1
|
Dorji T, Wangmo S, Dargay S, Dorji N, Dorjey Y, Pradhan B, Pema D, Dema C, Choden J, Dorji T, Mynak ML, Pempa, Jamphel K. Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100370. [PMID: 38444883 PMCID: PMC10910341 DOI: 10.1016/j.lansea.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.
Collapse
Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sangay Wangmo
- Department of Surgery, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sonam Dargay
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Yeshey Dorjey
- Department of Obstetrics and Gynaecology, Phuentsholing General Hospital, Phuentsholing, Bhutan
| | - Birendra Pradhan
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Choney Dema
- National Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Jamyang Choden
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | | | | | - Pempa
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | - Kinga Jamphel
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| |
Collapse
|
2
|
Chophel T, Tshering S, Dorji N, Tshomo U. Stomach Cancer Screening Services of Bhutan. Indian J Surg 2022; 85:1-6. [PMID: 35912395 PMCID: PMC9307435 DOI: 10.1007/s12262-022-03519-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023] Open
Abstract
Stomach cancer is a common public health problem in South East Asia including Bhutan. Chronic infection with Helicobacter pylori is regarded as the principal cause of stomach cancer. Herein, we present the incidence of stomach cancer in Bhutan for eight years (from 2014 to 2021). We also discuss the steps taken for the prevention and early detection of stomach cancer.
Collapse
Affiliation(s)
- Thukten Chophel
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sangay Tshering
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Tshomo
- Principal Investigator of Population-Based Cancer Registry, Thimphu, Bhutan
| |
Collapse
|
3
|
Polivanova TV, Malaty H, Vshivkov VA. Epidemiology Helicobacter pylori infection in children in the Tyva Republic (Russia). Helicobacter 2022; 27:e12882. [PMID: 35285106 DOI: 10.1111/hel.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Tyva Republic is a small mountainous area at the geographical center of Asia in southern Siberia, with a high incidence of gastric cancer. AIM We examined the prevalence of H. pylori and associated risk factors among children in Tyva. METHODS Cross-sectional study was conducted among Tuvan children who had upper gastrointestinal symptoms and underwent upper gastroscopy with gastric biopsies. Informed consent was obtained from the parents and assent from the children. Demographic information, ethnicity, parents' education and employment status, and family size were collected. H. pylori infection was diagnosed by histologic examination. RESULTS There were 270 children between the ages 7 and 17 years (mean 13.4 ± 2.7); 64% girls; 147e Tuvan and 123 Caucasians. The overall prevalence of H. pylori was high and similar between boys and girls (55 vs. 57%, respectively, p = 0.42). The infection was highest in Tuvan children (67%. vs. 43%, respectively (OR = 2.4; 95%CI = 1.9.4-3), p = 0.05. H. pylori prevalence increased with age from 44% among 7 to 10 years and 64% among those 14 to 17 (OR = 3.0; 95%CI = 1.6-5.8), p = 0.0.005; the pattern was consistent among both ethnic groups. The prevalence of the infection among Caucasian children was inversely correlated with the level of mother's education (44%, vs. 61%) (i.e., for with and without a college education the OR = 2.3; 95%CI = 1.2-3.7), p = 0.02. Neither the total number of children nor adults living in the same household correlated with H. pylori prevalence. CONCLUSIONS Strategies to reduce the incidence of gastric cancer in Tyva will need to start in childhood.
