Muslim 60 17.14
Others 6 1.71
Total 340 350
Family income Low 129 36.86
Medium 190 55.9
High 21 6
Total 340 100

Table 1: Socio-demographic factors of the participants

29
4.2. Prevalence of Helicobacter pylori among the participants

Fig 1: shows that the prevalence of this study is 62.9% were out of the 340 patients tested for H.

pylori, 214 were positive and only 126 (37.1%) were negative.

Prevalence of H. pylori

37.1% positive
negative
62.9%

Fig 1: Prevalence of H. pylori

4.3 Associated risk factors of Helicobacter pylori

Table 2: shows that out the 171 (50.3%) who leave in crowded housing condition, 135 (39.7%)

were positive for H. pylori, 174 (51.2%) out of the 274 (80.3%) who also drink borehole water

were also positive for H. pylori, among the 214 (62.9%) who agreed of having family history of

gastric ulcer, 174 (51.2%) tested positive for H. pylori, 159 (46.8%) accepted using pit latrine out

of which 100 (29.4%) had H. pylori infection. Those living >4 persons in a house recorded a

higher prevalence where 134 (39.4%) out of 171 (50.3%).

30
 Variable Response Helicobacter pylori status Total

Positive Negative
N % N %
Living condition Crowded home 135 39.7 36 10.3 171 (50.3%)
Normal 49 14 60 17.1 109 (31.1%)
Spacious home 30 8.6 30 8.6 60 (17.2%)
Total 214 62.9 126 37.1 340 (100%)
Source of drinking Municipal treated 38 10.9 22 6.3 60 (17.2%)
water water
Well water 2 0.6 4 1.2 6 (1.7%)
Boreholes 174 51.2 100 28.6 274 (80.3%)
Total 214 62.9 126 37.1 340 (100%)
Family history of Yes 174 51.2 40 11.4 214 (62.9%)
gastric ulcer No 40 11.4 86 24.6 126 (36%)
Total 214 62.9 126 37.1 340 (100%)
Type of sewage Pit latrine 100 29.4 59 16.9 159 (46.8%)
disposal
Open defecation 20 5.7 30 8.6 50 (14.3%)
Water closet 94 27.7 47 13.4 141 (41.5%)

Total 214 62.9 126 37.1 340 (100%)

Number of person in <4 80 22.9 89 25.4 169 (48.3%)
the house
>4 134 39.4 37 10.6 171 (50.3%)
Total 214 62.9 126 37.1 340 (100%)
Table 2: the associated risk factors of H. pylori with prevalence

4.4. Prevalence in association to socio-demographic data

Table 3: shows that majority 117 (34.4%) of the participants with H. pylori were within the 27-

35 age range, 175 (54.1%) out of 209 (61.5%) females in this study had H. pylori, out of the 184

(55.4%) singles involved in this study, 134 (39.4%) tested positive for H. pylori. Out of the 126

university students, 111 (32.7%) tested positive for H. pylori prevalence was high among

Christian with 178 (52.4%) out 274 (80.6%) low income families also recorded the highest

prevalence where out of 129 (36.9%), 111 (32.7%) were positive for H. pylori.

31
 90.0%
80.3%
80.0%

70.0% 62.9%
60.0% 52.1%
50.3% 51.2% 50.3%
46.8%
50.0% total
39.7% 39.4%
40.0% positive
28.6% 29.4%
negative
30.0%
16.9%
20.0% 11.4%
10.3% 10.6%
10.0%

0.0%
Crowded boreholes pit lantrine family >4 persons at
home history home

Parameters Variables Positive Negative Total Total

N % N % N %
Age 15-20 30 8.6 45 12.9 75 21.4
21-26 67 19.1 57 16.3 124 35.4
27-35 117 34.4 24 6.9 141 42.2
Total 214 62.9 126 37.1 350 100
Gender Male 39 11.1 92 26.3 131 37.4
Female 175 51.5 34 9.7 209 61.5
Total 214 62.9 126 37.1 350 100
Marital Single 134 39.4 50 14.3 184 54.1
status Married 48 13.7 52 14.9 100 28.6
Divorce 32 9.4 22 6.3 56 16
Total 214 62.9 126 37.1 350 100
Educational Primary 3 0.9 55 15.7 58 16.6
level Secondary 86 24.6 20 5.7 106 30.3
University 111 32.7 15 4.3 126 37.1
No formal education 14 4.0 36 10.3 50 14.3
Total 214 62.9 126 37.1 350 100
Religion Christian 178 52.4 96 27.4 274 80.6
Muslim 36 10.3 24 6.9 60 17.1
Others 0 00 6 1.7 6 1.7
Total 214 62.9 126 37.1 350 100
Family Low 111 32.7 18 4.6 129 37.9

32
income Medium 90 26.5 100 28.6 190 55.9
High 13 3.7 8 2.3 21 6
Total 214 62.9 126 37.1 350 100
*N stands for the frequencies

