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Prevalence and risk factors of Helicobacter Pylori Infection among Children with Protein –Energy Malnutrition

Azza Ibrahim El-Desouky1, Sahar Abd El-Raaof El-Shaarawy2, Naglaa Ali Khalifa3,Shimaa Mohamed Safwat Amin4

1Professor of Pediatrics, Faculty of Medicine – Zagazig University, Egypt

2Professor of Pediatrics, Faculty of Medicine – Zagazig University, Egypt

3Professor of Clinical Pathology, Faculty of Medicine – Zagazig University, Egypt

4M.B.B.CH Zagazig University,Resident of Neonatology at Al-Ahrar Hospital, Egypt Corresponding Author Name: Shimaa Mohamed Safwat Amin

Abstract

Background:Helicobacter Pylori is a gram-negative pathogen that is widespread all over the world, infecting more than 50% of the world’s population. H.pylori infection is almost always life-long, generally acquired during early childhood, it is usually acquired during the early years of life and persists for several years. Protein –Energy Malnutrition (PEM) has been identified as the most lethal form of malnutrition which indirectly or directly causing annual death of at least 5 million children worldwide. The present work aimed to assess prevalence of H.pylori infection in children with PEM and study related risk factors.

Methods:The current study conducted on 75 infant and young children with malnutrition and 19 with non malnutrition included in a cross section study in nutrition unit, Pediatric Department at Zagazig University Hospitals and Pediatric department in Al-Ahrar Hospital. The studied cases were subjected to Full history, general, full systemic examination and laboratory investigations as stool analysis and CBC and detection of H.pylori antigen in stool sample by immuno chromatography technique. Results:Prevalence of H.pylori among studied group with malnutrition is 28%. There was statistically significant relation between child order within family and H. pylori infection, Prevalence of H. pylori infection in rural area (35%) was more than urban (20%) but without significant difference denoting no relation to H. pylori with residence. Our study showed statistically significant relation between socioeconomic level and H.pylori infection. As regards the type of feeding we found in our study that there was no statistical significant difference between feeding pattern and infection with H. pylori. Our study shows there was statistically significant relation between other parasitic infestation and H.pylori infection and presence of parasitic infestationis a significant predictor of H-pylori infection. Prevalence of other parasitic infestation in malnourished children 73.7%

was higher than prevalence in non malnourished children 46.7%. No statistically significant relation between edema and H. pylori infection. There is statistically insignificant difference between BMIZ, WAZ, WLZ between H. pylori positve and negative cases. Conclusion: The prevalence of H. pylori infection in early childhood among children with PEM is 28% which is considered high for this age. This organism may worse malnutrition by increasing the incidence of many GIT disorders (diarrhea, vomiting, poor appetite and maldigestion) and by association with other parasitic infest.

Keywords: H.pylori- PEM-risk factors.

Introduction:

H.pylori is a gram-negative pathogen that is widespread all over the world, infecting more than 50% of the world’s population(1). H.pylori infection is almost always life-long, generally acquired during early childhood, it is usually acquired during the early years of life and persists for several years.It seems to be an association between the prevalence of H. pylori in adults and the risk of acquisition of H. pylori infection during childhood(2).

PEM has been identified as the most lethal form of malnutrition which indirectly or directly causing annual death of at least 5 million children worldwide (3).

H. pylori, according to some authors play a role on the balance of nutritional status. The incidence of H.

pylori infection in childhood in developing countries is high and has been correlated with malnutrition and growth retardation. Contracting H. pylori infection in childhood may result in a series of events that

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influence morbidity and mortality(1), and it seems to be the primary event for chronic malnutrition and diarrhea syndrome with failure to thrive (4).

The present work aimed to assess prevalence of H.pylori infection in children with PEM and study related risk factors.

Patients and Methods

Study design and setting:

The present study is a Cross-section study that was carried out in nutrition unit, Pediatric Department at Zagazig University Hospitals and Pediatric department in Al-Ahrar Hospital during the period from December 2016 to July 2017.

Study sample:

The current study conducted on 75 infant and young children with malnutrition diagnosed according to Gomez classification. Weight-for-age used for malnutrition classification as mild (Grade I) fell between 75%–89% of the standard value (standard is the 50th percentile of the Harvard value), moderate (Grade II) malnutrition fell between 60%–74%, sever (Grade III) malnutrition less than <

60%(5). The study also included 19 non-malnurished infant and young children.

"Classification of malnutrition (5)"

Degree of PEM % of desired body weight for age and sex

Normal 90%-100%

Mild: Grade I (1st degree) 75%-89%

Moderate: Grade II (2nd degree) 60%-74%

Severe: Grade III (3rd degree) <60%

Inclusion criteria:

1- Children with malnutrition aged6months.

