1. Introduction
Helicobacter pylori is a microaerophilic, Gram-negative spiral bacterium. Its helix shape is thought to have evolved to penetrate the mucoid lining of the stomach, where they are protected by the mucus and the body immune cells are not able to reach them. The bacteria can interfere with immune response and ensure that they are not destroyed. This can lead to stomach ulcers [1] . Helicobacter pylori (H. pylori), is an important global infection with a worldwide prevalence of about 45%. This infection is mostly acquired during childhood through the fecal-oral and oral-oral route. H. pylori is contagious, although the exact route of transmission is not well known [2] . Person-to-person transmission by either the oral-oral or fecal-oral route is most likely. Initial infection with this organism is usually asymptomatic but symptoms and pathologic changes occur later in life. The clinical conditions and pathologic changes associated with H. pylori infection include gastritis, gastric and duodenal ulcers, gastric cancers, iron deficiency anaemia and idiopathic thrombocytopenic purpura [3] . Helicobacter pylori is a common type of bacteria that grows in the digestive tract and has a tendency to attack the stomach lining. It infects the stomach of approximately 45 percent of the world’s adult population. H. pylori infections are usually harmless, but they are responsible for the majority of ulcers in the stomach and small intestine. H. pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce its acidity so they can survive. It is still not known exactly how H. pylori infections spread. The bacteria have coexisted with humans for many thousands of years. H. pylori infection exhibits a varied geographic distribution on both local and global scales. A number of other symptoms may be associated with H. pylori infection, including: excessive burping, feeling bloated, nausea, heartburn, fever, lack of appetite, or anorexia, unexplained weight loss, trouble swallowing, anemia and blood in the stool. These are common symptoms that could be caused by other conditions. Some of the symptoms of H. pylori infection are also experienced by healthy people [4] .
Their risk is higher mostly due to lack of proper hygiene. Adults risk for infection partly depends on the environment and living conditions. The risk is higher among people living in a developing country, sharing housing with others who are infected with H. pylori, living in overcrowded housing and hostel, having no access to hot water, which can help to keep areas clean and free from bacteria [5] .
Most people with H. pylori do not have any symptoms. When the infection leads to an ulcer, symptoms may include abdominal pain, especially when your stomach is empty at night or a few hours after meals. The pain is usually described as a gnawing pain, and it may come and go. Eating or taking antacid drugs may relieve this pain. Some of the symptoms of H. pylori infection are also experienced by healthy people [4] . Children are more likely to develop an H. pylori infection. About 10 percent of people infected with H. pylori develop a peptic ulcer [6] . Long-term use of nonsteroidal anti-inflammatories (NSAIDs) also increases the risk of getting a peptic ulcer. H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications [7] . These include:
• internal bleeding, which can happen when a peptic ulcer breaks through your blood vessel and is associated with iron deficiency anemia
• obstruction, which can happen when something like a tumor blocks the food from leaving your stomach
• perforation, which can happen when an ulcer breaks through your stomach wall
• peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity
Studies show that infected people also have an increased risk of stomach cancer. While the infection is a major cause of stomach cancer, most people infected with H. pylori never develop stomach cancer [8] .
People suffering from H. pylori normally need to take a combination of two different antibiotics, together with another drug that reduces the stomach acid. Lowering stomach acid helps the antibiotics work more effectively. This treatment is sometimes referred to as triple therapy. Some of the drugs that are used in a triple therapy treatment include: clarithromycin, proton-pump inhibitors (PPI), such as lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), or rabeprazole (AcipHex), metronidazole (for 7 to 14 days) and amoxicillin (for 7 to 14 days). In most cases, only one round of antibiotics is needed to clear the infection, but you might need to take more, using different drugs [9] .
According to the bulletin, Helicobacter pylori and cancer (2013), there is no evidence that food and nutrition play a role in preventing or causing peptic ulcer disease in people infected with H. pylori. However, spicy foods, alcohol, and smoking may worsen a peptic ulcer and prevent it from healing properly. If the infection still persists after one round of treatment, a peptic ulcer could return or, more rarely, stomach cancer could develop. Very few people infected with H. pylori will develop stomach cancer. However, people with a family history of stomach cancer, should get tested and treated for H. pylori infection [10] .
