ABSTRACT
Risk factors associated with Helicobacter pylori infection among patients attending private clinics in Borama district, Somaliland, are studied. We specifically investigated the association among the use of non-steroidal anti-inflammatory drugs, the users’ socioeconomic status, and the household hygiene practice of people with H. pylori infection attending the Borama private clinic. Helicobacter pylorus (H. pylori) is a Gram-negative spiral-shaped bacterium that infects gastric-type epithelium, and it is probably the most common bacterial agent in humans after Streptococcus mutans, which causes dental caries. H. pylori infection is now recognized as a worldwide problem and it is the most common cause of chronic gastritis and is strongly linked to peptic ulcer disease and gastric cancer. The prevalence of H. pylori infection is high in less-developed Asian countries like India, Bangladesh, Pakistan, and Thailand, and is acquired at an earlier age than in the more developed Asian countries like Japan and China. H. pylori infection is a global public health problem, affecting over 50% of the population worldwide.
HIGHLIGHTS
There are risks associated with non-steroidal anti-inflammatory drugs and association with the occurrence of Helicobacterpylori infection.
The risks are common to patients attending private clinics.
It is due to the most common bacterial agents.
Study in patients attending private clinics in Borama district, Somaliland.
The researchers recommend that the study be done on a larger scale in order to cover more areas.
INTRODUCTION
Risk management is vital for daily living and human survival. In January 2022, some studies were conducted to investigate the use of wastewater-based epidemiology (WBE) so as to estimate heavy metal exposure in Sungai Petani (Ruzi et al. 2024). In the course of the research in Malaysia, atomic absorption spectroscopy was used to detect copper. Atomic absorption spectroscopy was used to detect copper (Cu), nickel (Ni), zinc (Zn), iron (Fe), and cadmium(Cd) in wastewater from eight sewage treatment facilities in Sungai Petani. The results of WBE estimation showed that Fe, Ni, and Zn had the highest estimated per population exposure levels, while Cd had the lowest. This was compared to a similar study conducted in Penang, Malaysia, which found that all metals except Cu were had higher concentrations in Sungai Petani, even though it is a non-industrial district, which emphasized the importance of addressing heavy metal contamination in Sungai Petani and to implement effective risk management and prevention strategies. WBE has expanded as a tool for collecting COVID-19 surveillance data, but there is limited information on the feasibility of this form of surveillance within decentralized wastewater systems (e.g., septic systems). A study was also conducted in 2020 (Tanvir Pasha (2024). The study assessed SARS-CoV-2 RNA concentrations in wastewater samples from a septic system servicing a mobile home park (66 households) and from two pumping stations serving a similarly sized (71 households) and a larger (1,000 households) neighborhood within a nearby sewershed over 35 weeks. The results suggested that sampling from decentralized wastewater infrastructure can be used for continuous monitoring of SARS-CoV-2 infections, which can invariably be highly vital in risk control and management. Fecal–oral and oral–oral are the most commonly known routes for transmission of H. pylori, therefore contaminated water plays an important role in transmission of H. pylori to humans. Please refer to the study by Atipo-Ibara et al. (2023). Fecal–oral transmission of H. pylori occurs through several channels such as feeding contaminations, poor hygiene, and close and direct contact. It could result in gastric cancer, peptic ulcers, gastrointestinal diseases, and malnutrition, which could create severe and serious economic impacts (Keita 2022). Helicobacter pylorus (H. pylori) is a Gram-negative spiral-shaped bacterium that infects gastric-type epithelium, and it is probably the most common bacterial agent in humans after Streptococcus mutans, which causes dental caries (Francisco & Ramesh 2017). It affects over 50% of the population worldwide (Eshraghian 2014). Prevalence of H. pylori infection is high in less developed Asian countries like India, Bangladesh, Pakistan, and Thailand, and is acquired at an earlier age than in more developed Asian countries like Japan and China (Mishra 2008). In sub-Saharan countries, specifically Ethiopia, the prevalence of H. pylori infections is 52.2% and it is recognized as a major cause of gastrointestinal diseases (Addisu et al. 2019). The prevalence of H. pylori in Somaliland is 60% (Ahmed 2018). In Borama town, H. pylori infection is a health problem mostly seen in both public and private hospitals. Although H. pylori infection is mostly found in Borama town, the exact factors associated with this increase are not clearly known and remain undocumented.
