EPIDEMIOLOGY OF HELICOBACTER PYLORI INFECTION IN RURAL BOLIVIAN CHILDREN

Introduction: Helicobacter pylori (Hp) is acquired in childhood, causes gastritis, duodenal ulcers, and is linked to MALT lymphoma and gastric cancer. Studies suggest that infection is the cause of iron deficiency anemia in Alaska Natives and in Bangladeshi children. Consumption of contaminated water has been reported as a risk factor for Hp infection in South America, although exact routes of transmission are not defined. Objectives: We determined the seroprevalence and risk factors for Hp infection acquisition in rural Bolivian children, and if an association between Hp and anemia existed in this population. Methods: The Hp serostatus and hemoglobin levels of 1,392 (70%) children between 6 months and 9 years living in 17 villages were determined. Information on dietary practices, hygeine, and water handling were performed. Drinking sources were tested for fecal coliforms. Results: Overall, 44% of children were Hp seropositive, 49% seronegative, and 7% had indeterminate serostatus. Of 1,293 children with defined serostatus, seroprevalence increased from 7% in children aged 6-12 months to 59% in 4-year olds. Controlling for age and family clustering, drinking contaminated water was associated with Hp infection (p<0.05). Univariate analysis demonstrated consumption of premasticated food was significantly associated with Hp infection in infants 6 months to 1 year (p<0.05). Overall, 38% of children were anemic. Anemia status decreased from 77% in < 2 years to 17% in 9-year olds. Multivariate analysis demonstrated no association between Hp infection and anemia. Conclusions: Hp seroprevalence is high in rural Bolivian children and most children are infected by 5 years of life. Contaminated drinking water may be a risk factor for Hp infection which suggests that intervention in drinking water purity may decrease seroconversion rates. Although anemia is significant in this population, an association between Hp infection and anemia was not confirmed.