Why many children in Rwanda live with undiagnosed H. pylori infections

For weeks, Epiphanie Nyiransabimana watched her son struggle with persistent stomach pain that seemed to have no clear cause. Some days it was a dull ache lingering in his upper abdomen. On others, it became a burning sensation deep in his stomach—often worse late at night or early in the morning, when long hours without food made the discomfort sharper. Gradually, his appetite disappeared. He began refusing meals, saying his stomach hurt even before he had finished eating. Nausea followed, and at times vomiting deepened the family’s concern. “He kept telling me his stomach was hurting, and I could see it was not just normal pain,” Nyiransabimana recalls. “Sometimes he would wake up at night crying. Other times, he didn’t want to eat at all. That’s when I knew something was wrong.” Alarmed, she sought medical care at Masaka District Hospital. Tests confirmed that her son was infected with Helicobacter pylori (H. pylori), a bacterium that colonises the lining of the stomach. ALSO READ: H. pylori: A potent stomach enemy Widely recognised by clinicians as one of the leading causes of chronic gastric conditions in Rwanda, H. pylori is often acquired in childhood and can remain dormant for years before symptoms appear. For Nyiransabimana, the diagnosis was both a relief and a surprise. “I didn’t know children could suffer like this from H. pylori,” she says. “I thought it was something adults get. I didn’t imagine it could affect a child so badly.” Doctors say her experience reflects a much broader pattern quietly unfolding across Rwanda’s healthcare system. No age group is spared At the University Teaching Hospital of Kigali (CHUK), Dr Marie Solange Mukanumviye from the Department of Gastroenterology and Hepatology describes H. pylori as one of the most frequently detected infections in stomach-related investigations. “H. pylori infection is very common in our setting, and symptoms vary widely,” she says. “Some patients have no symptoms at all, while others present with abdominal pain, vomiting, anaemia, or black stools, which indicate bleeding from the stomach or duodenum.” She adds that complications are not uncommon. “We see gastric and duodenal ulcers, loss of appetite, and significant weight loss, which can make daily life extremely difficult.” Crucially, she stresses that age offers no protection. “Children, adults, and the elderly can all get H. pylori. There is no group that is spared,” Dr Mukanumviye says. “The bacteria spreads mainly through contaminated food or water and poor hygiene during food preparation—conditions that are still common in many households.” ALSO READ: Infections: What causes anti-microbial resistance? An infection often acquired in childhood Dr Patrick Shumbusho, a gastroenterologist and hepatologist at Rwanda Military Hospital (RMH) in Kanombe, notes that most patients are unaware of when they first acquired the infection. “Most people become infected during childhood, especially in overcrowded households with poor sanitation,” he explains. “Unsafe water, poor hygiene, and sharing utensils significantly increase the risk.” In his daily practice, the infection is a familiar diagnosis. “On an average day, I see about forty patients, and roughly five may have H. pylori,” he says. “It’s not an exact figure, but it reflects how widespread the infection is.” Dr Shumbusho explains that the bacterium is primarily spread through the faecal–oral route. “If someone doesn’t wash their hands properly after using the toilet, they can easily transmit H. pylori to others,” he says. “Contaminated food and water are also major sources.” Overcrowding further compounds the risk. In close living conditions, infections can spread rapidly within households, meaning that when one child is infected, siblings and adults are often exposed as well. Diagnosing H. pylori: what works—and what doesn’t Accurate diagnosis is critical, yet not all testing methods are equally reliable. At Cerba Lancet Rwanda, laboratory manager Valens Karenzi says stool antigen testing has become the standard for detecting active H. pylori infection. “Stool antigen tests are very accurate. They confirm whether a patient is currently infected and whether treatment has worked,” Karenzi says. “Blood antibody tests cannot distinguish between past and current infection, which makes them unsuitable for confirming cure.” ALSO READ: What you need to know about viral infections In more complex cases, endoscopy with biopsy allows doctors to detect the bacteria directly and assess complications such as ulcers. Karenzi adds that advanced diagnostic tools, including PCR testing to identify antibiotic resistance, are