H. pylori has various definitions. According to (Goodwin 1987), H. pylori is defined as organisms that are spiral, microaerophilic, gram-negative bacteria that demonstrate bluntly rounded ends in gastric biopsy specimens. H. pylori is a small (0.5–1.0 μm in width and 2.5 to 5.0 μm in length), spiral-shaped, highly motile, gram-negative rod with 4–6 unipolar sheathed flagella that causes H. pylori c infection. It can also be defined as a highly heterogeneous bacterium with a large genomic diversity, in addition, humans may sometimes harbor multiple strains, and H. pylori can change genotypically and phenotypically during colonization in a single host (Suerbaum & Josenhans 2007). In this study, H. pylori is defined as a bacterium that causes stomach inflammation and ulcers in the stomach and duodenum detectable through a laboratory test of stool called a stool polymerase chain reaction (PCR) test.
Risk factors associated with H. pylori infections have been studied by different authors. These risk factors are characterized as household hygiene practices, socioeconomic status and socio-demographic factors (Maria et al. 2002). Maria (2002) studied risk factors associated with H. pylori infections as environmental factors, sociocultural factors and socioeconomic status. Furthermore, the factors such as crowded living conditions, smoking, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) can also be studied (Segal et al. 2001). This study includes risk factors associated with H. pylori infections, including NSAIDs, socioeconomic status, and household hygiene practices.
NSAIDs are drugs that are used to reduce pain and fever. This study will focus on the NSAIDs such as Ibuprofen, Aspirin, and Diclofenac.
Socioeconomic status has a variety of definitions. Elizabeth (2014) defined socioeconomic status as a measure of one's combined economic and social status. It can also be viewed as a combined measure of society's economic and social position relative to others, based on income, education, and gender (Saifullah & Tariq 2011). Socioeconomic status is defined as a measure of the economic and social status of mothers; it can be seen as level of education, income and gender (Kibua 2014). In this study, socioeconomic status is classified based on income, education, and gender.
Household hygiene practices are a hygiene promotion that encourages people to replace their unsafe hygiene practices with simple, safe alternatives; the elements of household hygiene practices are seen as food hygiene and safety, water supply and toilet availability (Abdallah & Burnham 2004). In this study, household hygiene practices are maintaining all levels of house sanitation. Household hygiene practices will be defined as food hygiene and safety, water supply, hand wash practice, and toilet availability and usage.
Socioeconomic status and H. pylori infection
This aspect of socioeconomic status is classified based on income, education, and gender. Levels of education are an ordered set of categories, intended to group educational programs in relation to gradations of learning experiences and the knowledge, skills and competencies which each program is designed to impart. Income is the flow of cash or cash equivalents received from work (wage or salary), capital (interest or profit), or land(rent) (William 2000). Gender is not something we are born with and not something we have, but something we do.
The link between socioeconomic status and H. pylori infection has been investigated in various places. A study by Zhang et al. (2017) in China on socioeconomic status factors that increase the risk of H. pylori infection in China found that there were associations between income level and H. pylori infection. Another study by Midhet et al. (2010) in Uganda on Socioeconomic Status related risk factors of H. pylori infection found that there is a strong association between H. pylori infection and adults' level of education and gender. A study conducted by Lori et al. (2008) in Russia suggested that in the study about socioeconomic status is a factor influencing the acquisition and prevalence of H. pylori infection. Another study by Nahar et al. (1995) on socioeconomic status in Bangladesh showed that poor socioeconomic conditions, such as low income, and the use of a stove for heating or cooking caused a high prevalence of H. pylori infection. Furthermore, a study conducted by Tedla (1992) in Ethiopia showed that socioeconomic factors, such as low-income levels can contribute to H. pylori infections. Thus, socioeconomic status is related to the H. pylori infection among patients attending private clinics. However, these studies were all conducted outside Somaliland. As such, they cannot be applied fully without empirical justification.
Household hygiene practices and H. pylori infections
This study focuses on household hygiene practices such as food hygiene and safety, water supply and toilet availability. Food hygiene and safety is the careful hygienic preparation and storage of complementary foods which is crucial to prevent contamination (Aching 2014). Water supply is the provision of water by public utilities, commercial organizations, community endeavors or individuals, usually via a system of pumps and pipes. Irrigation is covered separately by WHO (2013). Toilets are sanitation facilities at the user interface that allow safe and convenient urination and defecation.
