Prevalence of H.pylori Among Prison Inmates in Otukpo LGA of Benue State
CHAPTER ONE
Objectives of the study
To determine the Prevalence of H.pylori among prison inmates in Otukpo LGA of Benue state. Specific Objectives
- To determine the prevalence of H. pylori among prison inmates in Otukpo LGA of Benue state.
- To determine the H. pylori infection pattern among various age groups in patients with ulcers among prison inmates in Otukpo LGA of Benue state.
- To determine the risk factors associated with H.pylori infection in patients with ulcers among prison inmates in Otukpo LGA of Benue state.
CHAPTER TWO
Literature Review
Prevalence of H. pylori infection
Understanding the epidemiological aspects of H. pylori infection is significant and helpful in illustrating the consequences and complications of the infection. It is also fundamental for the eradication, treatment, and the establishment of the pattern of antibiotic resistance. Several Countries in the World Health Organization, Eastern Mediterranean Regional Office (EMRO) including a group of developing countries in southwest and western Asia as well as North Africa and the ancient land of Iran, have no systematic reviews on the prevalence and epidemiology of H. pylori infections (Eshraghian, 2014).
In many countries, the incidence of H. pylori infection has been decreasing steadily in association with improved standards of living. Yet the occurrence of this bacterium is still ever present, especially in the Far East (Brown et al., 2002). It is the main cause of chronic gastritis and the main etiological agent for gastric cancer and peptic ulcer disease (Bauer and Meyer, 2011). In most regions, the main mechanism of spread is intrafamilial transmission. The prevalence remains high in most developing countries and it is generally related to socioeconomic status and levels of hygiene. Understanding the global epidemiologic patterns of H. pylori will aid us in prioritizing and customizing public health efforts to better manage the burden of this disease (Hooi et al., 2017). In Brazil, epidemiological studies of H. pylori infection have reported a 40% seroprevalence in children less than 6 years of age from a low income population (Camilo et al., 2011). H. pylori infection is very common among adults in southern Brazil as it is in the other developing countries. Socio-economic conditions in childhood besides ethnicity and presence of dyspeptic symptoms in Brazil were found to be the factors significantly associated with the infection (Santos et al., 2005).
Pylori is a pathogen that plays a major role in the development of gastritis and it is also an important risk factor for peptic ulcers in Chinese population. H. pylori was classified as a class I carcinogenic agent, which includes agents that can cause gastric carcinogenesis and primary gastric B-cell lymphoma. The prevalence of H. pylori differs significantly among various countries, with higher prevalence in developing countries compared to developed countries. In both developing and developed countries, high prevalence of H. pylori is apparently associated to poor socioeconomic conditions (Shi et al., 2008). In Kenya, a study on prevalence of H. pylori infection by Nabwera et al., 2000 on school going children from the age of 3 years to 15 years was found to be 80.7%.
The age at which this bacterium is acquired seems to control the possible pathologic outcome of the infection: individuals who are infected with H. pylori at an early age are likely to develop more intense inflammation that may well be followed by atrophic gastritis with a higher subsequent risk of gastric ulcer, gastric cancer or both (Mitchell et al., 2003).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
In this chapter, we would describe how the study was carried out.
Research design
Research design is a detailed outline of how an investigation took place. It entails how data is collected, the data collection tools used and the mode of analyzing data collected (Cooper & Schindler (2006). This study used a descriptive research design. Gill and Johnson (2002) state that a descriptive design looks at particular characteristics of a specific population of subjects, at a particular point in time or at different times for comparative purposes. The choice of a survey design for this study was deemed appropriate as Mugenda and Mugenda (2003) attest that it enables the researcher to determine the nature of prevailing conditions without manipulating the subjects.
