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Taye B, Enquselassie F, Tsegaye A, Amberbir A, Medhin G, Fogarty A, Robinson K, Davey G. Association between infection with Helicobacter pylori and atopy in young Ethiopian children: A longitudinal study. Clin Exp Allergy 2017; 47:1299-1308. [PMID: 28787771 DOI: 10.1111/cea.12995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Epidemiological evidence from developed countries indicates that Helicobacter pylori infection correlates with a reduced risk of atopy and allergic disorders; however, limited data are available from low-income countries. OBJECTIVE We examined associations between H. pylori infection in early childhood and atopy and reported allergic disorders at the age of 6.5 years in an Ethiopian birth cohort. METHODS A total of 856 children (85.1% of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half years. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Serum samples were analysed for total IgE levels and anti-H. pylori cytotoxin-associated gene A (CagA) IgG antibody using commercially available ELISA kits. Stool samples were analysed for H. pylori antigen using a rapid immunochromatographic test. The independent effects of H. pylori infection (measured at age of 3, 5 and 6.5 years) on prevalence and incidence of atopy and reported allergic disorders (measured at age of 6.5 years) were determined using multiple logistic regression. RESULTS In cross-sectional analysis, current H. pylori infection at age 6.5 years was inversely, though not significantly, related to prevalence of atopy and "any allergic condition" at age 6.5 years. However, detection of H. pylori infection at any point up to age 6.5 years was associated with a significantly reduced odds of both atopy and "any allergic condition" (adjusted OR AOR, 95% CI, 0.54; 0.32-0.92, P = .02, and .31; 0.10-0.94, P = .04, respectively). In longitudinal analyses, H. pylori infection at age 3 was inversely associated with incidence of atopy (AOR, 95% CI, 0.49; 0.27-0.89, P = .02). Furthermore, among H. pylori-infected children, those with a CagA+ strain had a more pronounced reduction in odds of atopy (AOR = 0.35 vs 0.63 for CagA+ vs CagA-), and this reduction reached borderline significance. CONCLUSION These data are consistent with the hypothesis that early exposure to H. pylori is inversely associated with atopy and allergic conditions. A possible modest protective association against atopy was observed in those infected with a more virulent CagA+ strain of H. pylori.
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Affiliation(s)
- B Taye
- Department of Biology, Colgate University, Hamilton, NY, USA
| | - F Enquselassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - A Tsegaye
- School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - G Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - A Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - K Robinson
- Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - G Davey
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Brighton, UK
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Deribew A, Kebede B, Tessema GA, Adama YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Desalegn B, Abajobir AA, Shafi O, Abera SF, Negussu N, Mengistu B, Amare AT, Mulugeta A, Kebede Z, Mengistu B, Tadesse Z, Sileshi M, Tamiru M, Chromwel EA, Glenn SD, Stanaway JD, Deribe K. Mortality and Disability-Adjusted Life-Years (Dalys) for Common Neglected Tropical Diseases in Ethiopia, 1990-2015: Evidence from the Global Burden of Disease Study 2015. Ethiop Med J 2017; 55:3-14. [PMID: 28878427 PMCID: PMC5582634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. METHODS We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). RESULTS All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. CONCLUSIONS Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.
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Affiliation(s)
- A Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia
- Dilla University, Dilla, Ethiopia
- Micronutrient Initiative, Ethiopia
| | - B Kebede
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - GA Tessema
- Department Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - YA Adama
- School of Medicine, The University of Adelaide, Adelaide South Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - A Misganaw
- Institute for Health Metrics and Evaluation, University of Washington
| | - T Gebre
- International Trachoma Initiative, the Task Force for Global Health, Addis Ababa, Ethiopia
| | - A Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - B Desalegn
- University of South Australia, Adelaide, Australia
| | - AA Abajobir
- School of Public Health, the University of Queensland, Queensland, Australia
- Debremarkos University, Debremarkos, Ethiopia
| | - O Shafi
- Rollind schools of public Health, Emory University, USA
| | - SF Abera
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | - N Negussu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - B Mengistu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - AT Amare
- School of Medicine, The University of Adelaide, Adelaide South Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - A Mulugeta
- World Health Organization, Addis Ababa, Ethiopia
| | - Z Kebede
- World Health Organization, Addis Ababa, Ethiopia
| | - B Mengistu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Z Tadesse
- The Carter Centre, Addis Ababa, Ethiopia
| | - M Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - M Tamiru
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - EA Chromwel
- Institute for Health Metrics and Evaluation, University of Washington
| | - SD Glenn
- Institute for Health Metrics and Evaluation, University of Washington
| | - JD Stanaway
- Institute for Health Metrics and Evaluation, University of Washington
| | - K Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- School of Public Health, Addis Ababa University, Ethiopia
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Amberbir A, Medhin G, Abegaz WE, Hanlon C, Robinson K, Fogarty A, Britton J, Venn A, Davey G. Exposure to Helicobacter pylori infection in early childhood and the risk of allergic disease and atopic sensitization: a longitudinal birth cohort study. Clin Exp Allergy 2014; 44:563-71. [PMID: 24528371 PMCID: PMC4164268 DOI: 10.1111/cea.12289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 12/21/2013] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Background An inverse relation between Helicobacter pylori infection and allergic disease has been reported by a range of independent epidemiological studies, but evidence from longitudinal studies is scarce. Objective We have investigated the effects of H. pylori infection on the incidence and prevalence of allergic diseases and sensitization in a low-income birth cohort. Methods In 2005/2006, a population-based birth cohort was established in Butajira, Ethiopia, and the 1006 singleton babies born were followed up at ages 1, 3, and 5. Symptoms of allergic disease were collected using the ISAAC questionnaire, allergen skin tests performed, and stool samples analysed for H. pylori antigen and geohelminths. Multiple logistic regression was used to determine the independent effects of H. pylori measured at age 3 on the incidence of each outcome between ages 3 and 5 years (in those without the outcome at age 3), controlling for potential confounders, and to additionally assess cross-sectional associations. Results A total of 863 children were followed up to age 5. H. pylori infection was found in 25% of the children at both ages 3 and 5, in 21% at age 5 but not 3, and in 17% at age 3 but not at age 5. H. pylori infection at age 3 was significantly associated with a decreased risk of incident eczema between ages 3 and 5 (adjusted OR, 95% CI, 0.31; 0.10–0.94, P = 0.02). Cross-sectionally at age 5, H. pylori infection was inversely associated with skin sensitization (adjusted OR, 95% CI, 0.26; 0.07–0.92, P = 0.02). Conclusion and clinical relevance These findings provide further evidence to suggest that early-life exposure to H. pylori may play a protective role in the development of allergy.