The association between household hygiene practices and H. pylori infections has been investigated in various places. A study by Will et al. (2003) in Nigeria on food hygiene and safety and H. pylori: evidence of a positive association from a large prospective cohort study, found that food hygiene and safety increased, the rate of H. pylori infection increased for both men and women. Another study by Merrill (2014) in South Sudan on the impact of water supply on the risk of H. pylori infection in middle-aged women found that water supply was also significantly associated with H. pylori infection. Another study done by Keith et al. (2016) in Egypt on toilet availability and risk of H. pylori infection found that toilet availability is associated with H. pylori infection.
A study conducted by Brown (2000) in Ethiopia found that elucidation of the paramount role played by household hygiene backed by domestic water quality in the transmission of bacterial pathogens is of great importance as a prophylactic move, both in developed and developing countries. Another study conducted by Abangwa et al. (2017) in Cameroon showed a low level of education, promiscuity, lack of basic services, swimming in rivers, the consumption of contaminated water and focally contaminated fruit and vegetables, improper food handling, lack of refrigeration, the poor quality and low quantity of food available, child malnutrition, poor house hygiene practices, contaminated food before and after cooking, and the lack of access to drinking water affect the incidence and prevalence of H. pylori infection. A study conducted by Neto et al. (2010) from Brazil shows that poor sanitation conditions may also constitute important risk factors for H. pylori infection. Household hygiene practices relate directly to the H. pylori infection among patients attending private clinics. However these studies were all conducted outside Somaliland, so they cannot be applied wholesale without empirical justification.
A study by Zhang et al. (2017) in China on socioeconomic status factors that increase the risk of H. pylori infection in China found that there were associations between household size and H. pylori infection.
METHOD
The methodology includes the research design, location of study, sampling techniques, sample size, research instruments, data collection procedures, and data analysis techniques. Here, the sample size was determined from which the samplings were taken from the research study location. Validity was determined from the ratings , where the items were rated 3 or 4 by both judges, and N is the total items in the instrument. This method has advantages with regard to ease of computation, focus on agreement of relevance, and provision of both item and scale information (Table 1).
Validity was determined from items rated 3 and 4 by both judges as CVI = n3/4/N, where n3/4 is items rated relevant and very relevant by both judges, and N is the total number of items: CVI = 29/34 = 0.85. A valid index of 0.85 was reported. This was an accepted measure because it was higher than the 0.70 value recommended in social science research.
The scores from parts of the tests are correlated. The researcher administered a single instrument to a non-probability through a stratified sampling method of 30 H. pylori-infected patients in Gabiley town and then correlated using a correlation formula. The reliability with high correlation indicates that a respondent would perform equally well (or as poorly) on both halves of the test. Split half-reliability uses one set of questions divided into two equivalent sets. The two tests are given to one group of respondents who sit the test at the same time. The instrument was administered to a non-probability sample through a stratified sampling of 30 H. pylori-infected patients in Gabiley town once by dividing the questions into half (odd and even or up and down) and then correlated using the Spearman Brown formula . The scores on the responses of each respondent were taken to provide a single score for each respondent on the instrument.
Data were analyzed at 95% level of confidence, 0.05 level of significance and 5% margin of error. 95% level of confidence means that findings arrived at had 95% chance of being true, 0.05 level of significance means that the maximum probability of accepting a null hypothesis if it was true was 5 in every 100, and 5% margin of error indicates that the maximum expected difference between true population and the sample of any parameter cannot exceed ±5. These levels were selected because they are conventional measures commonly used in social science research.
FINDINGS AND RESULTS
This section presents findings and results of the study on the risk factors associated with H. pylori infection among patients attending private clinics, in Borama District, Somaliland. The study investigated three specific objectives: the relationship between uses of NSAIDs, socioeconomic status and household hygiene practices and H. pylori infection among patients attending private clinics in Borama district, Somaliland. Ibuprofen, Aspirin, and Diclofenac are the elements of NSAIDs. Socioeconomic status is defined as income, education, and gender. Household hygiene practices were defined as: food hygiene and safety, water supply and toilet availability. Using a correlation cross-sectional survey research design, data were collected from 152 H. pylori-infected patients in Borama private clinics, which gives a response-return rate of 100%.