2- All are full term and their birth weight was normal.

Exclusion criteria:

1- Infant6months.

2- Preterm infants or with intrauterine growth retardation.

3- Congenital malformation.

4- Any diseases causing secondary malnutrition like metabolic or CNS diseases.

5- Chronic renal or hepatic disease.

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Methods:

1): Full history:

Complete history was taken from parents like age, sex, residence with stress on child order within family, pattern of feeding in first 6 months if it was absolute or non-absolute breast feeding, artificial or mixed, presence of gastro intestinal (GIT) upsets as diarrhea during the study, recurrent vomiting or anorexia.

2) Family socioeconomic scale (SES):

The parents of the children enrolled in the study responded to a structured questionnaire to obtain parental data on occupation, education level, residence and environmental information, such as the number of persons living in the house, type of house, crowding index, availability of potable water and sanitary conditions.

Socioeconomic level: to be classified into low level less than (50%), middle Socio economic level (50% - <75) and high ( ≥75 %) depending on the quartiles of the score calculated Socio economic (6).

3) Clinical Examination:

General examination as vital signs, pallor and edema and full systemic examination including respiratory, cardiovascular, GIT and nervous system to exclude presence of any chronic illness with emphasis on:

Anthropometric measurements particularly:

1. Body weight(kg) was measured early in the morning, after voiding, without heavy clothes or blankets using electronic scales, approximated to the nearest 0.1 kg

2. Length/height (cm) measured to the nearest 1 cm using an extensible tape, depending on a child’s age and ability to stand, measure the child’s length or height. A child’s length is measured lying down (recumbent). Height is measured standing upright.

 A child is less than 2 years old, measured in recumbent length, placed on a board, holded the baby's head in place, laied on his back compressing the hair, an imaginary vertical line from the ear canal to the lower border of the eye socket is perpendicular to the board. (The child’s eyes should be looking straight up)

 A child aged 2 years or older and able to stand measured standing height, the child stand on the wall with feet slightly apart. The back of the head, shoulder blades, buttocks, calves, and heels should all touch the wall; hold the child’s knees and ankles to help keep the legs straight and feet flat. To keep the head in this position, hold the bridge between your thumb and forefinger over the child’s chin.

3. Head circumference(cm) is measured with a tape measure extending from the middle of the forehead above eyebrows and ears to the farthest part in the rear of the head over the occipital prominence,

4. BMI is a number that associates weight with height/length. BMI can be a useful growth indicator when it is plotted on a graph against a child’s age. BMI is calculated as follows:

weight in kg / Height in m approximated to the nearest 0.1 cm.

5. Weight -for- age (WAZ), height-for-age (HAZ), weight-for- height (WHZ) and BMI for-age (BMIZ) were calculated,z- score is the number of standard deviations from the mean a data

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point is. But more technically it’s a measure of how many standard deviations below or above the population mean a raw score is. A z-score is also known as a standard score and it can be placed on a normal distribution curve. Z-scores range from -3 standard deviations (which would fall to the far left of the normal distribution curve) up to +3 standard deviations (which would fall to the far right of the normal distribution curve). In order to use a z-score, you need to know the mean μ.

Investigation:

Patients were subjected to the following laboratory investigations;

A-Routine:

Complete blood count (CBC):

For detection of anaemia, anaemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status. Nutritional anemia is considered when the haemoglobin cut- off of 110 g/l (11g/dl) for children 6 - 59 months of age, anaemia is considered when the haemoglobin cut-off of 110 g/l (11g/dl) for children 6 - 59 months of age (7).

 Sterile syringes for blood sample collection and sterile tubes with anticoagulant for CBC

 By automated cell counter, Sysmex KX-21N. About 1 ml of venous blood was taken from each patient by sterile veni puncture in EDTA containing tube for determination of CBC.

Stool analysis.

 Dry clean covered plastic cups and wooden sticks for stool collection

 Stool sample is collected in a clean container and then sent to the laboratory for analysis within 1-2 hours of collections by direct smears and concentration methods. Macroscopic examination included consistency and presence of gross blood, mucus or worms, whereas microscopic examination was conducted to reveal the presence of blood, fat and / or mucus; Giardia cysts and other protozoa, helminthic parasites.

B-Special:

Detection of H .pylori Antigen in stool sample by(immuno chromatography technique). It is a convenient office-based method for detection of H. pylori antigen in stool specimens(8).

Results Interpretation:

Rapid one-step immunoassay for the detection of H. pylori antigens in human stool. Utilizes a monoclonal anti-H. pylori antibody as the capture and detector antibodies. A diluted patient stool sample is dispensed into the sample port of the test device and the appearance of a pink-red line in the reading window next to the letter T after 5 minutes of incubation at room temperature (20°–26° C) indicates a positive result Positive Test.