Table 3: Prevalence in association to socio-demographic data

33
 CHAPTER FIVE

DISCUSSION, CONCLUSION, RECOMMENDATION

5.0. Introduction

This chapter will discuss and conclude on the results of the previous chapter as well as will

contain recommendations made based on the conclusions drawn from the results

5.1. DISCUSSION

In this study, A total of 340 questionnaires were administered in the Molyko Community and

all the questionnaires were answered giving a 100% success and out of this, that majority 141

(41.5%) of the participants were within 27-35 age range, 209 (61.5%) were females, 184

(54.1%) were single and 126 (37.1%) were university students. 274 (80.6%) were Christian

and 190 (55.9%) came from a medium family income

Prevalence of Helicobacter pylori among the participants

The prevalence of H. pylori among the patients of Regional Hospital Buea was found to be

62.9% This is close to 60.9% prevalence found by Ikpeme et al. [2013] in Uyo, south-south

Nigeria but lower than values of 67.6% and 82% documented by Senbanjo et al. [2014] and

Holcombe et al. [2018] in Lagos and Maiduguri, respectively. Possible explanation for this

variation may be low standard of living especially water supply over time. There is reported

increase in the proportion of Nigerian household access to improved water supply over the

last 3 decades.

The high prevalence rates observed in the current study (62.9%) and the empirical review

studies highlight the significant burden of H. pylori infection, particularly among youths and

34
children. The factors associated with infection, such as family socioeconomic status, parental

infection status, and environmental factors (e.g., water source), underscore the importance of

addressing these determinants in intervention strategies.

Associated risk factors of Helicobacter pylori

Based on the second objective, the results presented provide insights into the prevalence of

Helicobacter pylori infection and its potential association with various factors, including

housing conditions, water sources, and dietary habits. Out of the 172 individuals (52.76%)

who lived in normal housing conditions, 35.12% was positive for H. pylori. Regarding water

sources, only 8 individuals 2.45% out of the 2.76% who drank well water were positive for

H. pylori, while a higher proportion, 107 individuals 45.34%, out of the 52.76% who drank

borehole water were also positive for the infection.

Dietary habits also seemed to play a role in H. pylori prevalence. Out of the 85 individuals

26.07% who ate commercial food, 27.54% tested positive for the infection. Additionally, 78

individuals (23.93%) out of the 30.67% who ate vegetables once a week had H. pylori, and a

significant proportion, 100 individuals (30.67%) out of 181 (55.52%), who ate spicy food

tested positive for the infection.

These findings can be compared and contrasted with the study conducted by Kouitcheu

Mabeku (2018), which reported an overall prevalence of 64.39% for H. pylori infection. The

study found that factors such as upper abdominal pain, frequent burping, family history of

gastric cancer, low socioeconomic status, blood group O, and NSAID use were associated

with higher rates of H. pylori infection. Interestingly, the findings also noted that

overcrowded households had a higher rate of 65.32% seropositivity, while 58.24% of

subjects with normal weight were seropositive.

35
While the current results do not provide direct comparisons for some of the factors mentioned

in the empirical review, they offer insights into the potential role of housing conditions, water

sources, and dietary habits in H. pylori transmission and infection. The empirical review by

Kouitcheu M et al. (2018) suggests that socioeconomic factors, family history, and lifestyle

factors (e.g., NSAID use) may also contribute to the risk of H. pylori infection, which

highlights the multifactorial nature of this health issue.

Prevalence in association to socio-demographic data

Objective 3 provide valuable insights into the prevalence and risk factors associated with

Helicobacter pylori infection. In this study, the majority of participants with H. pylori

infection, 64 (27.12%), were within the 27-35 age range. This finding is noteworthy when

compared to the study by Khasag et al., (2019) which found that age over 40 years (odds

ratio: 1.5; 95% CI: 1.0-2.0; p < 0.02) was associated with an increased risk of atrophy, and

age over 40 years (odds ratio: 3.8; 95% CI: 2.4-6.0; p < 0.0001) was associated with an

increased risk of intestinal metaplasia. While the current study did not investigate specific

conditions like atrophy or intestinal metaplasia, the high prevalence of H. pylori among the

younger age group (22-26 years) suggests the need for early intervention and prevention

strategies.

Regarding gender differences, 97 (40.68%) out of 172 (72.88%) females in the current study

had H. pylori infection. This finding aligns with the general understanding that gender-related

factors may contribute to variations in susceptibility or exposure to H. pylori. However, the

study by Khasag et al. (2010) did not specifically address gender-related differences in H.

pylori infection.

The current study also revealed a high prevalence of H. pylori infection among single

individuals, with 138 (58.47%) out of 163 (69.07%) singles testing positive. This finding may

36
be related to lifestyle factors, such as dietary habits and living conditions, which could

influence the risk of H. pylori transmission and infection. While the Khasang et al (2019) did

not specifically address marital status, it highlighted the role of high salt intake (odds ratio:

1.6; 95% CI: 1.0-2.3; p < 0.02) as a risk factor for intestinal metaplasia, which could be

linked to certain dietary habits.

