Risk factors associated with the prevalence of Helicobacter pylori among community members in Kibwezi West Sub-County, Makueni County

INTRODUCTION

Helicobacter pylori are gram-negative pathogens that affect around 1/2 of the global populace. Recurrent H. pylori infection has been attributed to gastro-esophageal reflux disorders, duodenal ulceration, stomach sores, recurrent inflammation and stomach cancer.¹ In 2015, it believed that 4.4 billion individuals globally infected.²

According to surveys performed with the assistance of Hooi et al and published throughout 1970 and 2016, South America and Western Asia had the greatest rates of H. pylori infection, with 69.4% and 66.6% respectively.² In Saudi unwell patients with recurring stomach discomfort and those under the age of 55, Akeel et al discovered a high prevalence of this infection. Severe gastritis also appeared to be substantially associated with H. pylori infection.³

According to Zamani et al Nigeria has the greatest frequency of H. pylori infection on the continent, at 89.7%.⁴ The increased incidence of H. pylori on the continent is assumed to be attributed to sociodemographic and geographic aspects.⁵ Based on Lehours the incidence of this ailment is higher in people in poor countries, including people in low socio-economic backgrounds.⁶

In an investigation performed in Kenya, H. pylori was shown to be present in 73.3% of children and 54.8% of elderly individuals with dyspepsia.⁷ Established potential variables for increased illness in African countries include home water sources, sanitation and personal hygiene.⁸ According to Li et al diabetic individuals showed considerably greater incidence of H. pylori illness than non-diabetic participants.⁹ Furthermore distinction currently only applies to type II diabetes not type I.

Dinda and Kimang'a identified H. pylori genetic material in 2 household shallow wells and one stream in Nairobi.⁷ The wells were in two locations. Their findings supported the idea that H. pylori might be transmitted through contaminated drinking water. According to Miernyk et al H. pylori was once found among rural populations, with social and economic factors such as congestion and consumption of formerly channelled/ supplied water being associated with H. pylori acquisition.¹⁰

Despite the availability of data in the KHIS revealing an increase in H. pylori infection from 20.1% in 2015 to 27.5% in 2020, no research has been published in Makueni County among community individuals.¹¹ As a result, the goal of the investigation sought to determine the extent of H. pylori illness and its association with socioeconomic variables. The study’s specific objectives were: To establish the extent of H. pylori amongst Kibwezi West Sub County community members, to identify socioeconomic factors associated with the presence of H. pylori amongst Kibwezi West Sub-County residents and to determine association between socio-economic factors and extent of H. pylori amongst Kibwezi West Sub County community members.

METHODS

The researcher used an analytical cross-sectional method for his investigation. This method works well for obtaining data to determine the relationship between independent and dependent variables.¹² The participants in this study were residents of Kibwezi West Sub County, Makueni County, Kenya. The six wards that make up the Sub-County are Kikumbulyu North, Kikumbulyu South, Emali, Makindu/Kiboko, Nguumo, and Nguu/Masumba.

Due to its lack of water, Makueni County is classified as an arid and semi-arid environment. The County has few water supply systems, with a maximum output of 18,490 m³ per day. Because of the increased frequency of H. pylori illness, Kibwezi West Sub County was chosen via purposive sampling (37.3%). Cluster sampling was employed to organize community members in terms of wards, and simple random sampling was employed to choose 344 community members from the Sub-County, which has a population of 200,909 residents.

Background characteristics (age, gender, marital status, residential location, religion) and risk factors were included as independent variables (socio-economic factors). The extent of H. pylori amongst Kibwezi West Sub County residents, Makueni County, Kenya, was the dependent variable. Stool samples were analyzed using the idea of immunochromatography in vitro to detect H. pylori antigens in a qualitative manner in order to ascertain prevalence. A questionnaire was utilized to collect information on background characteristics and factors linked with H. pylori illness amongst community members. The questionnaire was examined by supervisors and peers to confirm its validity. A pre-test was conducted among the residents of Kibwezi East Sub County to confirm that questionnaire items were reliable.

The Chi-square test was used to look into the links between categorical variables (background and socio-economic factors) and H. pylori infection status.

RESULTS

Background characteristics of the respondents

A total of 344 residents of Kibwezi West Sub-County were surveyed, with a response rate of 100% (344). The sociodemographic profile of the study participants is shown in Table 1. As shown in the table, there was almost equal representation from the four clusters in the Sub-County. The majority of participants sampled were aged under 58 years (90.1%, n=310). Most respondents were married (81%, n=280), female (75%, n=259), and practicing Christians (84%, n=288).

The extent of H. pylori infection among the community members

The H. pylori test results are shown in Figure 1. Only a third (32%, n=109) of the samples tested positive, with the rest (68%, n=225) returning negative results.

A Chi-square analysis was applied to examine the relationship of background features and the infection status of the residents. As shown in Table 2 none of tested features considered significant for H. pylori infection.

