**3. Results**

In this study, we investigated the epidemiology of *H. pylori* infection by serum antibody and stool antigen determination approaches among students of Nasarawa State University, Keffi. A total of 400 students consisting of 192(48.0%) males and 208 (52.0%) females were screened for both antibody and antigen to *H. pylori* using rapid diagnostic methods. Of the 400 students screened, 166 (41.5%) showed positivity to *H. pylori* IgG, and 128 (32.0%) showed positivity to *H. pylori* antigen (**Figure 1**).

There was no statistically significant difference between age and seromarkers of *H. pylori* (P > 0.05). However, the infection was highest both antibody (46.4%) and antigen (36.6) among those aged 21–30 years old. Also, students aged ≥40 years had the least prevalence of *H. pylori* infection (Ab = 25.0%, Ag = 16.7%) when compared to other age groups. There were more females (208) than males (192) and among the 192 males tested, 79 (41.2%) and 59 (30.7%) showed positivity for antibody and antigen of *H. pylori* respectively. Nevertheless, of the 208 females, 87 (41.8%) tested positive for *H. pylori* antibody while 69 (33.2%) were positive for stool antigen. However, this variation was not found to be statistically significant (P > 0.05). There was no statistical significant association between *H. pylori* seromarkers and marital status (P > 0.05). Of the 92 married students, 45 (48.9%) showed positivity for serum antibody while 35 (38.0%) showed positivity for stool antigen. Similarly, 121 (39.3%) of the unmarried reported positive for serum antibody and 93 (30.2%) tested positive for stool antigen. The rate of serum antibody was reported high among students from rural areas (44.4%) than those from urban areas (39.4%) (P < 0.05). But surprisingly, considering stool antigen as a marker for *H. pylori* infection, both those from rural (33.1%) and urban (33.2%) areas almost had equal infection burden (**Table 1**).

No statistically significant association was reported between the bacterial infections and socio-economic status (P > 0.05). Notwithstanding, students with poor socio-economic status had higher prevalence of both serum antibody (46.2%) and stool antigen (48.1%) while the least prevalence of the infections (Ab = 38.2%, Ag = 25.5%) was recorded among those with very good socio-economic status.

Helicobacter pylori *- From First Isolation to 2021*


#### **Table 1.**

*Distribution of markers of* H. pylori *infections among students of a tertiary institution in Central Nigeria in relation to socio-demographic factors.*

Furthermore, *H. pylori* serum antibody was highest among students who source water from river/stream (54.2%) than those who source water from tap (43.1%), well (39.8%) and borehole (38.4%) (P < 0.05). However, those who source water from well (39.8%) had the highest prevalence of stool antigen when compared to other sources of water. Similarly, there was statistically significant association between type toilet and *H. pylori* stool antigen in this study (P < 0.05), as higher rate was recorded among students who use pit toilet (39.0%) than those who use toilet with water system (29.8%). On the other hand, higher rate of *H. pylori* serum antibody was recorded among those with toilets with water system (43.9%) compared to those with pit toilets (33.7%). Additionally, place of residence was also associated with *H. pylori* stool antigen (P < 0.05). Higher prevalence of both stool antigen (36.2%) and serum antibody (43.6%) To*h. pylori* were reported among students residing in the hostel as compared to those who reside at home/off-campus (Ab = 40.1%, Ag = 29.1%). Surprisingly, both smoking and alcoholism were not significantly associated with *H. pylori* infections in this study (P > 0.05). However, higher prevalence of the infections was recorded among smokers (Ab = 47.3%, Ag = 40.5%) than those who do not smoke (Ab = 40.2%, Ag = 30.4%). Nonetheless, the infections was higher among those who do not take alcohol (Ab = 42.4%, Ag = 33.1%) than those who take alcohol (Ab = 38.2%, Ag = 28.1%). Self-medication was also not significantly associated with *H. pylori* infections (P > 0.05). However, those who do not self-medicate were more infected (Ab = 42.7%, Ag = 33.7%) than those who self-medicates (Ab = 41.2%, 31.5%) (**Table 2**).