 BLUE band at Control Line plus PINK-RED band at Test Line.

 No other bands should be seen.

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 Negative Test

 BLUE band at control line only. No other bands should be seen.

Invalid Results

1. Band at Test Line without band at Control Line, or 2. Band of wrong color at Test Line, or

3. No Test Line AND no Control Line, or 4. Test Line band that appears after 6 minutes C. Statistical management:

 All data were collected, tabulated and statistically analyzed using SPSS 20.0 for windows (SPSS Inc., Chicago, IL, USA).

 Quantitative data were expressed as the mean ± SD & median (range), and Independent sample t test was used to compare between the two groups for quantitative normally distributed data.

 Qualitative data were expressed as number& percentage. Fisher's exact test is a statistical significance test used in the analysis of contingency tables, it is employed when sample sizes are small,X² (Chi-square ) (test of significance) used for difference between two or more qualitative variable

 All tests were two sided. p-value < 0.05 was considered statistically significant (S), and p- value ≥ 0.05 was considered statistically insignificant (NS).*

Results:

This table shows that 64% of malnourished cases are females; mean age is 17.45 months old, 53.3% living in rural areas, 89.3% one and more live per room and 66.7% their order are other than the first (Table 1).

This table shows the prevalence of Helicobacter pylori among malnourished cases is 28%

(Table 2).

This table shows that there is statistically in-significant relation between degree of malnutrition and H. pylori infection of malnourished cases p>0.05 (Table 3).

This table shows that there is statistically insignificant relation between sex and Helicobacter pylori infection of malnourished cases p>0.05 (Table 4).

This table shows that statistically significant relation between socioeconomic level and crowding index and H. pylori infection p<0.05 no statistically significant relation between residence and H. pylori infection(Table 5).

This table shows that statistically significant relation between child order within family and H.

pylori infection in malnourished cases p<0.05(Table 6).

This table shows that statistically insignificant relation between feeding pattern and H. pylori infection of malnourished cases p>0.05(Table 7).

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This table shows that statistically significant relation between diarrhea and H. pylori infection of malnourished cases insignificant relation between anorexia and vomiting and H. pylori infection p>0.05(Table 8).

This table shows that statistically significant relation between parasitic infestation and anemia and H. pylori infection of malnourished cases p<0.05 and insignificant relation between edema and H. pylori infection(Table 9).

This table shows that statistically insignificant difference between body mass index z- score(BMIZ), weight age z-score(WAZ) , weight length (WLZ) of H. pylori infection positive and H.

pylori infection negative of studied group p>0.05(Table 10).

This table shows that there is statistically significant difference between malnourished and non malnourished childern regard other parasitic infestation and H. pylori infection (P <0.05)(Table 11).

Table (1): Demographic data of malnourished cases

Demographic data

All studied patients (N=75)

No. %

Sex

Female 48 64

Male 27 36

Age (months)

Mean ± SD 17.45±6.4

Median (Range) 17(7-35)

Socioeconomic level Low

Middle

64 85.3 11 14.7 Residence

Rural Urban

40 53.3 35 46.7 Crowding index

One and more per room

< one per room

67 89.3 8 10.7 Child order within family

First Others

25 33.3 50 66.7 Table (2): Prevalence of H. pylori among malnourished cases.

(No=75)

No. %

Helicobacter pylori Present

Absent

21 54

28 72

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Table (3): Relation between degree of malnutrition and H.pylori inmalnourished cases.

H. pylori

Total (n) Present(21) Absent(54)

Test p-value (Sig.)

No. % No. %

Malnutrition

Mild 21 5 23.8 16 76.2

0.9 0.6 (NS) Moderate

Sever

40 14

13 3

32.5 21.4

27 11

67.5 78.6

Table (4): Relation between sex and H.pylori infection of malnourished cases.

H. pylori

Total (n) Present(21) Absent(54)

X2 p-value (Sig.)

No. % No. %

Sex

Female 48 16 33.3 32 66.7

1.8 0.1

Male 27 5 18.5 22 81.5

Table (5): Relation between residence, socioeconomic level, crowding index and H. pylori infection in malnourished cases.

H. pylori

Total (n) Present(21) Absent(54)

χ 2 p-value (Sig.)

No. % No. %

Residence Rural Urban

40 35

14 7

35 20

26 28

65

80 2 0.14

Socioeconomic level Low

middle

64 11

21 0

32.8 0

43 11

67.2

100 f 0.03(S) Crowding index

one and more per room

≤ one per room

67 8

21 0

31.3 0

46 8

68.7

100 f 0.09 Table (6): Relation between child order within family and H.pylori of malnourished cases.