Socio-economic factors associated with H. pylori

Table 3 shows several socio-economic characteristics of the respondents that were relevant to H. pylori transmission. Almost 9 out of 10 residents (89%, n=305) had some form of employment. Similarly, 88% (n=302) engaged in farming as their source of income. Sixty-three percent (n=215) had attained primary education, followed by secondary education at 22% (n=74). On average, most households (87%, n=298) had 4-5 family members, lived in a house that had 3-4 sleeping rooms (99%, n=341), and used a pit latrine (80%, n=276). Additionally, 82% (n=283) relied on dams for water supply, and 16% (n=55%) relied on shallow wells. One in every eighteen residents (5.5%, n=19) of Kibwezi West Sub-County has diabetes mellitus type 2 as most prevalent (88%, n=15).

Association between socio-economic factors and H. pylori test results

Table 4 shows the association between the various socio-economic characteristics of the residents and the infection status. The proportion of those who turned positive for H. pylori differed significantly by level of education (LR=10.620, df=3, p=0.014), such that those with a high level of education were less infected. The proportion of those who turned positive for H. pylori differed significantly with the source of drinking water (LR=123.177, df=2, p=0.001) in that those who got water from the dam were mostly infected. Further, the proportion of those who turned positively to H. pylori differed significantly among participants with diabetes mellitus (p=0.010). Nonetheless, there was no evidence of a link between H. pylori infection and employment status (χ2=0.055, df=1, p=0.814), number of members in a household (LR=0.276, df=2, p=0.871), number of rooms used for sleeping per household (LR=0.004, df=1, p=1.000), and type of toilet in the homesteads (χ2=0.510, df=1, p=0.475).

LR=Likelihood ratio, DM=Diabetes mellitus.

DISCUSSION

Among the population surveyed, males and females had a close range of prevalence (31.8% and 31.7%), and this indicated that every person in Kibwezi West Sub County can acquire the infection. The results could be attributed to the fact that males and females are exposed to a similar environment. The findings slightly differ from a study by Lehours who indicated that the infection is more common in females than in males.⁶

This investigation further revealed that the prevalence of H. pylori illness varied by age group, with 37.5% in the 18-27-year-old group and 26.5% in the over-58-year-old group. This finding are consistent with those of Nabwera et al who in their study of Kenyan school-aged children in multiple Nairobi hospitals in 2000, reported a high occurrence rate of H. pylori infection (80.7%) among youngsters.¹³

Another investigation in Kenya by Kimang’a et al discovered the extent of H. pylori was extremely high (73.3 percent) for teenagers but low (54.8 percent) for the elderly, corresponding to Shmuely et al study involving Nakuru residents, who documented high frequencies of infection among young respondents.^14,15

The investigation didn't show correlation of all background characteristics (age, gender, religion, marital status, and residence) and the extent of H. pylori illness. The results of this study determined the extent of H. pylori illness amongst Kibwezi West Sub County residents to be 32%. This study favorably compares the findings with data from KHIS, whereby Kibwezi West Sub County prevalence is found to be slightly higher at 37.3%.¹¹ The results of the study, which took place in Makueni County in Kenya, a developing country, reveal that the frequency of H. pylori continues to be a community health threat in developing regions. The study's diagnostic test of choice was the H. pylori stool antigen test.

According to this study, H. pylori infection was closely linked to level of education, the source of drinking water, as well as being diabetic. In a study of the general populace in Cameroon, investigators reported a link between education and the prevalence of H. pylori infections within respondents.¹⁶ However, the prevalence of H. pylori reported in people with advanced education by Abongwa et al was lower than that seen in this study.¹⁶ In addition, the association between H. pylori and the sources of drinking water could be a result of 90.9% of the participants using common sources, such as shallow wells and dams. Similar findings by Smith et al demonstrated H. pylori presence among rural residents, with social and economic characteristics being congestion and consumption of water that was once channelled or supplied to the residents.¹⁷ The study indicated a considerable relationship between diabetes and H. pylori infection, as many studies suggest that H. pylori is more common in people with type 2 diabetes than in healthy people. The cause could be due to H. pylori infection, which causes inflammation and the generation of inflammatory cytokines, as well as hormonal imbalances linked to diabetes mellitus.

CONCLUSION

In conclusion, the extent of H. pylori seems to be lower than what is reported in most Kenyan studies. This study discovered a strong relationship between the level of education, drinking water source, and diabetes, all of which appeared to correlate with H. pylori illness. As a result, the authors recommend that asymptomatic and healthy people be tested for H. pylori on a regular basis. This will enable better and speedier treatment for those who have tested positive, decreasing transmission and halting the overall spread of the disease.

Also, the County government of Makueni, through the ministry of health, should ensure that water samples from all public water sources are being collected and tested for H. pylori infection to determine areas where fecal contamination of water sources could be occurring. In addition, public health officers and community health volunteers should encourage community members to adhere to environmental hygiene and sanitation rules.

Further, and in view of the observation that socio-economic factors are linked to H. pylori infections, the study recommends additional research uncovering certain aspects that have yet to be completely investigated and which could lead to an "African conundrum" for H. pylori illness.

ACKNOWLEDGEMENTS

The authors would like to thank the residents of Kibwezi West Sub County for their willingness to participate in this research. The authors are also grateful to the County and Sub-County administrations for permitting this study to take place in their respective areas.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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