PEPTIC ULCER PREVALENCE AMONG PATIENT ATTENDING

KAMPALA INTERNATIONAL UNIVERSITY TEACHING

HOSPITAL IN ISHAKA BUSHENYI MUNICIPALITY

BY

NAMUGERWA JULIANA

DCM /0020/143/DU

A RESEARCH REPORT SUBMITTED TO SCHOOL OF ALLIED

HEALTH SCIENCES IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE AWARD

OF DIPLOMA IN CLINCAL MEDICINE

AND COMMUNITY HEALTH AT

KAMPALA INTERNATIONAL

UNIVERSITY

JUNE, 2017

DECLARATION

I, Namugerwa Juliana (REG. No: DCM/ / /DU) declare that this thesis is my own work and

that all the sources that I have used or quoted have been indicated and acknowledged by mean of

complete reference.

SIGNATURE………………………..

DATE…………………………………

SUPERVISOR’S APPROVAL

This research proposal/report has been done under my supervision and is ready to be submitted

for examination with my approval.

SUPERVISOR: MR. TASHOBYA DANIEL KAMUGISHA

Signature………………………………

Date……………………………………

ACKNOWLEDGEMENT

First and foremost I am thankful to the almighty God for the gift of life and good heath that has

enabled me to reach this far in my studies and work as well.

Special appreciation to my research supervisor Mr. Tashobya Daniel Kamugisha for all the help

and guidance he has accorded me throughout my research and without whose efforts this work

would be in vain.

My sincere gratitude also goes to the entire academic staff, School of Allied Health Sciences

(SAHS), Kampala International University- Western Campus, for their coordinated effort and

commitment to ensure that we acquire necessary competences both in class and in the field.

I do extend my infinite gratitude to my …family members (name

them)………………………………whose prayers, moral, social and financial support has

brought me this far.

Last but not least, I extend my special thanks to all my classmates 14 series for the

encouragement during the course of our study.

Thank you all so much.

DEDICATION

The research is dedicated to my family members, all my friends and more importantly to my

supervisor Mr. Tashobya DanielKamugisha for his kindness, generosity and guidance. I

appreciate every little contribution every one of you rendered towards this research report. Am

humbled and God bless you all.

TABLE OF CONTENTS

SUPERVISOR’S APPROVAL ........................................................................................................................ 3

ABBREVIATIONS AND ACRONYMS ........................................................................................................... 8

ABSTRACT. ............................................................................................................................................ 10

CHAPTER ONE ....................................................................................................................................... 11

1.0 INTRODUCTION ....................................................................................................................... 11

1.1 BACKGROUND ......................................................................................................................... 11

1.2 PROBLEM STATEMENT .......................................................................................................... 12

1.3 OBJECTIVES ............................................................................................................................. 13

1.3.1 Broad objective ..................................................................................................................... 13

1.3.2 Specific objectives ................................................................................................................ 13

1.4 Research questions ....................................................................................................................... 13

1.5 STUDY JUSTIFICATION........................................................................................................... 13

1.6 SCOPE OF THE STUDY ............................................................................................................ 13

1.6.1 Geographical scope ............................................................................................................... 13

1.6.2 Content scope........................................................................................................................ 14

1.6.3 Time scope. ........................................................................................................................... 14

CHAPTER TWO ...................................................................................................................................... 15

LITERATURE REVIEW.............................................................................................................................. 15

2.0 INTRODUCTION ....................................................................................................................... 15

2.1 EPIDEMIOLOGY OF PUD ......................................................................................................... 15

2.2 GENDER DISTRIBUTION ......................................................................................................... 17

2.3 AGE DISTRIBUTION. ............................................................................................................... 18

CHAPTER THREE .................................................................................................................................... 18

METHODOLOGY .................................................................................................................................... 19

3.0 Introduction ................................................................................................................................. 19

3.1 Study Design ............................................................................................................................... 19