H. pylori

Total (n) Present(21) Absent(54)

X2 p-value (Sig.)

No. % No. %

Child order within family First

others

25 50

3 18

12 36

22 32

88

64 6.1 0.03(S)

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Table (7): Relation between feeding pattern and H.pylori infection of H pylori in malnourished cases.

H. pylori

Total (n) Present(21) Absent(54)

χ 2 p-value (Sig.)

No. % No. %

Feeding pattern

Non absolute Breast feeding Artificial

mixed

41 24 10

11 6 4

30.6 22.2 33.3

25 21 8

69.4 77.8 66.7

0.7 0.6

Table (8): Relation between H. pylori infection and GIT upset of H.pylori in malnourished cases.

H. pylori Present(21) Absent(54)

test p-value (Sig.)

No. % No. %

Diarrhea present Absent

21 0

100 0

43 11

79.6

20.4 fisher exact 0.03(S) Anorexia

present Absent

16 5

76.2 23.8

43 11

79.6

20.4 fisher exact 0.5 Vomiting

Present Absent

11 10

52.4 47.6

33 21

61

39 *0.5 0.5

*chisquare test significant

Table (9): Relation between parasitic infestation, anemia, edema and H. pylori infection of malnourished cases.

H. pylori Present(21) Absent(54)

χ 2 p-value (Sig.)

No. % No. %

Parasitic infestation present

Absent

19 2

90.5 9.5

16 38

29.6

70.4 22 0.0001(S) Anemia

present Absent

20 1

95.2 4.8

34 20

63

37 7.8 0.005(S)

Edema Present Absent

2 19

9.5 90.5

3 51

5.6

94.4 f 0.6 f=Fisher's exact test

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Table (10): Comparison BMIZ, WAZ, WLZ, of H. pylori infection positive and H.pylori infection negative of studied group.

Helicobacter pylori Present(21) Absent(54)

χ 2 p-value (Sig.)

No. % No. %

BMIZ

<-3 -3 to +3

10 11

47.6 52.4

37 17

68.5

31.5 2. 8 0.09 WAZ

<-3 -3 to +3

3 18

14.3 85.7

5 49

9.3

90.7 f 0.67

WLZ

<-3 -3 to +3

10 11

47.6 52.4

28 26

52

48 0.1 0.7 f=Fisher's exact test

Table (11): comparison between malnourished and non malnourished children regard clinical picture.

Items Studied groups sig Test

÷ 2 P malnourish (n=75) Non malnourish(n=19)

Other Parasitic infestation Present

Absent

35(46.7) 40(53.3)

14(73.7)

5(26.3) 4.4 0.03(S)

Heliobacter pylori Present

Absent

21(28) 54(72)

0

19(100) f 0.008(S)

S: significant. F:Fisher's exact test Discussion

As regard demographic data, our studyshows the prevalence of malnutrition among females 48(64%) was more than its prevalence among male children 27(36%),Ahmed et al (9)and Abdullah

(10)demonstrated that male were significantly more underweight, stunted and wasted than the female children underweight, stunted and wasted,found that malnutrition was more prevalent in males than in females.

Malnutrition in rural areas was more than urban areas which is due to the poor economic status, cultural status, income level, food behavior, and less health care in rural areas that are known as the risk factor for malnutrition(11).‏

Prevalence of H.pylori among studied group with malnutrition is 28%. In other studies, Barakat et al (12) found that H.pylori infection had a high prevalence in malnourished children (66%) and it may be an important co-factor in the etiology of some aspects of protein energy malnutrition, Abdulqawi et al (13) found in a study on 50 symptomatic Egyptian children whose ages ranged between two and eighteen years with dyspeptic symptoms that 68% of patients were positive for H.

pylori test.

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Prevalence of H.pylori among studied non malnourished group was 0%. Soylu and Ozturk

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in theirstudy do not support the data that H. pylori infection plays an extra role in malnutrition and growth failure in children. Mohammad et al (15)in astudy among Egyptian children the prevalence of H. pylori infection was 72.38%. Chi et al (16)showed prevalence of H. pylori infection in high-school students on Lanyu Island, Taiwan was 26.4% in the control group in high-school students on Lanyu Island

There was statistically in-significant relation between degree of malnutrition and H.pylori infection. Our result is in agreement with Egorov et al (17), showed that prevalence rates of Helicobacter infection at study exit were 73% in substantially malnourished, 47% in mildly malnourished, and 67% in normally nourished children. On the contrary, Kehrt et al (18)found that there was no association between H. pylori and malnutrition,

PEM refers to an imbalance between the supply of protein and energy and the body's demand for them to ensure optimal growth and function(19).