Collapse
Affiliation(s)
- Tamara Vladimirovna Polivanova
- Scientific Research Institute for Medical Problems of the North, Federal Research Center «Krasnoyarsk Science Center» of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - Hoda Malaty
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Vitaliy Alekseevich Vshivkov
- Scientific Research Institute for Medical Problems of the North, Federal Research Center «Krasnoyarsk Science Center» of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| |
Collapse
|
4
|
Vilaichone RK, Aumpan N, Ratanachu-Ek T, Uchida T, Tshering L, Mahachai V, Yamaoka Y. Population-based study of Helicobacter pylori infection and antibiotic resistance in Bhutan. Int J Infect Dis 2020; 97:102-107. [PMID: 32474200 DOI: 10.1016/j.ijid.2020.05.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Bhutan suffers from a high prevalence of Helicobacter pylori (H. pylori) infection and gastric cancer-related mortality. In preparation for a countrywide H. pylori eradication program, the antibiotic resistance patterns of H. pylori infection were surveyed in different geographical regions. METHODS Dyspeptic patients in 6 districts including Thimphu, Punakha, Wangdue, Trongsa, Bumthang, and Haa underwent upper gastrointestinal endoscopy during GASTROCAMP and were enrolled between December 2010 and April 2015. Gastric biopsies were obtained for rapid urease test, histopathology, and H. pylori culture. Antimicrobial susceptibility testing was later performed if the culture was positive. RESULTS A total of 1178 patients were surveyed. The overall H. pylori infection in Bhutan was 66.2%. Punakha had the highest prevalence of H. pylori infection (85.6%). Thimphu and Punakha (city areas) had higher prevalence of H. pylori infection than rural districts (73.5% vs 63.3%, OR=1.61, 95% CI 1.22-2.13, p=0.0008). There were 357 patients (30.3%) with positive H. pylori culture completed antimicrobial susceptibility testing. The mean age was 40.5 years with female predominance (57.1%). No amoxicillin resistant strains were found. Metronidazole resistance was 81% followed by levofloxacin resistance (8.1%). Clarithromycin (2%) and tetracycline (0.6%) resistance was rare except in Thimphu, the capital city (10%) vs 0% in rural areas, p<0.001. The metronidazole resistance rate remained stable at approximately 80% during the past 5 years of study. Levofloxacin-resistant strains gradually rose from 5.3% in 2010 to 9.9% in 2015. CONCLUSIONS Bhutan had a high prevalence of H. pylori infection. Metronidazole resistance was extremely high, whereas clarithromycin resistance was quite low in this specific area. Antibiotic resistance pattern could be good evidence for guiding a proper treatment regimen for H. pylori infection in Bhutan.
Collapse
Affiliation(s)
- Ratha-Korn Vilaichone
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand; Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand; Digestive Diseases Research Center (DRC), Thammasat University, Pathumthani, Thailand.
| | - Natsuda Aumpan
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | | | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Lotay Tshering
- Department of Surgery, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Varocha Mahachai
- Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand; Digestive Diseases Research Center (DRC), Thammasat University, Pathumthani, Thailand; Gastrointestinal and Liver Center, Bangkok Hospital, Bangkok, Thailand
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| |
Collapse
|
5
|
Vilaichone RK, Aumpan N, Ratanachu-Ek T, Gamnarai P, Uchida T, Tshering L, Mahachai V, Yamaoka Y. Efficacy of Omeprazole, Tetracycline, and 4 Times Daily Dosing of Amoxicillin in Helicobacter pylori Eradication in Limited Resource Area in Bhutan: A Prospective Randomized Trial (BHUTAN Study). Asian Pac J Cancer Prev 2020; 21:1109-1114. [PMID: 32334478 PMCID: PMC7445957 DOI: 10.31557/apjcp.2020.21.4.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
