Abstract
BackgroundEpidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort.MethodsIn 2011/12, 856 children (85.1 % of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Haemoglobin level and red cell indices were examined using an automated haematological analyzer (Cell Dyn 1800, Abbott, USA), and stool samples analyzed for H. pylori antigen. The independent effects of H. pylori infection (measured at age 3.5 and 6.5 years) on anaemia, haemoglobin level, and red cell indices (measured at age 6.5 years) were determined using multiple logistic and linear regression.ResultsThe prevalence of anemia was 34.8 % (257/739), and the mean (SD) haemoglobin concentration was 11.8 (1.1) gm/dl. Current H. pylori infection at age 6.5 years was positively, though not significantly related to prevalence of anaemia (adjusted OR, 95 % CI, 1.15; 0.69, 1.93, p = 0.59). Any H. pylori infection up to age 6.5 years was significantly associated with an increased risk of anaemia at age 6.5 (adjusted OR, 95 % CI, 1.68; 1.22, 2.32, p = 0.01). A significant reduction in haemoglobin concentration and red cell indices was also observed among children who had any H. pylori infection up to age 6.5 (Hb adjusted β = −0.19, 95 % CI, −0.35 to −0.03, p = 0.01; MCV adjusted β = −2.22, 95 % CI, −3.43 to −1.01, p = 0.01; MCH adjusted β = −0.63, 95 % CI, −1.15 to - 0.12, p = 0.01; and MCHC adjusted β = −0.67, 95 % CI, −1.21 to −0.14, p = 0.01), respectively.ConclusionThis study provides further evidence from a low income country that any H. pylori infection up to age 6.5 is associated with higher prevalence of anaemia, and reduction of haemoglobin level and red cell indices at age 6.5.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1012-y) contains supplementary material, which is available to authorized users.
Highlights
Epidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort
When red cell indices among all children followed up to age 6.5 years were regressed against any H. pylori infection up to age 6.5 years, being infected was associated with lower red cell indices; Mean Cell Volume (MCV), Mean Cell Haemoglobin (MCH) and Mean Cell Haemoglobin Concentration (MCHC) respectively (Table 4). In this population-based birth cohort of young Ethiopian children followed-up to age 6.5 years, we have examined the association between earlier and current H. pylori infection and anaemia at age 6.5 years
We found that current H. pylori infection at age 6.5 years was positively, though not significantly, related to prevalence of anaemia, while any H. pylori infection up to age 6.5 years was significantly associated with an increased odds of anaemia
Summary
Epidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort. The bacterium is a ubiquitous micro-organism, infecting half of the world's population [2] and is widely accepted as the main etiological factor for peptic ulcer disease and gastric malignancy [3, 4]. The consequences of H. pylori infection in gastroduodenal diseases are not well understood [7]; the majority have no specific symptoms [8, 9] and peptic ulcer disease is relatively rare in childhood [10]. Improvement in iron deficiency anaemia (IDA) after H. pylori eradication has been demonstrated in children and adults with unexplained IDA [16,17,18]
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