Prevalence of Helicobacter pylori Infection among Anemic School-Age Children in Egypt: A Cross-Sectional Population-Based Study

Abstract Anemia and Helicobacter pylori infection in school-age children are important public health problems. The association between H. pylori infection and the development of anemia, especially iron deficiency anemia, has been previously studied and until now it is still a matter of argument. This study aimed to determine the prevalence of anemia and H. pylori infection among school-age children and to find the association between H. pylori infection and anemia in school-age children. We conducted this population-based cross-sectional study in six Egyptian primary schools over a 12-month-period, including 1,200 students from all grades who fulfilled the inclusion criteria. The study participants were subjected to the following: medical history, clinical examination, and laboratory investigations included complete blood count and H. pylori antigen in stool, and according to the level of hemoglobin (Hb), we divided the students into two groups; the anemic group with Hb level <11.5 g/dL and nonanemic group with Hb level ≥11.5 g/dL, and the serum ferritin levels were measured only for the anemic group as the best indicator for iron status. The overall prevalence of H. pylori infection was 25%. The overall prevalence of anemia was 13.25%, of which hypochromic microcytic anemia represented 87.4% of the anemic group, and the mean ferritin level in the anemic group was 18.56 ± 9.96 ng/mL. The prevalence of anemia among H. pylori-infected patients (62.3%) was significantly (p < 0.001) higher than in noninfected children (37.7%). In the anemic group, the mean ferritin level in H. pylori-infected children was significantly lower than the mean level in the noninfected children (p <0.001). Furthermore, the anemic group had a significantly higher incidence of H. pylori infection and a lower age (p <0.001) in comparison with the nonanemic group. The dominant type of anemia in H. pylori-infected children was the microcytic hypochromic anemia, with a significantly higher incidence in comparison to other types of anemia (p <0.001). The findings of this study demonstrate a significant association between H. pylori infection and anemia in school-aged children, especially iron deficiency anemia, as the incidence of H. pylori infection was greater in anemic children than in non-anemic children.