Backgrourd: H. pylori-associated gastric cancer is the first cancer-related death in Bhutan. Effective regimen for H. pylori eradication is essential to reduce risk of developing gastric cancer. Clarithromycin is not widely used in this limited resource country. Aim of this study was to evaluate proper regimen and prevalence of antibiotic resistance pattern for H. pylori eradication in Bhutan. Methods: Five hundred and forty-six patients underwent gastroscopy during GASTROCAMP between October 2014 and April 2015 in Bhutan and 77 patients were enrolled. Four gastric biopsies were obtained for rapid urease test, histopathology, H. pylori culture with Epsilometer test. All H. pylori-positive patients were randomized to receive either 7-day or 14-day of 500 mg amoxicillin four times daily, 500 mg tetracycline four times daily, and 20 mg omeprazole twice daily. Results: Seventy-seven subjects were enrolled (54 females, 23 males, mean age = 45.4 years). Of 77 patients, 52 (67.5%) received 7-day regimen while 25 (32.5%) had 14-day regimen. Prevalence of H. pylori was 38.2%. Antibiotic resistance was 80.0% for metronidazole, 11.1% for levofloxacin and no resistance seen in amoxicillin, tetracycline and clarithromycin. Overall eradication rates of 7-day and 14-day regimens were 51.9% and 80.0%, p = 0.02. Female and age ≥40 years had significantly higher eradication rate when receiving 14-day compared to 7-day regimen (94.1% vs. 45.9%, OR = 18.82; 95% CI 2.26-157.02, p = 0.0007 and 86.7% vs. 50.0%, OR = 6.50; 95% CI 1.25-33.91, p = 0.02, respectively). Conclusions: Fourteen-day regimen might be an acceptable regimen for H. pylori eradication in limited resource area such as Bhutan. Female and age ≥40 years should receive longer duration of treatment. This 14-day regimen could at least reduce the risk of developing H. pylori-associated diseases especially peptic ulcer with complications and gastric cancer which lead to many deaths in Bhutan.
Collapse
Affiliation(s)
- Ratha-Korn Vilaichone
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.,Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Pathumthani, Thailand.,Digestive diseases Research Center (DRC), Thammasat University, Pathumthani, Thailand
| | - Natsuda Aumpan
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.,Digestive diseases Research Center (DRC), Thammasat University, Pathumthani, Thailand
| | | | - Pornpen Gamnarai
- Digestive diseases Research Center (DRC), Thammasat University, Pathumthani, Thailand.,Department of Biochemistry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tomahisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Lotay Tshering
- Department of Surgery, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Varocha Mahachai
- Gastrointestinal and Liver Center, Bangkok Medical Center, Bangkok, Thailand
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| |
Collapse
|
6
|
Ding J, Jin Z, Yang X, Lou J, Shan W, Hu Y, Du Q, Liao Q, Xu J, Xie R. Plasma membrane Ca 2+-permeable channels and sodium/calcium exchangers in tumorigenesis and tumor development of the upper gastrointestinal tract. Cancer Lett 2020; 475:14-21. [PMID: 32004573 DOI: 10.1016/j.canlet.2020.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/30/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022]
Abstract
The upper gastrointestinal (GI) tumors are multifactorial diseases associated with a combination of oncogenes and environmental factors. Currently, surgery, chemotherapy, radiotherapy and immunotherapy are relatively effective treatment options for the patients with these tumors. However, the asymptomatic phenotype of these tumors during the early stages poses as a significant limiting factor to diagnosis and often renders treatments ineffective. Therefore, new early diagnosis and effective therapy for upper GI tumors are urgently needed. Ca2+ is a pivotal intracellular second messenger and plays a crucial role in living cells by regulating several processes from cell division to death. The aberrant Ca2+ homeostasis is related to many human pathological conditions and diseases, including cancer, and thus the changes in the expression and function of plasma membrane Ca2+ permeable channels and sodium/calcium exchangers are frequently described in tumorigenesis and tumor development of the upper GI tract, including voltage-gated Ca2+ channels (VGCC), transient receptor potential (TRP) channels, store-operated channels (SOC) and Na+/Ca2+ exchanger (NCX). This review will summarize the current knowledge about plasma membrane Ca2+ permeable channels and sodium/calcium exchangers in the upper GI tumors and provide a synopsis of recent advancements on the role and involvement of these channels in upper GI tumors as well as a discussion of the possible strategies to target these channels and exchangers for diagnosis and therapy of the upper GI tumors.
