PREVALENCE AND RISK FACTORS OF HELICOBACTER PYLORI AND INTESTINAL PROTOZOAL INFECTIONS AMONG SEWAGE WORKERS IN MANSOURA, EGYPT

Background: The occupational risks for sewage exposed workers for developing Helicobacter pylori and protozoal infections have received a little attention. Studies revealed that H. pylori organism discharged in stool and could be transmitted through contaminated water and consequently could present a significant health problem to sewage workers. Objective: to estimate the prevalence of H. pylori and protozoal infections and to assess the gastrointestinal symptoms and hematological profile among sewage workers. Also, to determine the risk factors of H. pylori infection.
Methods: A comparative cross sectional study was conducted for 60 workers working in Mansoura sewage treatment plant and maintenance of sewage collection system and 30 matched unexposed referents working as food handlers and supervisors in Mansoura University Hospitals. Demographic, occupational and gastrointestinal symptoms data
were collected. Also, laboratory procedures include, complete blood count, stool analysis and culture and detection of H. pylori antigen using immunochromatographic rapid assay were done. Results: The prevalence of H. pylori in sewage workers was 56.7% compared to 16.7% among the control group with highly statistically significant difference between both groups. Heartburn with or without epigastric pain was the only significant gastrointestinal symptoms among sewage workers (43.3%) compared to comparison group (20.0%). Prevalence of E. histolytica in both exposed and comparison groups were high (65% & 56.6%) respectively without statistically significant difference. Giardia Lamblia was more frequent in sewage workers (20.0%) than comparison workers (10.0%) without significant difference. Stool culture was negative for pathogenic organisms (Salmonella or Shigella) in both groups. The risk of H. pylori was significantly higher
among workers with poor compliance with personal protective equipment (PPE) (OR=3.00, 95%CI: 1.07-10.35), workers with duration of work > 20 years (OR=4.71, 95% CI: 1.10-20.20), workers older than 45 years (OR=4.27, 95%CI: 1.00-18.15) and low educated workers (OR=11.2, 95%CI:1.23-101.89). On logistic regression analysis, the independent predictors of H. pylori infection in sewage workers were low education (OR=43.35) and poor compliance with PPE (OR=5.21).Conclusion: H. pylori infection and heartburn with or without epigastric pain are significant health problems in the studied sewage workers. On logistic regression, low education and poor compliance with PPE were the significant predictors of H pylori infection in sewage workers.