We found that there was no significant difference between H. pylori infection and sex. Our result was in agreement with other studies as Huang et al (20)in Malaysia, in Egypt, Elhag and Ali(21) found insignificant difference between H. pylori infection and gender. On the contrary, Leandro et al

(22) found that the prevalence was significantly higher in boys.

In our study there was statistically significant relation between child order within family and H. pylori infection, Our result is in agreement with a study done by Ford et al (23), found that prevalence of infection increased according to sibling number, infection became substantially higher when the individual had two older siblings compared with being first born and this increased steadily with increasing number of older siblings.‏On the contrary, in a German a study done by Rothenbacher et al (24)on children attending a pre-school medical examination, H. pylori status was assessed by urea breath test, reported that number of siblings was only a weak predictor of positivity, and an association with birth order was not demonstrated.

Prevalence of H. pylori infection in rural area (35%) was more than urban (20%) but without significant difference denoting no relation to H. pylori with residence. Our result is in agreement with AL-Ezzy (25), showed that peoples residence in rural areas have 0.63 fold risk of H. pylori acquisition compared with those from urban without significant difference between patients from rural and urban areas infected with H. pylori. On the contrary, in astudy done by Tadesse et al (26), seroprevalence of H.pylori children under 15 years old was significantly higher in rural (71.2%) compared to urban residents (28.8%), similary Dore et al (27) found that among children, the seroprevalence of H.

pylori infection was significantly higher in rural areas (37%) than in urban areas (13%) .

The epidemiology of H.pylori infection is related to human poverty with marked differences between developing and developed countries. Socioeconomic factors and living standards are the main determinants of the age-dependent acquisition rate of H. pylori, and consequently its prevalence

(28).

Our study showed statistically significant relation between socioeconomic level and H.pylori infection. Our result is in agreement with Hasosahet al (29), shows that H. pylori infection is highly prevalent among Saudi children characterized by a low socioeconomic level and crowded living conditions (bed sharing, contact with the community, big family size and low annual income).

Czkwianianc et al (30)in a study in Lodz observed a much higher prevalence of H pylori infection in children from poor living condition.The risk of infection is related mainly to socio-economic status.

The spread of H. pylori infection is promoted by bad sanitary conditions and poor personal hygiene.Significant differences were observed with regard to the place of residence,also, Celinski et

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al (31)shows thatH pylori infection was strongly affected by the lack of basic personal hygiene the highest risk of H pylori infection was found in children of mothers with basic or lower education, living in crowded accommodations, without access to running warm water, and residing in smaller towns. On the contrary,Jarosz et al (32)estimated that there were no differences between analysed lifestyle factors between patients with H pylori re-infection and the control group.

In our study, there is no statistically significant relation between crowding index and H. pylori infection eventhough 31.3% live in one and more per room and 0% lives in ≤ one per room. Our result is in agreement with a study done byJung et al (33)found that crowding condition and type of house did not affect significantly on seroprevalence of H. pylori infection. On the contrary, in a study done by Webb et al (34)H. pylori infection seropositivity was significantly associated with number of siblings and crowding index.

As regards the type of feeding we found in our study that there was no statistical significant difference between feeding pattern and infection with H. pylori. Our result is in agreement with Senbanjoet al (35) as they did not find any significant difference between breast feeding and artifical feeding as regard the H.pylori infection. Also they reported that there was no protective effect of breastfeeding against H. pylori infection. On the contrary, Rothenbacher et al. (36) reported an increase in the rate of H. pylori infection with breastfeeding ,especially in children breastfed longer than six months.

Our study shows there was statistically significant relation between other parasitic infestation and H.pylori infection and presence of parasitic infestationis a significant predictor of H-pylori infection. Our result is in agreement with Gilman et al (37), hesaid that H. pylori may contribute to childhood malnutrition through malabsorption or increased susceptibility to enteric infections . Smolka and Backert (38), had shown the association between both types of infections from different parts of the world.In Egypt, Abou et al (39)showed that concomitant infection with G. lamblia and H.

pylori was reported in a number of studies. However, Hassanein et al (40) showed that the majority of G. lamblia and H. pylori infections exist as monoinfections.

Our study showed that prevalence of other parasitic infestation in malnourished children 73.7% was higher than prevalence in non malnourished children 46.7%. That gives a good idea about the effect of H. pylori association with parasitic infestation, this explained by Reji et al (41) who did not find any statistically significant association between Giardiaintestinalis and malnutrition, and explained that malnutrition is associated with chronic conditions such as prolonged food shortage of balanced meals, especially among children from poor families but they didnt study H.pylori infectionin their studies.

