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Helicobacter pylori infection in Ethiopian children: a cohort study
P Lindkvist1, F Enquselassie, D Asrat
1Division of Infectious Diseases, Huddinge University Hospital, Sweden.
Insights
Children in Ethiopia under 6 years old are highly susceptible to Helicobacter pylori (HP) infection. Drinking water source and antibiotic use significantly increase HP infection risk in young children.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Helicobacter pylori (HP) infection is a significant global health concern, particularly in developing countries.
- Understanding risk factors for HP acquisition in early childhood is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the incidence and risk factors for Helicobacter pylori seroconversion in young Ethiopian children.
- To identify age-specific patterns and environmental/treatment-related predictors of HP infection.
Main Methods:
- A cohort study of 121 seronegative children aged 2-4 years in Ethiopia.
- Longitudinal blood sampling at baseline, 12, and 30 months to assess seroconversion.
- Parental interviews using structured questionnaires to collect data on potential risk factors, including water sources and antibiotic use.
Main Results:
- The seroconversion rate was 31% in the first year and 24% annually thereafter.
- Children aged 36-41 months showed the highest seroconversion rate (73%) over 30 months.
- Independent predictors of HP seroconversion included drinking water from wells versus rivers/pipes (RR=1.46) and antibiotic treatment (RR=1.84).
Conclusions:
- Peak age for HP infection in this Ethiopian cohort is below 6 years.
- Drinking contaminated water and receiving antibiotic treatment are significant risk factors for HP infection in young children.
- The findings suggest a potential for repeated seroconversion and sero-reversion in early childhood, highlighting the need for targeted interventions.
Abstract:
Risk factors for infection with Helicobacter pylori (HP) were investigated in a cohort study of 121 seronegative children in Ethiopia aged 2-4 y, who had previously participated in a case-control study. Blood samples were drawn at inclusion in the cohort study and again after 12 and 30 months. At 12 months the parents were also interviewed about putative risk factors for infection, using a structured questionnaire. Analyses were made by comparing risk factors in seropositive and seronegative children. The seroconversion rate during the first year was 31% (27/87) and during the following 18 months 34% (17/50; corresponding to an annual incidence of 24%). After a period of 30 months, 58% (14/24) of the children who were 24-29 months old at inclusion in the study had seroconverted, compared with 40% (4/10) of those who were 30-35 months old, 73% (22/30) of those who were 36-41 months old and 31% (4/13) of those who were 42 months old or more. These results indicate that peak age for HP infection is below 6 y in this cohort in Ethiopia, and might also reflect a pattern of repeated seroconversion and sero-reversion in early childhood. Independent predictors of HP-seroconversion were the variables 'drinking-water', comparing water from a well with water from rivers or pipes (RR = 1.46, 95% CI 1.0-2.15) and 'antibiotic treatment' (RR = 1.84, 95% CI 1.16-2.92).