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Affiliation(s)
- A Amberbir
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Amberbir A, Medhin G, Erku W, Alem A, Simms R, Robinson K, Fogarty A, Britton J, Venn A, Davey G. Effects of Helicobacter pylori, geohelminth infection and selected commensal bacteria on the risk of allergic disease and sensitization in 3-year-old Ethiopian children. Clin Exp Allergy 2011; 41:1422-30. [PMID: 21831135 DOI: 10.1111/j.1365-2222.2011.03831.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Epidemiological studies have suggested that gastro-intestinal infections including Helicobacter pylori, intestinal microflora (commensal bacteria) and geohelminths may influence the risk of asthma and allergy but data from early life are lacking. OBJECTIVE We aimed to determine the independent effects of these infections on allergic disease symptoms and sensitization in an Ethiopian birth cohort. METHODS In 2008/09, 878 children (87% of the 1006 original singletons in a population-based birth cohort) were followed up at age 3 and interview data obtained on allergic symptoms and potential confounders. Allergen skin tests to Dermatophagoides pteronyssinus and cockroach were performed, levels of Der p 1 and Bla g 1 in the child's bedding measured and stool samples analysed for geohelminths and, in a random subsample, enterococci, lactobacilli, bifidobacteria and H. pylori antigen. The independent effects of each exposure on wheeze, eczema, hayfever and sensitization were determined using multiple logistic regression. RESULTS Children were commonly infected with H. pylori (41%; 253/616), enterococci (38.1%; 207/544), lactobacilli (31.1%; 169/544) and bifidobacteria (18.9%; 103/544) whereas geohelminths were only found in 8.5% (75/866). H. pylori infection was associated with a borderline significant reduced risk of eczema (adjusted OR 0.49, 95% CI 0.24-1.01, P=0.05) and D. pteronyssinus sensitization (adjusted OR 0.42, 95% CI 0.17-1.08, P=0.07). Geohelminths and intestinal microflora were not significantly associated with any of the outcomes measured. CONCLUSION AND CLINICAL RELEVANCE Among young children in a developing country, we found evidence to support the hypothesis of a protective effect of H. pylori infection on the risk of allergic disease. Further investigation of the mechanism of this effect is therefore of potential therapeutic and preventive value.
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Affiliation(s)
- A Amberbir
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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Belyhun Y, Amberbir A, Medhin G, Erko B, Hanlon C, Venn A, Britton J, Davey G. Prevalence and risk factors of wheeze and eczema in 1-year-old children: the Butajira birth cohort, Ethiopia. Clin Exp Allergy 2010; 40:619-26. [PMID: 20447078 DOI: 10.1111/j.1365-2222.2010.03479.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The rising global prevalence of asthma and other allergic conditions has been linked to potential aetiological factors influencing the developing immune system. OBJECTIVE To investigate the prevalence and associated risk factors for wheeze and eczema in 1-year-old children in a birth cohort from Butajira, Ethiopia. METHODS In 2005/6, a population-based cohort of 1065 pregnant women was established. At 1 year of age, data on wheeze and eczema in the children were collected from the mother via an interview-administered questionnaire, along with numerous demographic and lifestyle factors. A stool sample was also obtained from the child for geohelminth analysis. RESULTS The prevalence of wheeze was 11.5% (103/899) and eczema 8.6% (77/899). Independent predictors of wheeze were maternal allergic history [adjusted OR (AOR)=3.00, 95% CI 1.23-7.36], paternal allergic history (AOR=2.59, 95% CI 1.08-6.25), increasing household size (P for trend=0.023; AOR=3.54, 95% CI 1.31-9.56 for 7+ vs. 1-3 individuals) and paracetamol use by the child (overall P<0.001; AOR 11.04, 95% CI 4.30-28.31 for 4+ tablets in past month vs. never). Factors independently associated with eczema were maternal allergic history (AOR=3.68, 95% CI 1.54-8.77), household size (overall P=0.035; AOR=0.45, 95% CI 0.23-0.87 for 4-6 individuals relative to 1-3) and place of sleeping (overall P<0.001; AOR=0.29, 95% CI 0.10-0.82 for floor vs. bed/platform). CONCLUSION These findings support the hypothesis that eczema in early life in these children is a manifestation of allergy, while wheezing is probably due to infection as well as allergy.
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Affiliation(s)
- Y Belyhun
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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