Furthermore, the current study found that 94 (39.83%) out of 154 university students tested

positive for H. pylori. This finding underscores the importance of addressing H. pylori

infection among student populations, as it may impact their overall health and academic

performance. The study by Khasag et al.(2019) did not specifically focus on student

populations but reported a high overall infection rate of 80.06% for H. pylori among

dyspeptic patients in Mongolia.

Overall, the results from the current study and the empirical review by Khasag et al. (2019)

highlight the significant burden of H. pylori infection and the need for targeted interventions

and prevention strategies tailored to specific demographic groups and risk factors.

CONCLUSION

Based on the findings, the following conclusions can be made;

The prevalence of H. pylori amongst youths in the Molyko community is 62.9% which is

relatively high, were out of the 340 youths tested for H. pylori, 214 were positive

Secondly, factors such as water source, food source and spicy food are associated with H.

pylori as most infected either consume borehole water, Family history of gastric ulcer,

Number of person in the house.

37
Finally, H. pylori are most prevalent amongst single, females between the age 27-35 years

old. These people are viewed as high consumers of street, spicy food which is also highly

associated to H. pylori infection.

RECOMMENDATIONS

With authorization, the researcher can go on a screening and testing for Helicobacter pylori

infection campaign, particularly among younger populations (e.g., individuals in their 20s), to

facilitate early detection and prompt treatment.

Also, raise awareness about the importance of early detection and treatment of H. pylori

infection to prevent potential long-term complications, such as atrophy and intestinal

metaplasia, as highlighted in the empirical review.

Provide education on risk factors, transmission routes, and preventive measures for H. pylori

infection, with a particular focus on lifestyle factors, dietary habits, and living conditions.

Develop and implement targeted interventions and educational campaigns tailored to specific

demographic groups, such as females, single individuals, and university students, who were

found to have higher prevalence rates of H. pylori infection

38
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 APPENDIX I: CONSENT FORM

Dear respondents

My name is --------------- a medical laboratory science student of Redemption Higher Institute

of Biomedical and Management Sciences. I am carrying out a study “PREVALENCE AND

ASSOCIATED RISK FACTORS OF HELICOBACTER PYLORI AMONG PATIENTS

AT THE REGIONAL HOSPITAL BUEA”. Your participation is voluntary and you may

pull out at any time if you wish. There are no risks associated with your participation in the

study. The study will benefit females of child bearing ages and the community as they will

get an opportunity to be updated on their knowledge on the prevalence and associated risk

factors of Helicobacter pylori.

You are under no obligation to participate in the study and refusal to participate will not

affect you in anyway.

All data will be kept in a safe place and will not be shared with anybody and will not be used

for any other purposes apart from the study. You are free to ask any questions about the study

at any time if you need more clarification

I have explained the study purpose and objectives of the study to the participants, and they

have understood and voluntarily consented to participate in the study.

Researcher’s Signature………………………Date…………………(RESEARCHER)

The topic and its objectives have been fully explained to me, and I have understood and

voluntarily agreed and consented to participate in the study. Respondents

Signature………………Date…………………..(RESPONDENT)

46
 APPENDIX II: QUESTIONNAIRE

Dear correspondent,

I am called ------------------ an HND final year Medical Laboratory Science student of

Redemption Higher Institute of Biomedical and Management Sciences (RHIBMS) Molyko

Buea. I am currently taking a research as one of my requirement needed for the award of an

HND certificate on “PREVALENCE AND ASSOCIATED RISK FACTORS OF

HELICOBACTER PYLORI AMONG PATIENTS AT THE REGIONAL HOSPITAL

BUEA”. I will be grateful and highly honoured if you can kindly take some of your time to

complete this questionnaire. Your honest respond to these questions shall be highly

appreciated. Thanks for your keen attention.

INSTRUCTIONS: Tick the correct answer(s) or give your own option (s) in the blank space

provided below

SECTION A: Demographic data

1) Age a) 15-20 years b) 21-26 years c) 27-35 years

2) Gender a) male b) females

3) Education a) first school b) ordinary level c) advance level d) degree/ diploma

4) Religion a) Christian b) Muslim

5) Marital status a) married b) single c) divorce

6) Family income a) low b) medium c) high

SECTION B: ASSOCIATED RISK FACTORS

1. Types of sewage disposal

a. Pit latrine

47
 b. Open defecation

c. Water closet

2. Source of household water

a. Borehole

b. Well

c. Stream

3. Number of people in the house

a. < 4

b. > 4

Please tick the correct answer

Questions Response

Living condition Crowded home

Normal
Spacious home
Total
Source of drinking water Municipal treated water
Well water
Boreholes
Family history of gastric ulcer Yes
No
Type of sewage disposal Pit latrine

Open defecation

Water closet

48
APPENDIX III: CLEARNCE FORM

49
APPENDIX IV: AN AUTHORIZATION LETTER

50
APPENDIX V: AUTHORIZATION LETTER FROM RHIBMS LABORATORY

51
52