Helicobacter pylori *Seromarkers in a University Students Population in Central Nigeria DOI: http://dx.doi.org/10.5772/intechopen.96762*

#### **Table 2.**

*Distribution of markers of* H. pylori *infections among students of a tertiary institution in Central Nigeria in relation to risk factors.*

## **4. Discussion**

*Helicobacter pylorus* is a ubiquitous bacterium which is found in about two-third of the world's population [15, 28]. This current study was conducted to investigate the seromarkers and predisposing factors of *H. pylori* infections among students of Nasarawa State University, Kefii, Nigeria. A total of 400 students participated in the study and they were screened for both stool antigen and serum antibody (IgG) to *H. pylori* using rapid diagnostic approaches. Out of the 400 students screened, 166 (41.5%) showed positivity to serum antibody (IgG) and 128 (32.0%) were positive to stool antigen.

It is worthy of note that, presence of serum antibody (IgG) and absence of stool antigen in an individual is an indication of immunity to *H. pylori* due to past exposure to the bacterium. But when an individual is tested positive for both the antigen and the antibody at the same time, it means that there is an existing infection, while those that shows negative to both stool antigen and serum antibody are prone to *H. pylori* infections [22, 28, 29].

The 41.5% *H. pylori* IgG seroprevalence recorded in the study is higher than the 28.0% reported by Enitan *et al.* [22] among students of tertiary institution in Ogun, 35.0% by Ombugadu *et al.* [5] among dyspeptic patients in Jos and 15.4% by Moujaber *et al.* [30] in Australia. However, it is lower than the 57.9% found by Oti *et al.* [26] among patients in North-Central Nigeria, 51.9% by Gide *et al.* [6] among dyspeptic patients in Damaturu and 47.0% by Bastos *et al.* [20] among adult in Portugal.

On the other hand, the 32.0% stool antigen positivity recorded in this study is higher than the 22.8% reported by Adeniyi *et al.* [31] in malnourished children in Lagos and 23.5% by Enitan *et al.* [22] among students of tertiary institution in Ogun. Nevertheless, higher rates have also been reported. It was 38.8% among dyspeptic patients in Jos [5], 35.0% among malnourished children in Iraq [32] and 84.0% among African refugee children from resettlement in Australia [33]. The differences in the rates of *H. pylori* infection markers observed in different studies may be due to differences in population type and location with different peculiar risk factors.

Although, there is no statistically significant association between age and infections due to *H. pylori* (p > 0.05), students aged 21–30 years old were more infected than other age groups. This is indicated by high serum IgG (46.4%) and stool antigen (36.6%) among those in this age bracket. The results of this study were not in consonance with the reports of other previous studies [26, 34–38]. The higher prevalence of the infection among younger students in this current study might be because a good number of them reside in the hostel where there is overcrowding and poor hygienic conditions.

In this current study, gender was not statistically associated with infections due to *H. pylori* (p > 0.05) as both males (IgG = 41.2%, Ag = 30.7%) and females (IgG = 41.8%, Ag = 33.2%) were almost equally infected. This is consistent with the report of Ombugadu *et al.* [5] among dyspeptic patients in Jos but they however recorded higher prevalence of the infection among males (IgG = 43.2%, Ag = 45.5%) than females (IgG = 25.0%, Ag = 30.6%) which they attributed to higher exposure of males to possible environmental sources of infection such as smoking and alcohol intake.

In a related development, *H. pylori* infection was not associated with marital status (p > 0.05). This report is in consonance with the reports from other researchers [12, 22, 26]. However, the higher prevalence of the bacterial infection markers recorded among married (Ab = 48.9%, Ag = 38.0%) than unmarried (Ab = 39.3%, Ag = 30.2%) in this study might be unconnected to the engagement of married people particularly women in house chores such as washing of toilets, bathrooms and taking care of babies which may probably put them at high risk of the pathogenic agent through fecal-oral routes.