The study collected data on the background information of the respondents, NSAIDs that were used, socioeconomic status and household hygiene practices (Figure 1).
Conceptual framework of the risk factors and Helicobacter pylori infection.
H. pylori infection and associated risk factors
Here, the risk factors associated with H. pylori infection among patients attending private clinics in Borama District, Somaliland were determined.
Content validity
. | . | Judge 2 . | . | |||
---|---|---|---|---|---|---|
. | . | 1 . | 2 . | 3 . | 4 . | Total . |
Judge 1 | 1 | 0 | 0 | 0 | 2 | 2 |
2 | 0 | 0 | 1 | 0 | 1 | |
3 | 0 | 0 | 1 | 1 | 2 | |
4 | 1 | 1 | 9 | 18 | 29 | |
Total | 1 | 1 | 11 | 21 | 34 |
. | . | Judge 2 . | . | |||
---|---|---|---|---|---|---|
. | . | 1 . | 2 . | 3 . | 4 . | Total . |
Judge 1 | 1 | 0 | 0 | 0 | 2 | 2 |
2 | 0 | 0 | 1 | 0 | 1 | |
3 | 0 | 0 | 1 | 1 | 2 | |
4 | 1 | 1 | 9 | 18 | 29 | |
Total | 1 | 1 | 11 | 21 | 34 |
Note: Shaded regions in 3 and 4 indicate items that were rated quite relevant and very relevant by both judges.
Variables score, rate, and weight
Variable . | Scores . | Level . | Code . | Analysis . |
---|---|---|---|---|
Uuse of non-steroidal anti-inflammatory drugs | 77– 11 | Not used | 1 | Chi-square test of independence |
12–16 | Sometimes used | 2 | ||
17–23 | Always used | 3 | ||
7–10 | Low | 1 | ||
Socioeconomic status | 11–14 | Medium | 2 | Chi-square test of independence |
15–20 | High | 3 | ||
14–26 | Poor | 1 | ||
Household hygiene practice | 27–40 | Good | 2 | Chi-square test of independence |
Helicobacter pylori infection | 1–2 | Clinic symptoms | 1 | Chi-square test of independence |
Lab test | 2 |
Variable . | Scores . | Level . | Code . | Analysis . |
---|---|---|---|---|
Uuse of non-steroidal anti-inflammatory drugs | 77– 11 | Not used | 1 | Chi-square test of independence |
12–16 | Sometimes used | 2 | ||
17–23 | Always used | 3 | ||
7–10 | Low | 1 | ||
Socioeconomic status | 11–14 | Medium | 2 | Chi-square test of independence |
15–20 | High | 3 | ||
14–26 | Poor | 1 | ||
Household hygiene practice | 27–40 | Good | 2 | Chi-square test of independence |
Helicobacter pylori infection | 1–2 | Clinic symptoms | 1 | Chi-square test of independence |
Lab test | 2 |
The use of NSAIDs and H. pylori infection
Table 3 shows the status of the usage of NSAIDs among H. pylori-infected patients attending private clinics in Borama District, Somaliland. It shows that most (47.4%) of the respondents always used NSAIDs, while 22.4% of respondents had not used NSAIDs. Data in the last row show the diagnosis of H. pylori infection among patients in Borama District. It shows that most (57.9%) patients are diagnosed by laboratory tests, whereas 42.1% are diagnosed by clinical symptoms (Table 2). Thus, the status of usage of NSAIDs among H. pylori-infected patients attending private clinics in Borama District Somaliland was generally high. On comparing with the diagnosis from laboratory tests, most (30.3%) of the patients with always-used NSAID status had diagnosis by laboratory test, while only 7.9% of patients with not-used NSAID status had diagnosis by laboratory test. Along the clinical symptoms column, most (17.1%) of the patients with always-used NSAID status had been diagnosed with clinical symptoms, while only 10.5% of patients with sometimes-used NSAID status had been diagnosed with clinical symptoms.
