HEALTH POINT PREVALENCE OF HELICOBACTER PYLORI IN CENTRAL HOSPITAL WARRI ,

Aim: More than 50% of the world’s population harbor Helicobacter pylori in their upper gastrointestinal tract. Infection is more prevalent in developing countries, and the incidence is decreasing in the West. This study aims to determine the health prevalence rate H. pylori in Central Hospital Warri. Method: All patients suspected of dyspepsia or/and gastritis from 2012 to 2014 were tested for H. pylori. Subjects were screened for H.pylori antibodies using qualitative membrane immunoassay. Results: A total of 936 patients were tested. A prevalence rate of 12.7% was obtained. Also, prevalence of 8.1% and 4.6% were recorded for females and males respectively. The highest prevalence of 3.5% was observed in the age group of 31 – 40 years. While the lowest prevalence of 0.3% and 0.2% was obtained among the children and the elderly Conclusion: This study has shown a decline in the trend of H. pylori infection in the study area.


INTRODUCTION
Helicobacter pylori previously named Campylobacter pylori, is a Gram-negative, micro aerophilic bacterium found in the stomach.Previous research has shown that H. Pylori is present in patients with chronic gastritis, duodenal ulcers , stomach cancer and gastric ulcers, conditions not previously believed to have a microbial cause.Over 50% of the world's population harbor H. pylori in their upper gastrointestinal tract.Infection is more prevalent in developing countries, and incidence is decreasing in Western countries (Yamaoaka, 2008 andBrown, 2000).Up to 85% of people infected with H. pylori never experience symptoms or complications (Bytzer et al., 2011).Acute infection may appear as an acute gastritis with abdominal pain or nausea (Butcher, 2003).Infection rates vary from nation to nation; the developing world has much higher infection rates than the West where rates are estimated to be around 25% (Pounder and Ng, 1995).The age at which this bacterium is acquired seems to influence the possible pathologic outcome of the infection.People infected with it at an early age are likely to develop more intense inflammation that may be followed by atrophic gastritis with a higher subsequent risk of gastric ulcer, gastric cancer, or both.Infections are usually acquired in early childhood in all countries (Kusters et al., 2006).The infection rate of children in developing nations is higher than in industrialized nations, probably due to poor sanitary conditions, perhaps combined with lower antibiotics usage for unrelated pathologies.In developed nations, it is currently uncommon to find infected children, but the percentage of infected people increases with age, with about 50% infected for those over the age of 60 compared with around 10% between 18 and 30 years (Pounder and Ng, 1995).The higher prevalence among the elderly reflects higher infection rates in the past when the individuals were children rather than more recent infection at a later age of the individual (Kusters et al., 2006).In the United States, prevalence appears to be higher in African-American and Hispanic populations, most likely due to socioeconomic factors (Smoak et al., 1994 andEverhart et al., 2000).In Nigeria, prevalence of 86.5% was reported in Abeokuta, Ogun State (Ejilude et al., 2009) and 85.6% in North-Ethiopia (Feleke et al., 2006).The lower rate of infection in the West is largely attributed to higher hygiene standards and widespread use of antibiotics.Despite high rates of infection in certain areas of the world, the overall frequency of H. pylori infection is declining (Malaty, 2007).The bacteria have been isolated from feces, saliva, and dental plaque of some infected people.It is more easily transmitted by gastric mucus than saliva.Transmission occurs mainly within families in developed nations, yet can also be acquired from the community in developing countries (Delport and Van der Merwe, 2007).H. pylori may also be transmitted through the ingestion of wastetainted water, so a hygienic environment could help decrease the risk of H. pylori infection (Brown, 2000).
The present study is to determine the prevalence rate of H. pylori in Warri, Delta State Nigeria.

MATERIALS AND METHOD
This study was conducted in Central Hospital Warri, a Medical facility located in South-Southern Nigeria.The study area lies approximately between longitude 5 0 .00'and 6 0 .45'East and longitude 5 0 .00'and 6 0 .30'South Southern Nigeria.The vegetation varies from the mangrove swamp to evergreen forest in the middle with two seasons; the wet or raining season (April To October) and the dry season (November To March).Warri environment is rich in mineral deposit and the occupants are mainly traders, transporters, fishermen, oil prospectors and civil servants.The area has serious ecological implications for the spread of diseases.These ecological problems are erosion, oil spillage and flood, in addition to overcrowding and poor unsanitary condition.All these activities expose them to communicable diseases including H. pylori infection.