Helicobacter pylori can cause hypochlorhydria and predispose to diarrheal infections(42), we found a statistically significant relation between diarrhea and H. pylori infection.Our result is in agreement with other studies done bySullivan et al. (43)who showed a significant association between diarrhea and H. pylori. On the contrary Rothenbacheret al(44)found that gastric H. pylori colonization may be a protective factor against diarrheal illnesses as they found a strong inverse association between gastric carriage of H. pylori and reported occurrence of diarrhea in children.

H. pylori can cause anorexia by its effect on the gastric derived hormones as leptin, ghrelin involved in controlling appetite (45). As regard poor appetite in our study, there was no statistically significant association between H. pylori infection and positive or negative cases. Our result is in agreement with Shokrzadeh et al (46)as they found that there was insignificant difference between anorexia and H. pylori infection . On the contrary, Abdel Razak and Ragab(45)found that anorexia was more significantly increased in their studied cases

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H pylori causes a noninvasive infection of the gastric epithelium and the mucous layer those coats this epithelium causing vomiting(47). From our study we found no significant difference between recurrent vomiting and H. pylori infection, our result is in agreement with Shokrzadeh et al (46) as they found in their study that there was insignificant difference between vomiting and H. pylori infection. On the contrary, Mansour et al (48) found in their study that vomiting was significantly higher in H. pylori infected children than in non-infected ones.

Our study shows that no statistically significant relation between edema and H. pylori infection.

H. pylori infections can interfere with micronutrient absorption, appetite, metabolism, and related factors, and thereby diminish children’s growth(49).

Results showed that there is statistically insignificant difference between BMIZ, WAZ, WLZ between H. pylori positve and negative cases. This was in agreement with Oderda et al (50), found that H. pylori was not a risk factor for short stature, and that reduced growth was related to genetic determinants such as parental height and to mixed genetic and environmental factors such as birth weight.Similarly, Quiñonez et al. (51) did not find significant differences in the nutritional parameters between infected and uninfected children. In another cross-sectional study of Turkish children.

On the contrary, Thomas et al (52)conducted that children with early H. pylori colonization had lower values for both length- and weight for-age Z scores than their peers in late infancy.

Conclusion:

The prevalence of H. pylori infection in early childhood among children with PEM is 28% which is considered high for this age. This organism may worse malnutrition by increasing the incidence of many GIT disorders (diarrhea, vomiting, poor appetite and maldigestion) and by association with other parasitic infest.

References:

1. Franceschi F, Annalisa T and Teresa DR. (2014): Role of Helicobacter pylori infection on nutrition and metabolism. World Journal of Gastroenterology: WJG, 20 (36), 12809-12817.‏

2. Mansour-Ghanaei, F., Mashhour, M. Y and Joukar, F. (2009): Prevalence of Helicobacter pylori infection among children in Rasht, Northern Iran. MEJDD, 1(2): 84-88.‏

3. Akugizibwe R, Kasolo J, Makubuya D B, and Damani A M. (2013): Missed opportunities in the diagnosis and management of protein energy malnutrition among children under 5 years in Waki, J Public Health Epidemiol, 5(11): 463-470.

4. Saboktakin L, Rafeey M, Kousha A and Moradi S M. (2012): Study on prevalence of Helicobacterpylori infection in adolescents with failure to thrive to compare with control group. Life Sci J, 9(4): 1425-1431.‏

5. Gomez F, Ramos G and Frenk S. (1956): Mortality in second and third degree malnutrition.

J Trop Pediatr , 2(2), 77-83.

6. El-Gilany A, El-Wehady A and El-Wasify M. (2012): Updating and validation of the socioeconomic status scale for health research in Egypt. Eastern Mediterr Health J, 18(9):962- 968.‏

7. WHO (2018b): Anemia, health topic, http://www.who.int.

8. Prasetyo D, Mertens,P, Labrune V and Leclipteux T. (2014): Comparison of enzyme- immunoassay and rapid immuno-chromatography Test for detecting Helicobacter pylori stool antigen. M K B, 46(1):52-56.‏

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9. Ahmed A M S, Ahmed T and Roy SK. (2012): Determinants of under nutrition in children under 2 years of age from rural Bangladesh. Indian Pediatr, 49(10):821-4.

10. Abdullah M M. (2017): Nutritional status of children under5 yearsin Sheikh-Omar center in Baghdad city. Al-Kufa JBiol, 9(3):78-85.

11. Saeidlou S N, Babaei F and Ayremlou P. (2014): Malnutrition, overweight and obesity among Urban and Rural children in north of West Azarbijan-Iran. J Obesity.‏1-5.