Collapse
Affiliation(s)
- JianHong Ding
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Zhe Jin
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Xiaoxu Yang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Jun Lou
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Weixi Shan
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Yanxia Hu
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Qian Du
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Qiushi Liao
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China
| | - Jingyu Xu
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China.
| | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, PR China.
| |
Collapse
|
7
|
Sterea AM, Egom EE, El Hiani Y. TRP channels in gastric cancer: New hopes and clinical perspectives. Cell Calcium 2019; 82:102053. [PMID: 31279156 DOI: 10.1016/j.ceca.2019.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023]
Abstract
Gastric cancer is a multifactorial disease associated with a combination of and environmental factors. Each year, one million new gastric cancer cases are diagnosed worldwide and two-thirds end up losing the battle with this devastating disease. Currently, surgery represents the only effective treatment option for patients with early stage tumors. However, the asymptomatic phenotype of this disease during the early stages poses as a significant limiting factor to diagnosis and often renders treatments ineffective. To address these issues, scientists are focusing on personalized medicine and discovering new ways to treat cancer patients. Emerging therapeutic options include the transient receptor potential (TRP) channels. Since their discovery, TRP channels have been shown to contribute significantly to the pathophysiology of various cancers, including gastric cancer. This review will summarize the current knowledge about gastric cancer and provide a synopsis of recent advancements on the role and involvement of TRP channels in gastric cancer as well as a discussion of the benefits of targeting TPR channel in the clinical management of gastric cancer.
Collapse
Affiliation(s)
- Andra M Sterea
- Departments of Physiology & Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emmanuel E Egom
- Egom Clinical & Translational Research Services Ltd, Halifax, Nova Scotia, Canada
| | - Yassine El Hiani
- Departments of Physiology & Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
8
|
Fu Z, Li G, Sun J, Zhai Y, Zhang J, Lu Z, Chu J, Zhang G, Guo X, Xu A. Incidence and mortality of stomach cancer in Shandong Province in 2012. PRECISION RADIATION ONCOLOGY 2018. [DOI: 10.1002/pro6.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Zhentao Fu
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Guigang Li
- Zhaoyuan Center for Disease Control and Prevention Zhaoyuan Shandong China
| | - Jandong Sun
- School of Public HealthQueensland University of Technology Brisbane Queensland Australia
| | - Yuting Zhai
- Zhaoyuan Center for Disease Control and Prevention Zhaoyuan Shandong China
| | - Jiyu Zhang
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Zilong Lu
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Jie Chu
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Gaohui Zhang
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Xiaolei Guo
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| | - Aiqiang Xu
- Academy of Preventive MedicineShandong University Jinan Shandong China
- Shandong Center for Disease Control and Prevention Jinan Shandong China
| |
Collapse
|
9
|
The Association Between Index of Nutritional Quality (INQ) and Gastric Cancer and Evaluation of Nutrient Intakes of Gastric Cancer Patients: A Case-Control Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.9747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
10
|
Wangda S, Richter JM, Kuenzang P, Wangchuk K, Choden T, Tenzin K, Malaty HM. Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan. Helicobacter 2017; 22. [PMID: 28940523 DOI: 10.1111/hel.12439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Bhutan 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. METHODS A 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. RESULTS There were 327 children between 4 and 19 years of age participated, 44% boys, mean age = 13.6 ± 3 years. 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 15-19 years 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). CONCLUSIONS H. 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.
Collapse
Affiliation(s)
- Sonam Wangda
- Health care and Diagnostic Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - James M Richter
- Harvard Medical School, Gastroenterology Associates Massachusetts General Hospital, Boston, MA, USA
| | | | - Kinley Wangchuk
- Sherbutse College, Kanglung, Royal University, Thimphu, Bhutan
| | - Tashi Choden
- Sherbutse College, Kanglung, Royal University, Thimphu, Bhutan
| | - Karma Tenzin
- Microbiology unit, Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Hoda M Malaty
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|