title: Impact of household hygiene and water source on the prevalence and transmission of Helicobacter pylori: a South Indian perspective.
abstract: BACKGROUND
  In developing countries, the Helicobacter pylori (H. pylori) infection rate is high, especially in lower socioeconomic groups. The populace in developing countries lives in conditions that are highly conducive to the acquisition of microorganisms. Poor hygiene, crowded household conditions and deficient sanitation mark their day-to-day life. We aimed to find out the roles of household hygiene and water source in the prevalence and transmission of H. pylori infection among the South Indian population using polymerase chain reaction (PCR) assay.
  
  
  METHODS
  The selected population consisted of 500 adults of varying ages ranging from 30 to 79 years, with upper gastrointestinal tract symptoms. Each participant in the study was given a questionnaire to complete. Samples to assess H. pylori infection included three gastric biopsies (two from the antrum and one from the corpus region). Infection was detected by PCR amplification of the 16S rRNA gene of H. pylori. The data was then examined statistically by univariate and multivariate analyses.
  
  
  RESULTS
  The overall prevalence of H. pylori was detected to be 80 percent. Prevalence increased with an increase in age and it was found to be 90 percent in the 70-79 year age group (p-value is less than 0.01). The prevalence of infection among people who drank water from wells was 92 percent compared with 74.8 percent of those who drank tap water (p-value is less than 0.001). H. pylori infection prevalence was found to be higher in people with low clean water index (CWI) (88.2 percent) than in those with higher CWI (33.3 percent) (p-value is less than 0.001). While the prevalence of H. pylori in the subjects with lower socioeconomic status was 86.1 percent, in higher groups, it was 70 percent (p-value is less than 0.001). The prevalence of H. pylori was also found to be higher in subjects who lived in overcrowded houses. It was 83.7 percent with high crowding index, 76.6 percent with medium crowding index, and 71.3 percent with low crowding index (p-value is less than 0.05).
  
  
  CONCLUSIONS
  The results of the present study suggest that the risk of acquisition and transmission of H. pylori can be prevented to a large extent by following improved household hygienic practices, proper waste disposal measures as well as the regular use of boiling water for drinking purposes.
authors.affiliation: Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, India.
authors.forename: K S
authors.initials: KS
authors.lastname: Ahmed
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: S K
authors.initials: SK
authors.lastname: Tiwari
authors.forename: A
authors.initials: A
authors.lastname: Habeeb
authors.forename: J D
authors.initials: JD
authors.lastname: Ahi
authors.forename: Z
authors.initials: Z
authors.lastname: Abid
authors.forename: N
authors.initials: N
authors.lastname: Ahmed
authors.forename: C M
authors.initials: CM
authors.lastname: Habibullah
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004203:Disinfection / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D016481:Helicobacter Infections / Q000191:economics / Q000453:epidemiology* / Q000235:genetics / Q000635:transmission*; D016480:Helicobacter pylori / Q000235:genetics / Q000472:pathogenicity; D006798:Housing; D006801:Humans; D006920:Hygiene; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D014865:Waste Disposal, Fluid; D014881:Water Supply