12. Barakat S H, Madina E H, El-Neanaey W and Sayed R. (2008): Helicobacter pylori infection: Relation to Protein-losing enteropathy in malnutrition. BMJ, 93(2): 1-4.

13. Abdulqawi K, El-Mahalaway A M, Abdelhameed A and Abdelwahab A A. (2012):

Correlation of serum antibody titres with invasive methods for rapid detection of Helicobacter pylori infections in symptomatic children. Int J Clin Exp Patho, 93(4): 295-304.‏

14. Soylu Ö B and Ozturk Y. (2008): Helicobacter pylori infection: effect on malnutrition and growth failure in dyspeptic children. Eur J Pediatr. 167(5): 557-562.‏

15. Mohammad M A, Hussein L, Coward A and Jackson S J. (2008): Prevalence of Helicobacter pylori infection among Egyptian children: impact of social background and effect on growth. Public Health Nutr, 11(3):230-236.‏

16. Chi H, Bair M J and Wu M S. (2009): Prevalence of Helicobacter pylori infection in high- school students on Lanyu Island, Taiwan: risk factor analysis and effect on growth. J Formos Med Assoc, 108(12): 929-936.‏

17. Egorov A I, Sempértegui F and Estrella B. (2010): The effect of Helicobacter pylori infection on growth velocity in young children from poor urban communities in Ecuador.

International J Infect Dis, 14(9):788-791.‏

18. Kehrt R, Becker M, Brosicke H and Kruger N.(1997): Prevalence of Helicobacter pylori infection in Nicaraguan children with persistent diarrhea, diagnosed by the 13C-urea breath test , 25(1):84-88.

19. Bhutia D T. (2014): Protein energy malnutrition in India: the plight of our under five children. Family Med Prim Care, 3(1):63-67.‏

20. Huang S S S, Hassan A K R and Choo K E. (2004): Prevalence and predictors of Helicobacter pylori infection in children and adults from the Penan ethnic minority of Malaysian Borneo. Am J Trop Med Hyg , 71(4): 444-450.‏

21. Elhag W I and Ali L E O. (2014): Frequency of H. pylori antibodies among patients with gastrointestinal symptoms attending Khartoum Teaching Hospital-Sudan. SOJ Microbiol Infect Dis, 2(1):1-5‏.

22. Leandro S L, Hernández M G and Torroba L A. (2005): Helicobacter pylori infection in the child population in Spain: prevalence, related factors and influence on growth. In Anales de pediatría, 63(6): 489-494.‏

23. Ford a C, Forman D and Bailey a G. (2007): Effect of sibling number in the household and birth order on prevalence of Helicobacter pylori: a cross-sectional study.Int J Epidemiol, 36(6): 1327-1333.

24. Rothenbacher D, Bode G and Berg G. (1998): Prevalence and determinants of Helicobacter pylori infection in preschool children: a population-based study from Germany. Int J Epidemiol. , 27(1), 135-141.‏

25. AL-Ezzy A I A. (2015): Evaluation of Clinicopathological and Risk Factors for Nonmalignant H. Pylori Associated Gastrod-uodenal Disorders in Iraqi Patients. Open AMJ Med Sci, 3(4): 645-654.‏

26. Tadesse E, Daka D, Yemane D and Shimelis T. (2014): Seroprevalence of Helicobacter pylori infection and its related risk factors in symptomatic patients in southern Ethiopia. BMC Research Notes, 7(1): 834-838.‏

(14)

27. Dore M P, Malaty H M and Graham D Y. (2002): Risk factors associated with Helicobacter pylori infection among children in a defined geographic area. Clin Infect Dis, 35(3): 240-245.‏

28. Thevakumar K, Chandren J R and Perez-Perez G I. (2016): Assessment of risk and sero- prevalence of Helicobacter pylori colonization among remote Orang Asli tribes in Peninsula Malaysia. PLoS One, 11(7): 0159830-0159838.‏

29. Hasosah M, Satti M and Shehzad A. (2015): Prevalence and risk factors of Helicobacter pylori infection in Saudi children: A Three - Year Prospective Controlled Study.

Helicobacter, 20(1):56-63.‏

30. Czkwianianc, E, Bak-Romaniszyn L and Małecka-Panas E. (1996): Prevalence of Helicobacter pylori in children dependently on age and living conditions. J Physiol Pharmacol: an official journal of the Polish Physiological Society, 47(1): 203-207.‏

31. Celiński K, Kurzeja-Mirosław A and Słomka M.(2006): The effects of environmental factors on the prevalence of Helicobacter pylori infection in inhabitants of Lublin Province.

Ann Agric Environ Med. 13: 185-191.