1.1. Statement of the Problem
Helicobacter pylori accounts for 90% of 80 million peptic ulcer cases in humans worldwide due to consumption of contaminated food, water and in 45% adult population worldwide. In the USA, rate of peptic ulcer cases is between 10 to 15 per 100,000 people. Ten percent is caused by consumption of contaminated food. Contaminated source of water and food have been implicated as sources of Helicobacter pylori in overcrowded camps and hostels, which could lead to wide scale epidemic. Open-air defecation and unhygienic environment have been indicted as easier source of contamination of water and food, a possible route of transmission to humans.
1.2. Significance of the Study
1) Rural setting sanitary facilities have been indicted as a cheaper source of carrier of Helicobacter pylori and a possible route of transmission to human.
2) The presence of asymptomatic carriers among internally displaced people and other rural dwellers makes Helicobacter pylori a serious public health challenge.
3) Heavy economic losses are incurred due to consistence treatments of the disease caused by Helicobacter pylori.
4) Helicobacter pylori are a bacterium infection in camps, unhygienic of rural setting and data on the prevalence and diagnostic test kits of peptic Ulcer is limited.
1.3. Aims and Objectives
1) To determine the prevalence rate of Helicobacter pylori among the internally displaced persons from Bakassi Peninsular and Etim Ekpo communities in the South Southern Nigeria, where there is a high prevalence of gastric cancer and peptic ulcer.
2) To assess the risk factors for Helicobacter pylori by using data on sex, age, educational level, smoking, drinking, as well as dietary factors.
3) To evaluate the sociocultural and demographic factors influencing the prevalence of this infection in the communities.
4) To evaluate the effectiveness of serological diagnostic test in the diagnosis of the disease caused by H. pylori in Nigeria.
2. Materials and Methods
2.1. Study Population and Design
This study is a descriptive cross-sectional study and was conducted from January 2018 to September 2018 within two rural communities in the Basin region of South Eastern zone of Nigeria. The South Eastern region is located at the South-South geopolitical zone with latitude 9.8˚-11.0˚ north and longitude 1.6˚-3.0˚ west, bounded to the estuaries of Cameron to the West. A total of 1560 persons (≥5 years) were recruited for the study. Informed consent was obtained through IDPs camp leaders, Health providers and parents of those who participated in the study.
2.2. Demographic Details
The age, gender, type of toilet facility, source of drinking water, number of people in their household or camp, number of siblings, the educational level of the people as well as their smoking, snuffing and alcoholic drinking habits were collected from all participants using a structured questionnaire.
2.3. Sample Collection
A total of one thousand five hundred and sixty (1560) blood specimens were aseptically collected (2 mls) randomly from the participants between 5 - 75 years of age, in the IDP camps within the South Eastern rural communities. The blood sample was collected using sterile vacutainers, needles and EDTA containers were labeled accordingly. The samples were transported to the Microbiology laboratory of Akwa Ibom State University (AKSU) with minimum delay for processing.
2.4. Specimen Preparation and Analysis
The kits are designed for qualitative detection of H. pylori antigens in the specimen through antigen antibody reaction with high degree of specificity and immune chromatography analysis. The membrane is immobilized with H. pylori antibodies-specific on the test well (T), and corresponding antibodies on the control well (C). The blood specimen was brought to the room temperature and 5 ul of the specimen was added aseptically into the test well (S). Procedures were followed according to the manufacturer recommendation. The Elisa kit used for the detection of H. pylori is manufactured by Zhuhai Encode Medical Engineering Co., Ltd. China.
2.5. Result Interpretation
During testing, the blood sample is added to the sample well (S) of the cassette and reacts with anti H. pylori antibodies conjugated to colored particles and pre-coated onto the sample pad of the test. The mixture migrates through the membrane by capillary action and interacts with reagents on the membrane. The H. pylori is positive, when the colored bands is formed at test well (T). No matter if the H. pylori antigen exist or not, red band will appear in control well (C) which serves as a procedural control.
2.6. Invalid Result
When the control band or both the control band and the test band is not seen, indicating an invalid result which may be as a result of following the direction correctly or expired kits, such specimens were retested using a new test kit.
2.7. Statistics
The data was captured using Microsoft excel, 2007 and exported to STATA version 11.0 for processing and analysis. Pearson’s chi squared and Fisher’s exact tests employed to test associations between various background characteristics of participants and the outcome of interest (H. pylori status) at p < 0.05 significance level.
