Prevalence of and risk factors for Helicobacter pylori infection in children under 64 months in Thimphu, Bhutan, and introducing the new in-house immunochromatography test kit: a cross-sectional study

Background: Helicobacter pylori ( H. pylori) is a widespread childhood infection that persists throughout life and can later develop into serious gastric diseases including gastric cancer in adults. Unlike adults, children with H. pylori rarely present with abdominal symptoms but may experience extraintestinal manifestations that impact their growth and development. Given these manifestations, children require different screening, diagnosis, and treatment strategies, especially in countries with a high risk of gastric cancer. Accurate diagnosis is fundamental to the management and prevention of infection. Among non-invasive diagnostic test methods, the H. pylori stool antigen test is suitable for diagnosing H. pylori in young children. Despite the high prevalence of H. pylori infection in Bhutan, diagnostic resources remain limited. The study’s objective was to determine the prevalence and risk factors of H. pylori infection in Bhutanese children and test a new in-house immunochromatography test (the A-ICT) kit. Results: A total of 226 children (mean age 33.28 months) participated in the study. The A-ICT kit showed high concordance with the commercial kit (Kappa 0.84 [95% CI: 0.78–0.89]) and excellent sensitivity (0.96) and specificity (0.95). The prevalence of H. pylori was 19.5% (95% CI:14.95–24.83). Risk factors included increasing age, having two or more siblings, and fathers who worked in government or the private sector. Children who were fed with or who ate using a spoon had a significantly lower risk of H. pylori infection than those who were fed or ate with fingers (p < 0.05). Conclusions: The A-ICT kit demonstrated remarkable sensitivity and specificity. Given that the prevalence of H. pylori in young children is high, prevention programs must be intensified among young adults and children. Improvements in hygiene and sanitation related to child feeding practices are essential. Awareness programs should target large families and individuals employed in the formal sector, including both household and workplace settings. The validation of the A-ICT is a significant step toward a gastric cancer prevention program that facilitates early diagnosis and H. pylori eradication. The test kit is highly recommended for H. pylori screening and the confirmation of eradication post-treatment given its accuracy, rapidity, and simplicity in execution.