Document Type : Original Article (Special Issue)


1 Faculty of Medicine, University of Misan, 62001 Misan, Iraq

2 Department of Surgery, University of Misan, Iraq

3 Department of Microbiology, University of Misan, Iraq


Helicobacter pylori infection is one of the major causes of persistent bacterial infection known to human. It is found to be directly or indirectly responsible for a variety of human diseases, the most frequent of which are chronic gastritis and peptic ulcer diseases. It has a high prevalence in both genders and all age groups. The purpose of this study is to find out the prevalence of active Helicobacter pylori (H. pylori) infection by employing a stool antigen test as a screening technique. This study enrolled a total of 389 subjects, with a mean age of 36 (±16) years, and of them 225 were women. The participants' personal data and lifestyle practices were recorded, as well as fecal sample was taken and sent for serology study as an evidence of H. pylori infection. The results show that, Helicobacter pylori infection was found in 54% (210) of the participants. Regarding risk factors, age, gender, residence, and educational background have no impact on the prevalence of the infection. On the other hand, the infection has a substantial link to the personal and family economy and fast food consumption. Conclusion, H. pylori infection is common in our community (albeit slightly less so in our research) among people of all ages and genders, and it appears that certain lifestyle choices play a crucial role in the disease transmission.

Graphical Abstract

Prevalence and Risk Factors of Helicobacter Pylori Infection in Misan, Iraq: A Cross-Sectional Screening Study Using Stool Antigen Test


Main Subjects


Helicobacter pylori (H. pylori) infection is the most prevalent cause of persistent bacterial infection [1,2]. The organism is most commonly seen in the Gastric antrum and sites of gastric metaplasia in the duodenum [3]. It has been implicated as the primary cause of chronic gastritis, gastric and duodenal ulcers, gastric B-cell lymphoma, and distal gastric cancer [3]. There are many hematological, immunological illnesses as well as the phenomena of insulin resistance syndrome have been linked to the infection at least in theory [4-6].

  1. Pylori is widespread in all age groups and all parts of the world, with current estimates indicating that half of the world population is afflicted [2]. In low-income countries, it is quite common, with some studies suggest a prevalence of about (80-95%) [7]. The typical transmission mode is unknown; however, household clustering implies that it spreads primarily from person to person at a young age [8]. The prevalence rate varies among researchers; in the middle east and north Africa, the prevalence was 36.8–94% in adults [9], whereas in Taiwan, the prevalence of stool-antigen positive H. pylori infection in patients with dyspepsia was 37.9 [10]. The prevalence was lowest reported at Switzerland of about 18.9% and highest in Nigeria of About 87.7% [7].

In low-income countries, the illness was thought to infect people earlier than in industrialized nations [11]. According to recent data, the prevalence of H. pylori has decreased in Saudi Arabia during the last ten years (12). In Egypt, the illness is widespread in healthy, asymptomatic persons, in people of all ages (13-15). In Egyptian research, poverty, developmental problems, living in the periphery, and lower educational levels were all considered risk factors for H. pylori infection (14).

Several risk factors are tied to getting the infection, including social circumstances, economic status, educational level, overcrowding and hygiene practices, running water, sewage system, and consumption of fast food. This study uses a stool antigen test to evaluate the prevalence of Helicobacter pylori infection in a sample of people with different gastrointestinal complaints, and to assess certain risk factors linked to the infection.

Method and Materials

At Al Sadder Teaching Hospital in Misan, Iraq, cross-sectional observational research was conducted. Before being enrolled in the study, all subjects gave their written permission. The study was authorized by Misan Medical College's Ethical Committee.

Data Collection

From December 2018 to May 2020, 389 subjects aged 18 and above were recruited randomly for the research. Exclusion criteria include: use of proton pump inhibitor in the last 14 days, use of antibiotics in the last one month, lower gastrointestinal bleeding, and history of gastric surgery, pregnancy, chronic kidney disease and Heart failure. There were 225 females and 134 males in the research.

Before enrolling  in the study,  each subject pass through a simple randomization method, in which the individual had to choose a random paper from a basket; each paper had a written number from 1-10, and any subject who had an even number was enrolled in the study, and those with odd number excluded. A basic closed-ended questionnaire was then used to obtain data on the participant's age and gender, home location (urban vs. rural), educational background, and earnings. Then we provided each subject with a plain tube and sampling stick and asked them to collect a sample of their stool after teaching them how to collect. Then the samples were processed for evidence of H. pylori antigen using a quick antigen test-based immunoassay cassette. The test is a rapid, qualitative, one-step H. pylori card test used to detect helicobacter pylori in the stool.

Statistical Analysis

Microsoft Access and Excel were used to enter and match data, subsequently analyzed using IBM SPSS Statistics for Windows, version 26.0. The data was expressed using univariate and multivariate analysis with the mean, standard deviation, or frequency (percent). A p-value of 0.05 was declared statistically significant in the research.