Further, the survey method was useful in describing the characteristics of a large population and no other method of observation can provide this general capability. On the other hand, since the time duration to complete the research project was limited, the survey method was a cost effective way to gather information from a large group of people within a short time. The survey design made feasible very large samples and thus making the results statistically significant even when analyzing multiple variables. It allowed for many questions to be asked about a given topic giving considerable flexibility to the analysis. Usually, high reliability is easy to obtain by presenting all subjects with a standardized stimulus; observer subjectivity is greatly eliminated. Cooper and Schindler (2006) assert that the results of a survey can be easily generalized to the entire population.
The study adopted a cross-sectional prison-based study.
Sources of Data
The data for this study were generated from two main sources; Primary sources and secondary sources. The primary sources include questionnaire, interviews and observation. The secondary sources include journals, bulletins, textbooks and the internet.
Population of the study
A study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitute of individuals or elements that are homogeneous in description (Udoyen, 2019). In this study the study population constitute of male and female prison inmates in Otukpo LGA of Benue state.
Sample Size Determination
The minimum sample size was calculated using the formulae of Fishers et al of 1998 method, using a prevalence of H. pylori infection of 54.8% (Okon et al., 2010).
CHAPTER FOUR
Results
Demographics characteristics of the participants
The social demographics information of the respondents was studied. A total of three hundred and eighty one (381) participants who had consented and were recruited in this study, took part by correctly filling the questionnaires and they also successfully produced stool samples for detection of H. pylori antigen.
Age of respondents
The participants in this study were between the ages of 6 months and 90 years old and the age was stratified into nine (9) age groups, namely; 11 – 20 years, 21 – 30 years, 31 – 40 years, 41 – 50 years, 51 – 60 years, 61 – 70 years 71 – 80 years and 81 – 90 years. The Mean age was calculated to be 42.03 with Standard Deviation of 20.11.
Out of the 381 participants in this study, those who were in the age group between 81 to 90 years and 71 – 80 years had the lower numbers of participants of thirteen (13) and fourteen (14) respectively. Those participants who were in the age group between the ages of 31 to 40 years had the highest number of members who participated in the study at one hundred and eighteen (118), as shown in Table 4.1; representation of ages of the participants.
CHAPTER FIVE
Discussion, Conclusions and Recommendations
Discussion
The results of this study determined the prevalence of H. pylori infection among prison inmates in Otukpo LGA of Benue state, to be 46.2%. This study favourably compares the finding with a study done in Beue and Limbe districts of Cameroon Ndip et al, (2004) where the prevalence was found to be 52.27%. The study having been carried out in Otukpo LGA of Benue state, the results proves the phenomenon that the prevalence of the H. pylori is usually high on developing countries and low in developed countries.
In the study, H. pylori stool antigen test was used as the diagnostic test of choice. According to Kenneth (2012), prevalence refers to the percentage of the individuals found to have the condition in a study population. It may be achieved by dividing the number of people found to be positive for the case with the total number of study population, and is usually expressed as a fraction, as a percentage (Gerstman, 2013).
This study has also established that, the occurrences of H. pylori infection among the various age groups was high, at thirty two point four per cent (32.4%) in the age bracket between 41 to 50 years and it was lower at three point four per cent (3.4%) in the age group between 91 years and older. A study in Kenyan school going children from the age of 3 to 15 years in various hospitals within Nairobi, by Nabwera et al., in 2000, found a prevalence rate of H. pylori infection to be 80.7%. Another study still done in Kenya by Kimang‘a et al, in 2010, also found the prevalence of H. pylori to be 73.3% in children and 54.8% in adults, similar to the findings by Shmuely et al., in 2013 in India, who documented prevalence rate of 60 to 73% in all age groups in patients with gastritis and dyspepsia. In contrast, a study done in the United States, which is among the developed countries, found that the occurrence of H. pylori infection was much lower with the prevalence of 5% (Everhart et al., 2000). Most of the studies on the prevalence of H. pylori infections in African countries including Ghana, Tanzania, Egypt and Gambia, were done on children at the school going age, at the age group of between 1 to 15 years and the results showed a prevalence of an average percentage.
