Awareness, attitude and practice of paediatricians in relation to helicobacter pylori infection diagnosis and management in Rwanda

Abstract

Background Helicobacter pylori infections (HPI) are a global public health problem, believed to cause more than 300,000 deaths each year. The prevalence is disproportionately higher in developing countries. In Rwanda, it is found in 80% of adult patients with gastritis at the University Teaching Hospital of Kigali. The infection starts during early childhood, making the utilization and adherence to evidence-based guidelines among paediatricians critical for diagnosis and management. This study explores the awareness attitudes and practice of paediatricians regarding the diagnosis and management of HPI in Rwanda. Methodology This was a descriptive cross-sectional study conducted from May to June 2022 in Rwanda. Among eighty registered paediatricians, 66 were recruited based on a simple random sampling approach. A self-administered questionnaire was distributed by the lead researcher. Data were analyzed using SPSS software and a p-value of ≤ 0.05 was considered significant. The study was approved by the institutional review board of the University of Rwanda. Results Among sixty-six recruited participants, 72.7% were male, 87.9% were general paediatricians, and 90.9% were primarily employed in the public sector. More than half (57.6%) initiate testing from 5-12 years of child’s age, 86.4% treat the infection after investigation and the most requested investigations were: stool antigen (90.6%), serology test (46.9%), and endoscopic exam (31.3%). Participants from public institutions were more likely to utilize stool antigen (90.0% vs 50.0%, OR: 1.800, p=0.006) and less likely to utilize serology tests (40.0% vs 83.3%, OR: 0.480, p=0.041). The majority (93.8%) supported that guideline-informed management would minimize diagnostic errors and promote the appropriate treatment. All participants and 93.1% respectively from the private and public sectors were in agreement with the role of guideline-informed management in quality care. Highlighted sources of information were medical journals (78.8%), internet sources (56.1%), and NASPGHAN (19.7%). All participants reported treating HPI with antibiotics plus proton-pump inhibitors. The antibiotics of choice were always amoxicillin plus either clarithromycin (59.1%) or another antibiotic (40.9%). Only 56.1% were adherent to a 14-day regimen prescription. Confirmation for eradication was by both clinical and control tests (12.1%) or by either alone (87.9%). Participants with the rank of consultant or beyond were more adherent to a 14-day antibiotic regimen than junior consultants (55.0% vs 26.9%, OR: 1.624, p=0.025). Participants with more than five years of experience were more likely to combine clinical and investigation tests to confirm eradication than their counterpart juniors who were more likely to utilize either alone (23.8% vs 6.7%, OR:1.225, p=0.047). Conclusions Rwandan paediatricians are aware of the current evidence on H. pylori and are willing to utilize evidence-based guidelines. The results express a need to institutionalize the existing evidence on HPI among the paediatric population and a need to promote continuous medical education for capacity building of the paediatricians. Where possible, hospitals should create and sustain the inter-facility agreement to utilize the existing minimum capacity, with the aim to serve the maximum number of patients, as stated by Sustainable Development Goal 17.