3. Discussion
H. pylori infection affects more than half of the global population including children. Due to it fecal-oral mode of transmission, it is more prevalent in poor socioeconomic environments and developing countries. H. pylori is described as a group 1 carcinogen but the health implications of infection in adult and children remains uncertain [10] . This may be problematic particularly in African countries that may harbor more virulent strains. H. pylori infection has been described as “African enigma”. It has however been shown that all complications including carcinoma do occur in the African population. Our study used a noninvasive serologic method to qualitatively detect H. pylori antigen in human blood specimen.
Transmission of H. pylori infection is rapidly decreasing in the developed countries predictably because of improvement in the sanitation [11] . There is infrequent H. pylori infection during childhood in the developed countries with the United States reporting less than 5% among under five years and up to 10% by adolescent age. In developing countries the story is different with over 48% of children under five years old infected and as high as 60% in some adult populations [12] . We recorded overall prevalence rate of 29.7% among symptomatic and asymptomatic internally displaced persons living in camps in South Southern Nigeria (Table 1). Out of this, 17.6% prevalence was demonstrated between the ages of 5 - 16 years and the prevalence decreases as the age of the people living in the various IDP camps advances according to our report in Table 2. This finding was not consistent with the developing countries data on the prevalence of H. pylori infection within this younger age group. This could be attributed to the differences in the study design, population dynamics, geographic values and hygienic conditions as well as the specificities of techniques employed in the studies.
The gender effect on prevalence of H. pylori infection in many populations varied, in our study female had dominance of 20% with higher H. pylori prevalence, than males (9.7%), and this is a reverse of the pattern in most population studies (see Table 3). Woodward and colleagues reported a higher prevalence in men than women, whiles others reported no difference. A meta-analysis reported a male predominance in adults but not in children [13] . Table 4 shows educational status has been used as a proxy marker of socioeconomic status and an important determinant of H. pylori prevalence in developed and resource limited settings [14] . The educational status of parents and children in our study did not show significant effect on the prevalence of H. pylori in the IDP camps in Nigeria. A total rate of 220 (14.08%) persons with primary education were recorded, 88 (5.68%) of secondary followed by tertiary with 69 (4.42%), none educated and Quranic shows 60 (3.84%) and 27 (1.73%) respectively [12] .
In our study, occupational status recorded 92 (5.89%) in farmers, 88 (5.63%) among Unemployed population, 80 (5.12%) in business group and 3.33% with a lower prevalence rate of 2.18% in civil servants (see Table 5). Habits such as smoking and snuffing consumption have been linked as risk factors with a prevalence rate of 11%, 12.4% respectively (Table 6). In contrast, our study shows that regular alcohol drinking was a protective factor for H. pylori infection. Crowding in camps and increasing household contact have been considered as risk factors of H. pylori infection [15] . As the number of people in a household increases the prevalence of H. pylori also increased. Source of drinking water other than pipe and borehole increased the prevalence of H. pylori infection as well as open-air defecation [16] (Table 7).
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Table 1. Percentage distribution of Helicobacter pylori among IDPs Camps in the South Eastern Nigeria.
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Table 2. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
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Table 3. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
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Table 4. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
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Table 5. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
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Table 6. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
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Table 7. Socio-demographic characteristics of IDPs in the South Eastern Nigeria.
Water is an important source of H. pylori spread as confirmed by other studies. Therefore, handling of water and poor sanitation will be a good milieu for the spread of this infection. In our environment, poverty and poor socioeconomic status are associated with higher household numbers. It is therefore not surprising giving the mode of transmission that prevalence in our study increased with increasing household numbers. Proper hand washing and waste disposing systems will help control infection in households especially in crowded places.
4. Conclusion
Our study demonstrated a high prevalence of H. pylori infection among various cadres of internally displaced persons in a rural camping. Educational status of parents did affect H. pylori prevalence and increasing household numbers, female gender, younger age, open-air defecation, habit addictions and source of drinking water other than pipe and borehole being associated with a higher prevalence. Adequate infrastructural provision and availability of portable water with good hygienic environment will drastically reduce the high rate of spread of Helicobacter pylori bacterium in the developing countries such as ours.