32. Jarosz M, Rychlik E, Siuba M, et al. Dietary and socio-economic factors in relation to Helicobacter pylori re-infection. World J Gastroenterol. 2009;15(9):1119-1125.

33. Jung M k, Kwon YS and Cho H. (2000): Relation between Helicobacter pylori Infection and Socioeconomic Status in Korean Adolescents.Korean J Pediatr Gastroenterol Nutr, 3(01):

17-22.

34. Webb P M, Knight T and Greaves S. (1994): Relation between infection with Helicobacter pylori and living conditions in childhood: evidence for person to person transmission in early life. BMJ, 308(6931): 750-753.‏

35. Senbanjo I O, Oshikoya K A and Njokanma O F. (2014): Helicobacter pylori associated with breastfeeding, nutritional status and recurrent abdominal pain in healthy Nigerian children. Jo Infect Dev Countr, 8(04), 448-453.‏

36. Rothenbacher D, Bode G and Brenner H. (2002): History of breastfeeding and Helicobacter pylori infection in pre-school children: results of a population-based study from Germany. Int J Epidemiol. 31(3): 632-637.‏

37. Gilman R H, Partanen R and Brown K H. (1988): Decreased gastric acid secretion and bacterial colonization of the stomach in severely malnourished Bangladeshi children.

Gastroen-terology, 94(6): 1308-1314.‏

38. Smolka A J and Backert S. (2012): How Helicobacter pylori infection controls gastric acid secretion. Gastroenterol J, 47(6): 609-618.‏

39. Abou S H, Anwar M M, Heshmat M G and Rashad M M. (2009): Effect of concommitant Helicobacter pylori infection in patients with Giardiasis lamblia in Egypt. J Egypt Soc Parasitol 39(2): 439-446.‏

40. Hassanein F I, Shehata A I and Abdul-Ghani R. (2017): G. lamblia and H. pylori infections among mentally challenged individuals in rehabilitation centers in Alexandria, Egypt. J Infect Dev Ctries, 11(07): 577-582.‏

41. Reji P, Belay G, Erko B, Legesse M and Belay M. (2011): Intestinal parasitic infections and malnutrition amongst first-cycle primary schoolchildren in Adama, Ethiopia. Afr J Prim Health Care Fam Med 3(1): 1-5.‏

42. Chang A H M, Haggerty T D and de Martel C. (2011): Effect of Helicobacter pylori infection on symptoms of gastroenteritis due to enteropathogenic Escherichia coli in adults.

Dig Dis Sci , 56(2), 457-464.‏

43. ‏Sullivan P B, Thomas J E and Wight DG. (1990): Helicobacter pylori in Gambian children with chronic diarrhoea and malnutrition. Arch Dis Child. 65(2): 189-191.

(15)

44. Rothenbacher D, Blaser M J, Bode G and Brenner H. (2000): Inverse relationship between gastric colonization of Helicobacter pylori and diarrheal illnesses in children: results of a population-based cross-sectional study. Infect Dis J, 182(5): 1446-1449.‏

45. AbdelRazak andRagab M S. (2014): Helicobacter pylori Infections in children of a rural community. J Bacteriol Parasitol 5(2): 185-189.

46. Shokrzadeh L, Baghaei K and Yamaoka Y. (2012): Prevalence of Helicobacter pylori infection in dyspeptic patients in Iran. Gastroenterol Insights, 4(1): 8-10.‏

47. Shaban M M, Kandil, H O and Elshafei A H. (2014): Helicobacter pylori seropositivity in patients with hyperemesis gravidarum. Ame J Med Sci, 347(2): 101-105.‏

48. Mansour M M H K, Al Hadidi Kh M and Omar M A. (2012): Helicobacter pylori and recurrent abdominal pain in children: Is there any relation?. Trop Gastroenterol, 33(1): 55-61.‏

49. Goodman K J, Correa P and Mera R. (2011): Effect of Helicobacter pylori infection on growth velocity of school-age Andean children. Epidemiol (Cambridge, Mass.), 22(1): 118- 126.‏

50. Oderda G, Palli D and Saieva C. (1998): Short stature and Helicobacter pylori infection in Italian children: prospective multicentre hospital based case-control study. Bmj, 317(7157):514-515.‏

51. Quiñonez J M, Chew F, Torres O and Begué RE. (1999): Nutritional status of Helicobacter pylori-infected children in Guatemala as compared with uninfected peers. Am J Trop Med Hyg, 61(3): 395-398.

52. Thomas J E, Bunn J E and Kleanthous H. (2004): Specific immunoglobulin a antibodies in maternal milk and delayed Helicobacter pylori colonization in Gambian infants. Clinical infectious diseases, 39(8): 1155-1160.‏

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