Using non-steroidal anti-inflammatory drugs with Helicobacter pylori infection
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
. | . | . | Clinical symptoms . | Lab test . | |
Use NSAIDs | not used | Count | 22 | 12 | 34 |
% with NSAIDs | 64.7% | 35.3% | 100.0% | ||
% with HBPI | 34.4% | 13.6% | 22.4% | ||
% of Total | 14.5% | 7.9% | 22.4% | ||
sometimes used | Count | 16 | 30 | 46 | |
% with NSAIDs | 34.8% | 65.2% | 100.0% | ||
% with HBPI | 25.0% | 34.1% | 30.3% | ||
% of Total | 10.5% | 19.7% | 30.3% | ||
always used | Count | 26 | 46 | 72 | |
% with NSAIDs | 36.1% | 63.9% | 100.0% | ||
% withHBPI | 40.6% | 52.3% | 47.4% | ||
% of Total | 17.1% | 30.3% | 47.4% | ||
Total | Count | 64 | 88 | 152 | |
% with NSAIDs | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
. | . | . | Clinical symptoms . | Lab test . | |
Use NSAIDs | not used | Count | 22 | 12 | 34 |
% with NSAIDs | 64.7% | 35.3% | 100.0% | ||
% with HBPI | 34.4% | 13.6% | 22.4% | ||
% of Total | 14.5% | 7.9% | 22.4% | ||
sometimes used | Count | 16 | 30 | 46 | |
% with NSAIDs | 34.8% | 65.2% | 100.0% | ||
% with HBPI | 25.0% | 34.1% | 30.3% | ||
% of Total | 10.5% | 19.7% | 30.3% | ||
always used | Count | 26 | 46 | 72 | |
% with NSAIDs | 36.1% | 63.9% | 100.0% | ||
% withHBPI | 40.6% | 52.3% | 47.4% | ||
% of Total | 17.1% | 30.3% | 47.4% | ||
Total | Count | 64 | 88 | 152 | |
% with NSAIDs | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
Note: NSAIDs, non-steroidal anti-inflammatory drugs; HBPI, Helicobacter pylori infection.
These results could be associated with the constant use of NSAIDs due to the occurrence of H. pylori infection among patients who attended private clinics in Borama District, Somaliland. The data in Table 3 were subjected to a chi-square test of goodness-of-fit to establish whether there were significant differences between the proportions reported, and to test the null hypothesis that the use of NSAIDs is not associated with the occurrence of H. pylori infection among H. pylori-infected patients attending private clinics in Borama District, Somaliland.
Ho1: Use of NSAIDs is not associated with the occurrence of H. pylori infection among H. pylori-infected patients attending Borama Private Clinics in Borama District, Somaliland. The results of the chi-square analysis are summarized in Table 4.
Summary χ2 test for using non-steroidal anti-inflammatory drugs
Variables . | N . | Df . | . | χ2 . | PC . |
---|---|---|---|---|---|
Uses NSAIDs | 152 | 2 | 9.197 | 0.010 | 0.239 |
Variables . | N . | Df . | . | χ2 . | PC . |
---|---|---|---|---|---|
Uses NSAIDs | 152 | 2 | 9.197 | 0.010 | 0.239 |
Note:.
Table 4 shows the results of chi-square test of the status of uses of NSAIDs among H.pylori-infected patients attending private clinics in Borama District, Somaliland. It shows that , p = 0.010. Further
which led to the rejection of the null hypothesis. This means that there were more respondents who rated always using NSAIDs than those who rated not using NSAIDs. The hypothesis that use of NSAIDs was not associated with the occurrence of H. pylori infection was, therefore, rejected. The finding suggested by the data in Table 4 was, therefore, upheld. The study, therefore, established that the H. pylori-infected patients who attended private clinics were generally always using NSAIDs when they were first diagnosed with H. pylori infection.
The contingency coefficient (C = 0.239) indicates an association of 0.239 which means that 23.9% of the variance in the occurrence of H. pylori infection is dependent use of NSAIDs. Therefore, up to 23.9% of the changes from always using NSAIDs to not using NSAIDs can prevent the occurrence of H. pylori infection in the Borama district of Somaliland.