Figure 1: Flowchart of the study



Women comprise 225 of the 389 participants in our research, while males make up 134. The participants are 36 (±16) years old on average. Two hundred ten people tested positive for H. pylori (54 %).

The participants' age, sex, residence, and educational qualification revealed no significant relationship with H. pylori infection. As indicated in table 1, there is a statistically significant (P value less than 0.05) link between H. pylori infection and income and junk food consumption.

Table 1: Prevalence and epidemiological characteristics of H. pylori infection in a sample of 389 of randomly selected subjects


H.pylori stool Ag test


Ag (+ve)

Ag (-ve)

Total number of subjects  (n = 389)

210 (54%)

179 (46%)


Age (mean ± standard deviation) years

37.8 ± 15

35.6 ± 17


Gender - n (%)

Women (n=255)

140 (54.9)

115 (45.1)


Men (n=134)

70 (52.2)

64 (47.8)

Residence - n (%)

Urban (n=288)

148 (51.4)

140 (48.6)


Rural (n=101)

62 (61.4)

39 (38.6)

Education - n (%)

Uneducated (n=142)

76 (53.5)

66 (46.5)


Primary (n=130)

74 (56.9)

56 (43.1)

Secondary (n=79)

42 (53.2)

37 (46.8)

College (n=38)

18 (47.4)

20 (52.6)

Income - n (%)

Low (n=141)

86 (61)

55 (39)


Average (n=210)

106 (50.5)

104 (49.5)

High (n=38)

18 (47.7)

20 (52.6)

Fast Food – n (%)

No fast food consumption (n=125)

57 (45.6)

68 (54.4)


Infreq. consumption  (n=91)

52 (57.1)

39 (42.9)

Freq. consumption (n=173)

101 (58.4)

72 (41.6)



Since first recognized more than a decade ago, infection with helicobacter pylori continues to be among the most common form of chronic infection Known to humankind [2]. Since then, Helicobacter pylori has been tied to many pathologies, and the list of diseases continues to expand [3,5,6], however the full range of implications is not entirely acknowledged.

The prevalence of positive H. pylori infection using stool antigen test was 54% among the participants of this study, which is lower than the expected figures reported in other parts of our country (67%) [12], and bordering countries [13,14]. This survey's lower prevalence might be attributed to a better standard of life, higher income, enhanced health awareness, and improved sanitation.

According to this study, the prevalence is slightly higher in women than in men (54.9 % vs. 52 %). Male predominance has been seen in numerous parts of the world, according to a recent meta-analysis of 184 research published in 2018 [15]. The higher prevalence of the infection among the women in our study might be due to cultural factors since women do most of the housekeeping and cooking, and food preparation.

Even though persons from rural areas had a greater frequency of H. pylori infection, the outcome was statistically insignificant (p-value 0.09). Many studies have found a link between where you live and the infection [16-18]. This might be due to inadequate sanitation, a lack of health knowledge, or water supply issues. The study found no link between educational attainment and the frequency of H. pylori infection (p-value 0.6). On the other hand, several studies suggest a link [19]. Our study's lack of a relationship might be due to limited sample size or increased public health awareness.

Our research found a statistically significant relationship between family and personal earnings and H. pylori infection (p-value 0.044). This finding has been confirmed in several investigations [19,20]. Overcrowding, sharing a bed, poor sanitation, and a lack of running water have all been associated with a greater risk of H. pylori infection in those with low income. The study also found a significant link between illness and fast food consumption (P-value 0.034), with daily out-of-door fast food intake being greater [21,22]. This link might be explained by improper food handling and person-to-person transfer.

There are many limitations to this study. First, our results are mainly based on a small sample size (389 individuals). These findings could be different if a more generous sample size or multicenter study were performed. Second, all individuals enrolled in this study are symptomatic. So the prevalence does not truly reflect the overall prevalence of H. pylori in the population since it does not include asymptomatic individuals. Another pitfall to be mentioned is that the test we use in this study is less sensitive and specific than the currently recommended ELIZA test or urea breath test. Our result may overestimate or underestimate the prevalence of the infection with H. pylori.


  1. pylori infection is common in our community (albeit slightly lower in our research) among people of all ages and genders. Several epidemiological and lifestyle factors appear to be crucial in disease transmission.


We appreciate the hospitality shown by all staff members in the main laboratory of Al-Sadr teaching hospital.



This research did not receive any specific grant from fundig agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions

All authors contributed to data analysis, drafting, and revising of the paper and agreed to be responsible for all the aspects of this work.


Conflict of Interest

There are no conflicts of interest in this study.



Omer Mansib Kassid

Ali Khalaf Raheem

Alaa Shamikh Hassan



Omer Mansib Kassid, Ali Khalaf Raheem, Alaa Shamikh Hassan. Prevalence and Risk Factors of Helicobacter Pylori Infection in Misan, Iraq: A Cross-Sectional Screening Study Using Stool Antigen Test. J. Med. Chem. Sci., 2022, 5(7) 1177-1182


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