Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan

AimBhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions. MethodsA cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H.pylori immunoglobulin G (IgG) by commercial ELISA kits. ResultsThere were 327 children between 4 and 19years of age participated, 44% boys, mean age=13.63years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P=.42. H. pylori prevalence was 75% among both 4-7 and 15-19years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P=.1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR=2.3; 95%CI=0.9-1.7), P=.08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR=1.7, 95% CI=[1.0-2.6], P=.05). ConclusionsH. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.