Sample Collection
Venous blood was collected from 936 patients suspected of dyspepsia, peptic ulcer and gastritis by stratified random sampling and apparently healthy subjects used as control.Samples were collected into EDTA containers after informed consent.The sample size of the study was determine using the statistical formula n =1.96II (1-II) e 2 n=sample size.II=Literature prevalence rate of attribute in population.E=error margin accepted.All samples were analyzed immediately.

Sample Analysis
Samples were analyzed for H. pylori antibodies using H. pylori kit device (Spodex limited USA) which is based on qualitative membrane immunoassay.In this test procedure, antihuman globulin (IgG) is immobilized in the test line region of the test.When sample is added to the sample well of the cassette, it reacts with H. pylori antigen coated particles in the test.The mixture migrates chromatographically along the line of the test and interacts with the immobilized antihuman globulin.If the sample contains H. pylori antibodies a colored line will appear in the test line region indicating a positive result.If the sample does not contain H. pylori antibodies, a colored line will not appear in this region indicating a negative result.A procedural control colored line will always appear in the control line region indicating that proper volume of sample has been added and membrane wicking has occurred.The result of the test should be read at 10 minutes.

Data Analysis
Data obtained were presented in tables of percentages.

RESULTS
Out of the total 936 patients screened for H. pylori, a prevalence of 12.7% was recorded.This was found to be higher in females 8.1% than in males 4.6% (Table : 1).Highest percentages of 1.6%, 3.5%, 2.4% and 2.4% were obtained for age groups of 21 -30, 31 -40, 41 -50 and 51 -60 years respectively.The lowest percentages of 0.3%, 0.9% and 0.7%, 0.7%, 0.2% were obtained in the age groups of 0 -10, 11 -20 for children and 61 -70, 71 -80, 81 -90 years for elderly respectively (Table : 2).Table 3 shows high prevalence in the middle age groups and sexes of 21 -30, 31 -40, 41-50 51 -60 years, with percentages of 1.5%, 3.6%, 2.0% and 2.2% in females; 1.7%, 3.1%, 3.1% and 2.8% in males respectively.et al., (2006) and Ejilude et al., (2009) who reported 85.6% and 86.5% in the North Ethiopia and Abeokuta, Ogun State of Nigeria in their studies respectively.This difference may be associated with social economic status of the environment, which may be largely attributed to higher hygiene standards and wide spread use of antibiotics in the area studied.However, our findings agreed with Malaty, (2007) who stated that frequency of H. pylori infection is declining despite the high rates of infection in certain areas of the world.It was observed that H. pylori infection was higher in the females than the males.This may be due to the female's method of cleaning up after defecation and the anatomical proximity of the females' urethra to the anus since fecal contamination has earlier been reported by Brown (2000) as one of the major route of infection.The high rate of infection reported among the middle age group for both sexes may be attributed to higher rates of infection in the past when the individuals were children rather than more recent infection as opined by Kusters et al., (2006).It could also be attributed to the poor eating habit of these age groups by way of visiting restaurants, eateries, overcrowding and unsanitary places.The low infection rates among the children and elderly in this study is in consonance with the earlier findings of Hida et al., (1999) Yamaoka (2008) and Brown (2000), this study has shown that the infection rates is on the decline compare to the West world where infections rates are estimated to be around 25% as reported by Pounder and Ng, (1995).In conclusion, the 12.7% prevalence rate reported in this study shows a declining trend in H. pylori infection in the area studied.However, the social economic factors of this area need to be improved upon in order to further reduce the current prevalent rate.

Table 1 :
Health point prevalence of H. pylori

Table 2 :
Age distribution of H. pylori

Table 3 :
Age and sex related distribution of H. pylori.
H. pylori prevalence variation is in proportion to age, ethnicity and social economic status of individual subjects screened.Although, H.pylori infection is more prevalent in developing countries has earlier reported by that