Prevalence, associated factors, and clinical outcomes of Helicobacter pylori infection in pediatric populations in a war-torn urban environment in Eastern Democratic Republic of Congo: a mixed methods study.

Abstract

Background: Helicobacter pylori (H. pylori) infection remains a significant public health concern in developing countries, especially among pediatric populations where data are limited. In war-torn regions like the Eastern Democratic Republic of Congo, the impact of H. pylori infection on children's health may be exacerbated due to disrupted healthcare systems and limited resources.

Methods: This mixed-methods study, incorporating both cross-sectional and prospective cohort designs, was conducted at Samaritan Doctor's Pediatric Centre between January 2020 and December 2022. The study enrolled 323 children aged 0 to 15 years presenting with gastrointestinal symptoms. Sociodemographic and clinical characteristics were assessed via questionnaire, and H. pylori stool antigen rapid tests were performed. Multivariate regression analyses were conducted. Participants were followed up and outcomes recorded after 30 days.

Results: Of the 323 participants, 119 (36.80%) tested positive for H. pylori infection. Independent factors associated with H. pylori infection included age between 37 and 59 months (aOR: 9.76, 95% CI: 2.62-36.40, p = 0.001), caretaker's occupation (aOR: 2.58, 95% CI: 1.19-5.54, p = 0.016), presence of pets at home (aOR: 0.371, 95% CI: 0.18-0.74, p = 0.005), drinking unsafe water (aOR: 0.13, 95% CI: 0.04-0.42, p = 0.001), anemia (aOR: 4.80, 95% CI: 1.12-20.53, p = 0.034), and presence of red blood cells in stool (aOR: 30.84, 95% CI: 13.97-68.10, p < 0.0001). Thirty days post-initial treatment with first-line medications (omeprazole, clarithromycin, and amoxicillin), 19.30% of patients remained positive for H. pylori.

Conclusion: Children with occult blood in stool and microcytic anemia should be tested for H. pylori using stool antigen tests. Treatment with clarithromycin should be guided by local antibiotic resistance data. Hygiene education, including safe water practices and managing pet contact, is crucial due to their association with H. pylori infection.