There is a statistically significant association between location and *H. pylori* stool antigen positivity in this study (p < 0.05). It was higher among rural settlers (IgG = 44.4%, Ag = 33.1%) than urban settlers (IgG = 39.4%, Ag = 31.2%). Most studies conducted in Nigeria also reported similar findings [5, 12, 26, 31]. This is

Helicobacter pylori *Seromarkers in a University Students Population in Central Nigeria DOI: http://dx.doi.org/10.5772/intechopen.96762*

no surprise because most Nigerian rural communities are characterized by lack of basic social amenities, poor hygienic environment and low socio-economic status [31, 36, 39].

This study reported no significant association between *H. pylori* infection and socio-economic status of participants in this study (p > 0.05). However, infection with *H. pylori* increased progressively with a decrease in socio-economic status of the participants. This observation agrees with findings of other researchers [5, 6, 36, 38]. Living in overcrowded homes that possess ugly environmental hygiene is associated with poor financial status individuals [12, 31, 39], thus, the possible reason the bacterial infection was high among them. There was a statistically significant association between students' water sources and *H. pylori* IgG seropositivity (p < 0.05). The prevalence was highest among those that use river/stream as their source of water (54.2%). This is no surprise because open defecation is common in Nigeria and water from river/stream can be easily contaminated with pathogenic organisms including *H. pylori* which are a fecal-oral pathogen [9]. Nevertheless, students which source of water is well had the highest prevalence of *H. pylori* antigen (39.8%). Other studies have reported similar outcomes [5, 38, 40].

Type of toilet facilities of the students was statistically associated with *H. pylori* antigen positivity in this study (p < 0.05). It was high among those that use pit toilets (39.0%). On the other hand, *H. pylori* IgG seropositivity was high among participants that use water system toilets (43.9%) compared to those that use pit toilets (33.7%). This observation may be an indication that the hygienic nature of the toilet and not its types is the reason behind the spread of the bacterial infection [6, 17, 38].

There was a statistically significant difference between place of residence and *H. pylori* antigen positivity (p < 0.05). The infection was more for both antigen (36.2%) and antibody (43.6%) among students residing in the hostel. This is expected because most hostels in Nigerian public tertiary institution are characterized with overcrowding and poor sanitary conditions which have been noted previously to be risk factors for the transmission of the infection [12, 33]. In this current study, both smoking and alcoholism were not statistically associated with the bacterial infection (p > 0.05) but there were arithmetic differences. This observation agrees with the report of Eshraghian [41]. Most previous studies have documented smoking and alcoholism as potential risk factors for *H. pylori* infection [9, 11, 12, 22, 26]. The higher prevalence of the infection among smokers in this study (IgG = 47.3%, Ag = 40.5%) may be connected with the fact that smoking, taking alcohol and coffee have been reported to increase the volume and concentration of stomach ulcer which can worsen an existing ulcer [22, 37].

Self-medication was not statistically associated with *H. pylori* infections in this study (p > 0.05). However, ulcer development has been linked to non-steroidal anti-inflammatory drugs (NSAIDs) usage such as, aspirin, ibuprofen and prioxican [11, 42]. These drugs are commonly used self-medications for headache, tiredness and fever. But surprisingly, in this study, participants who do not engage in self-medication were more infected with *H. pylori* (IgG = 42.7%, Ag = 33.7%) than those who engage in self-medication (IgG = 41.2%, Ag = 31.7%). Students who do not indulge in self-medication may have contracted the bacterium by living in overcrowded environment with poor hygienic and sanitary conditions hence the possible higher prevalence among them.

### **5. Conclusion**

This study confirmed the presence of anti-*H. pylori* IgG and Ag markers with 41.5% and 32.0% for past and current infections respectively. The antibody seromarker was higher in female while the *H. pylori* antigen was higher in males. Those students aged 21–30 years old reported the highest prevalence of the seromarkers while those of more than 41 years old had the least prevalence. Location, sources of water, types of toilet facility and place of residence were statistically associated with the bacterial infection. This is the first public report that has successfully reported the prevalence of these seromarkers among students of a tertiary institution in Nasarawa state. Priority should be given to personal and environmental hygiene of students to mitigate the spread of the infections.