available only in select laboratories. “These methods require specialised equipment and trained personnel,” he says. “If testing is inaccurate, it can affect treatment outcomes and contribute to antibiotic resistance. That’s why follow-up testing after treatment is so important.” Treatment available, adherence remains a challenge Although H. pylori can be treated successfully, Dr Mukanumviye says adherence to treatment remains one of the biggest obstacles. “Treatment involves two antibiotics and an acid-reducing drug taken over several weeks,” she explains. “Many patients stop medication once they start feeling better.” Others discontinue treatment due to side effects such as nausea, bloating, or stomach discomfort. “When treatment is stopped early, the bacteria may survive and develop resistance, making future treatment much more difficult,” she warns. System-level challenges also play a role. “At lower-level facilities, some healthcare providers may not prescribe the correct drug combinations or duration,” Dr Mukanumviye says. “Incomplete treatment contributes to failure.” Studies show that about 20 per cent of patients do not respond to standard therapy—an early warning sign of growing antibiotic resistance. ALSO READ: Increased antibiotic misuse a ticking time bomb Hygiene as the first line of defence Prevention, experts agree, hinges largely on hygiene and sanitation. “Proper handwashing, clean water, and hygienic food preparation are critical,” Dr Shumbusho says. “Overcrowding increases risk, and one infected household member can easily spread the bacteria if hygiene is poor.” Karenzi emphasises the importance of public awareness and long-term monitoring. “Even after successful treatment, reinfection is possible if hygiene conditions don’t improve,” he says. “Accurate diagnosis, proper treatment, and follow-up are essential to reducing H. pylori’s burden.” Antibiotic resistance and repeat infections Antibiotic resistance is an increasing concern. Dr Mukanumviye says about one in five patients fails initial treatment. “When a patient tests positive after treatment, we consider resistance—but reinfection is also possible,” she says. “That’s why completing treatment and maintaining hygiene are both critical.” Karenzi adds that testing accuracy plays a key role in managing resistance. ALSO READ: Centre of excellence for highly infectious diseases under construction “Inaccurate testing can lead to unnecessary repeat treatments, which only worsens resistance,” he says. “Confirming eradication after treatment is essential.” Cancer risk: real, but limited While H. pylori is a recognised risk factor for gastric cancer, Dr Shumbusho urges caution against alarm. “Less than one per cent of infected individuals develop gastric cancer,” he says. “The infection alone doesn’t cause cancer. Multiple risk factors must align. Early detection and treatment significantly reduce long-term risk.” Lessons learned For Nyiransabimana, her son’s recovery underscored an important lesson. “After treatment, his pain disappeared, his appetite returned, and his energy came back,” she says. “I learned that stomach pain should never be ignored. If it keeps coming back, you need proper testing and to follow treatment carefully.” Her experience mirrors that of many families across Rwanda navigating an infection that is widespread but often overlooked. “H. pylori is common, but it is not harmless,” Dr Mukanumviye says. “With accurate diagnosis, complete treatment, and good hygiene, it can be managed effectively. But it deserves attention.” Future trends and projections Recent epidemiological data suggest that H. pylori remains highly prevalent across Rwanda, particularly in densely populated and rural areas. Studies indicate that up to 50 per cent of children may be exposed by age ten, driven largely by household hygiene, water quality, and overcrowding. ALSO READ: Amoxicillin: Should doctors in Rwanda prescribe it amid falling efficacy? Experts warn that without improvements in sanitation and sustained public health campaigns, infection rates could remain steady—or even rise—in high-risk communities. Health authorities are now closely monitoring antibiotic resistance patterns, as repeated treatment failures could complicate long-term management. Projections suggest that proactive interventions—including nationwide hygiene campaigns, early diagnosis, and structured follow-up care—could reduce H. pylori prevalence and related complications by 15–20 per cent over the next five years, easing the burden of stomach-related disease among both children and adults.

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Why many children in Rwanda live with undiagnosed H. pylori infections