Even though previous studies have shown that H. pylori infection is linked with age, sex, and the state of the social economy (Aguemon et al., 2005), the main risk factors for the infection vary from population to population by countries (Allaker et al., 2002). From this study, majority of the participants found positive for H. pylori were between the age group between 41 to 50 years. They had the highest prevalence of thirty two point four (32.4%) (P = 0.004), and the group which was found to have the lowest prevalence was the age between 81 to 90 years, which was found to be three point four (3.4%). This was in similar to the study by Everhart et al, in 2000, where the study showed prevalence in various age groups varying from 16.7% for person 20 years and increasing to 56.9% for persons less than 70 years. This could have been attributed to fact that, H. pylori is acquired during young age as normal flora but in absence of treatment, the infection would persist throughout life time and manifest later in life (Naficy et al 2000). The outcome of the study was similar to the results of other studies done in most other developing countries. Moreover, results of 40% Seroprevalence in children less than 6 years of age from a low income population was reported (Braga et al, 2007).
The study also revealed that H. pylori infection is dependent upon some predisposing factors. Among the risk factors observed under this study, it was mainly water for consumption and other home usage that seemed to contribute to H. pylori infection. The same factors were also studied and described by Ertem et al, in 2003 with the addition of dietary habits. The factors included; age, gender, source of drinking water, level of education, place of waste disposal, number of house hold members and eating place. There may be a strong relation between these variables and when put in a logistic regression model (multivariate analysis), the level of education, where the participants ate meals and where they resided had no influence neither did they had relationship with H. pylori infection.
Several studies investigated putative risk factors for H. pylori infection. Gender and age do not seem to be associated with an increased risk of infection. Indeed, most studies reported no significant difference of H. pylori infection between men and women, both in adults and in children. No significant relationship was found between infection and the age in the adult population. The age-specific gradient in H. pylori prevalence reported by some studies seems to be related to a birth cohort effect (Eusebi et al., 2015).
Gender has not been identified as a relevant characteristic for H. pylori infection acquisition. In this study population, female gender had higher positive cases of 104, H. pylori infection than the male counterparts at 72 positive cases. According to Hunt et al., 2011, women usually consult their general practitioners more often than men and this trend applies across all gender-common ailments. These results were also similar to those of Nurgalieva et al (2002), who found that the source of drinking water had a strong effect on the prevalence of H. pylori infection. This showed that water can be a source of H. pylori infection and to avoid these infections, availability of adequate clean water should be in place.
It is generally considered that among the risk factors for H. pylori infection includes, more siblings or infected family members (Wang and Wang, 2003) (Farrell et al., 2005). This study found that the prevalence of H. pylori infection in this study was not associated with more family members, and that the prevalence tended to be more in the persons between the ages of 11 years to 30 years. The number of house hold members do not determine occurrence of gastritis and gastric ulcers. An association between bed sharing and the H. pylori infection was demonstrated by Danesh et al, (2000). This was in line with a study done in Bolivia which also found that, the place of food consumption was not significant in the transmission of H. pylori infection (Kathleen et al, 2002).
Conclusions
- This study established that the prevalence of H. pylori among prison inmates in Otukpo LGA of Benue state was at 46.2%.
- The participants with the age group between 41-50 years had the highest prevalence of H. pylori infection at 32.4% and the lowest prevalence was found in the age group between 91 years and older (3.4%). The occurrence of the H. pylori infection in various age groups was also found to be high in the ages between 31 years to 40 years old.
- From the results, it also concludes that the major predisposing factors for the establishment of H. pylori infection among prison inmates in Otukpo LGA of Benue state was found to be water for consumption and other domestic usages and female gender.
Recommendations
- This study recommends that the national and county governments should improve on the supply of clean, treated water among the individuals in their residential areas and also look up on other environmental sanitation which would generally help in the reduction of H. pylori infection among the community. Similarly, those diagnosed and found positive for the infection, should be treated on time and be followed up so as to curb the disease transmission.
- There should be frequent testing for H. Pylori of individuals which should be done routinely. This will allow for better and promptly management of those found positive so as to avoid transmission of the infection from one person to another.
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