Socioeconomic status and H. pylori infection
Table 5 shows the socioeconomic status among H. pylori-infected patients attending private clinics in Borama District, Somaliland. It shows that most (46.1%) of the respondents indicated that they had moderate socioeconomic status, while 25.7% of respondents indicated that they had low socioeconomic status. Data on the last row show the status of diagnosis among patients in Borama District. It shows that most (57.9%) of patients had been diagnosed with laboratory tests, while (42.1%) of patients were diagnosed with clinical symptoms Thus, the socioeconomic status among H. pylori-infected patients attending private clinics in Borama District Somaliland was generally moderate.
Socioeconomic status with Helicobacter pylori infection
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
Clinical symptoms . | Lab test . | ||||
SES | low | Count | 15 | 24 | 39 |
% with SES | 38.5% | 61.5% | 100.0% | ||
% with HBPI | 23.4% | 27.3% | 25.7% | ||
% of Total | 9.9% | 15.8% | 25.7% | ||
medium | Count | 27 | 43 | 70 | |
% with SES | 38.6% | 61.4% | 100.0% | ||
% with HBPI | 42.2% | 48.9% | 46.1% | ||
% of Total | 17.8% | 28.3% | 46.1% | ||
high | Count | 22 | 21 | 43 | |
% with SES | 51.2% | 48.8% | 100.0% | ||
% with SES | 34.4% | 23.9% | 28.3% | ||
% of Total | 14.5% | 13.8% | 28.3% | ||
Total | Count | 64 | 88 | 152 | |
% with SES | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
Clinical symptoms . | Lab test . | ||||
SES | low | Count | 15 | 24 | 39 |
% with SES | 38.5% | 61.5% | 100.0% | ||
% with HBPI | 23.4% | 27.3% | 25.7% | ||
% of Total | 9.9% | 15.8% | 25.7% | ||
medium | Count | 27 | 43 | 70 | |
% with SES | 38.6% | 61.4% | 100.0% | ||
% with HBPI | 42.2% | 48.9% | 46.1% | ||
% of Total | 17.8% | 28.3% | 46.1% | ||
high | Count | 22 | 21 | 43 | |
% with SES | 51.2% | 48.8% | 100.0% | ||
% with SES | 34.4% | 23.9% | 28.3% | ||
% of Total | 14.5% | 13.8% | 28.3% | ||
Total | Count | 64 | 88 | 152 | |
% with SES | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
Note: SES, socioeconomic status; HBPI, Helicobacter pylori Infection.
On cross comparison along the diagnosis laboratory test column, most (28.3%) patients with moderate socioeconomic status had diagnosis laboratory tests, while only 13.3% of patients with high socioeconomic status had diagnosis laboratory tests. The Clinical symptoms column shows most (17.8%) patients with moderate socioeconomic status were diagnosed with clinical symptoms, while only 9.9% of patients with low socioeconomic status had been diagnosed with clinical symptoms. While the figures do not suggest a clear-cut relationship, they tend to suggest that there is a positive association between socioeconomic status and H. pylori infection. The data in Table 5 were tested using the chi-square test of independence to establish if there were significant differences between the proportions reported, and to test the null hypothesis that socioeconomic status is not associated with the occurrence of H. pylori infection among H. pylori-infected patients attending private clinics in Borama District, Somaliland.
H01: Socioeconomic status is not associated with the occurrence of H. pylori infection among patients attending private Clinics in Borama District, Somaliland.
The results of the chi-square analysis are summarized in Table 6.
The result of chi-square analysis
Variables . | N . | dfχ2 . | P . |
---|---|---|---|
SES 152 | 2 | 2.018 | 0.365 |
Variables . | N . | dfχ2 . | P . |
---|---|---|---|
SES 152 | 2 | 2.018 | 0.365 |
Note:.
Table 5 shows the results of the chi-square test of the socioeconomic status among H. pylori-infected patients attending private clinics in Borama District, Somaliland. It shows that , p = 0.365. Further
which led to accepting the null hypothesis.
The hypothesis that socioeconomic status is not associated with the occurrence of H. pylori infection was, therefore, accepted. The finding suggested by the data in Table 5 was, therefore, upheld. The study established that H. pylori-infected patients who are attending private clinics generally have moderate socioeconomic status when they are first diagnosed with H. pylori infection.
Households Hygiene Practice and H. pylori infection
Table 7 shows the status of household hygiene practices against H. pylori infection. By examining the last column, Table 7 shows 50.7% of the patients had poor household hygiene practices and 49.3% had good household hygiene practices. Hence, H. pylori-infected patients attending private clinics in Borama District are generally poor. This could promote cases of H. pylori infections. The last row presents the same information as in Tables 3 and 5. Most patients (57.9%) had diagnosis laboratory tests, while 42.1% had clinical symptoms. The combination of poor household hygiene practices and H. pylori infections are more related.
Household hygiene practice and Helicobacter pylori infection
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
Clinical finding . | Lab test . | ||||
HHP | poor | Count | 26 | 51 | 77 |
% with HHP | 33.8% | 66.2% | 100.0% | ||
% within HBPI | 40.6% | 58.0% | 50.7% | ||
% of Total | 17.1% | 33.6% | 50.7% | ||
good | Count | 38 | 37 | 75 | |
% with HHP | 50.7% | 49.3% | 100.0% | ||
% with HBPI | 59.4% | 42.0% | 49.3% | ||
% of Total | 25.0% | 24.3% | 49.3% | ||
Total | Count | 64 | 88 | 152 | |
% with HHP | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
. | . | . | Helicobacter pylori infection . | Total . | |
---|---|---|---|---|---|
Clinical finding . | Lab test . | ||||
HHP | poor | Count | 26 | 51 | 77 |
% with HHP | 33.8% | 66.2% | 100.0% | ||
% within HBPI | 40.6% | 58.0% | 50.7% | ||
% of Total | 17.1% | 33.6% | 50.7% | ||
good | Count | 38 | 37 | 75 | |
% with HHP | 50.7% | 49.3% | 100.0% | ||
% with HBPI | 59.4% | 42.0% | 49.3% | ||
% of Total | 25.0% | 24.3% | 49.3% | ||
Total | Count | 64 | 88 | 152 | |
% with HHP | 42.1% | 57.9% | 100.0% | ||
% with HBPI | 100.0% | 100.0% | 100.0% | ||
% of Total | 42.1% | 57.9% | 100.0% |
Note: HHP, household hygiene practice; HBPI, Helicobacter pylori infection.
Further, an examination of Table 7 shows that of those with a diagnosis laboratory test, 33.6% had poor household hygiene practices, and 24.3% had good household hygiene practices. But among those with clinical symptoms, 25% had good household hygiene practices and just 17.1% had poor household practices. This could indicate the association between household hygiene practice and the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. The data in Table 8 were subjected to a chi-square test of goodness-of-fit to establish if there were significant differences between the proportions reported, and to test the null hypothesis that household hygiene practice is not associated with the occurrence of H. pylori infection among those attending private clinics in Borama District, Somaliland.
Summary of χ2 test on household hygiene practice
Variables . | N . | df . | χ2 . | p . | C . |
---|---|---|---|---|---|
HHP | 152 | 1 | 4.452 | 0.035 | 0.169 |
Variables . | N . | df . | χ2 . | p . | C . |
---|---|---|---|---|---|
HHP | 152 | 1 | 4.452 | 0.035 | 0.169 |
H01: Household Hygiene Practice is not associated with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. The results of the chi-square analysis are summarized in Table 8.
Table 8 shows the results of the chi-square test of the status of H. pylori infection among patients attending private clinics in Borama District, Somaliland. It shows that , p = 0.035. Furthermore,
which led to rejection of the null hypothesis. This means that there were more respondents who rated poor household hygiene practices than those who rated good household hygiene practices. The hypothesis that household hygiene practice is not associated with the occurrence of H. pylori infection was, therefore, rejected.
The contingency coefficient (C = 0.169) indicates an association of 0.233 which means that 16.9% of the variance in occurrence of H. pylori infection is dependent on moderate household hygiene practice. Therefore, up to 16.9% of the changes from moderate household hygiene practice to good household hygiene practice can prevent the occurrence of H. pylori infection in Borama District, Somaliland.
Summary
The association between the use of NSAIDs and the occurrence of H. pylori infection among patients attending private clinics in Borama district, Somaliland was determined. It was found that most (47.4%) respondents had always used NSAIDs, while 22.4% of the respondents indicated that they had not used NSAIDs. This indicates that the use of NSAIDs among patients with H. pylori infection attending Borama private clinics was generally high. This position was upheld by the chi-square test. The study established that patients who used NSAIDs were more likely to develop H. pylori infection than those who did not use them. The document analysis indicates that 52% of the respondents always used NSAIDs, 40% of the respondents sometimes used NSAIDs, and 8% of the respondents did not use NSAIDs.
Also, the correlation between socioeconomic status and the occurrence of H. pylori infection among patients at a private clinic in Borama District was determined. Socioeconomic status can be defined based on their levels of income, education, and gender. The study noted that 46.1% of the respondents indicated that they belonged to moderate socioeconomic status, while 25.7% of respondents indicated that their socioeconomic status was low. Thus, the socioeconomic status among H. pylori-infected patients attending private clinics in Borama District, Somaliland was generally moderate. The study established that socioeconomic status was moderate and it is not one of the factors associated with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. The document analysis indicates that 7% of the patients had good socioeconomic status, 30% of patients had poor socioeconomic status, and 63% had moderate socioeconomic status.
Finally, the correlation between household hygiene practices and H. pylori infection among patients attending private clinics in Borama District, Somaliland was also determined. Here, the household hygiene practices were defined based on food hygiene and safety, water supply, and toilet availability. It was shown that most (50.7%) of the patients had poor household hygiene practices and 49.3% had good household hygiene practices. The study established that the status of household hygiene practice was poor and it is one of the factors associated with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. Document analysis indicates that 60% of the respondents had poor household hygiene practices and 40% of the respondents had good household hygiene practices.
DISCUSSION
The results of the study are as follows :
The use of NSAIDs has a significant association with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland.
Socioeconomic status does not have a significant association with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland.
Household hygiene practices have a significant association with the occurrence of H. pylori infection among patients attending private clinics in the Borama District.
CONCLUSION
The use of NSAIDs has a significant association with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. Socioeconomic status does not have a significant association with the occurrence of H. pylori infection among patients attending private clinics in Borama District, Somaliland. Second, the study established that socioeconomic status is not significantly associated with the occurrence of H. pylori infection among patients attending private clinics in Borama District Somaliland. The finding of this study does not agree with previous similar studies. One such study by Midhet et al. (2010) in Uganda showed that there was a strong association between H. pylori infection and the patients’ level of education and gender, indicating their socioeconomic status. Another study done by Zhang et al. (2017) in China on socioeconomic status factors found that there was an association between income level and H. pylori infection. Lori et al. (2008) in Russia suggested in a study that socioeconomic status remains a factor influencing the acquisition and prevalence of H. pylori infection. Nahar et al. (1995) in Bangladesh showed that poor socioeconomic conditions, such as low income, and the use of a stove for heating or cooking result in high prevalence of H. pylori infection. Furthermore, a study conducted by Tedla (1992) in Ethiopia showed that socioeconomic factors such as low-income levels can contribute to H. pylori infections. Thus, the results of other studies are different from the findings of this study. Household hygiene practices are significantly associated with the occurrence of H. pylori infection among patients attending private clinics in Borama District.
The risk factors associated with H. pylori infection among patients attending private clinics in Borama District, Somaliland were investigated. The study mainly focused on the use of NSAIDs, socioeconomic status, and household hygiene practices. Based on the findings and above-mentioned discussion, the study concludes that the use of NSAIDs as well as improper practice of household hygiene is significantly associated with the infection, whereas the socioeconomic status is not associated with the infection.
LIMITATION
The availability of precious time and resources has greatly slowed further study and subsequent proceedings with regard to the research activities. Also, other factors associated with the occurrence of H. pylori infection could be studied. It is, therefore, recommended that other forms of research criteria apart from risk factors could also be studied. These could include but are not limited to factors such as family history, practices like smoking, and a host of other bacterial factors.
ACKNOWLEDGEMENTS
The authors express deep gratitude to the reviewers for their useful suggestions and corrections.
ETHICAL CONSIDERATIONS
Each participant was notified of the intentions of the study. The consent of each respondent was obtained. It was ensured that any information provided was confidential and should not be without the permission of the client.
DATA AVAILABILITY STATEMENT
All relevant data are included in the paper or its Supplementary Information.
CONFLICT OF INTEREST
The authors declare there is no conflict.