3.2 Study Area ................................................................................................................................... 19

3.3 Study Population.......................................................................................................................... 20

3.4 Sample Size ................................................................................................................................. 20

3.5 Sampling Method......................................................................................................................... 21

3.6 Inclusion Criteria ......................................................................................................................... 21

3.6.1 Exclusion criteria .................................................................................................................. 21

3.7 Ethical considerations .......................................................................................................... 21

3.8 Data collection ...................................................................................................................... 21

3.9 Data analysis and presentation ..................................................................................................... 21

3.10 Study Limitations ....................................................................................................................... 21

CHAPTER FOUR ..................................................................................................................................... 22

STUDY FINDINGS ................................................................................................................................... 22

4.0 Introduction ................................................................................................................................. 22

4.1 Socio-demographic characteristics ............................................................................................... 22

4.2 Clinical presentation .................................................................................................................... 22

4.3 Respondents’ gender distribution ................................................................................................. 22

4.4 Respondents’ age distribution ...................................................................................................... 23

4.5 Diagnosis of PUD ........................................................................................................................ 24

4.6 PUD specific gender distribution .................................................................................................. 24

4.7 PUD specific age distribution. ...................................................................................................... 25

4.8 PUD main symptoms. .................................................................................................................. 25

CHAPTER FIVE........................................................................................................................................ 27

DISCUSSION........................................................................................................................................... 27

5.0 Introduction ................................................................................................................................. 27

5.1 Prevalence of PUD ....................................................................................................................... 27

5.2 PUD gender distribution .............................................................................................................. 27

5.3 PUD age distribution ................................................................................................................... 27

5.4 Conclusion................................................................................................................................... 28

5.5 Recommendations........................................................................................................................ 28

REFERENCES .......................................................................................................................................... 29

APPENDIX: III ................................................................................................................................. 35

ABBREVIATIONS AND ACRONYMS

CDC Centers for Disease Control

DU Duodenal Ulcer

EGD Esophagogastroduodenoscopy

GERD Gastroesophageal Reflux Disease

GU Gastric Ulcer

H.Pylori Helicobacter pylori

KIU-TH Kampala International University-Teaching Hospital

KIU-WC Kampala International University-Western Campus

MCH Maternal Child Health

NSAIDs Non SteroidalAnti inflammatory Drugs

PPI Proton Pump Inhibitor

PUD Peptic Ulcer Disease

ABSTRACT.

The study assessed the prevalence of peptic ulcer disease among patients attending of Kampala

International University Teaching Hospital and the objectives of study were to find out the

gender distribution of peptic ulcer disease and to find out which age group is more affected by

peptic ulcer disease among patients attending of Kampala International University Teaching

Hospital

It was a retrospective study in which quantitative methods were used to collect data from the

patients and later described, compared and analyzed different variables

The study found out that PUD is highly prevalent among patients attending KIUTH (14.8%) and

is highest among the middle age group of 31-40 years (32.7%), with females (66.7%) being more

affected than males (33.3%).

In conclusion, although some interventions have been put in place to manage PUD, its

prevalence is still high and more interventions are required therefore the following were the

recommendations made after the study, Community sensitization on causes of PUD should be

enforced at hospitals and also better diagnostic techniques should be used for early diagnosis of

PUD

CHAPTER ONE

1.0 INTRODUCTION

This chapter will contain background of the study, problem statement, study objectives, study

questions and justification of the study and scope of the study.

1.1 BACKGROUND

Ulceration of the Gastric or Duodenal mucosa occurs in many individuals. The term peptic ulcer

disease includes both the gastric and duodenal ulcers. Among the mechanisms that may

contribute to ulcer formation are diminished effectiveness of the gastric mucosal barriers, hyper

secretion of acid, and infection by Helicobacter pylori bacteria.

PUD is a common disorder that affects millions of individuals in the United States each year.

Peptic ulcer disease has a major impact on our health care system by accounting for roughly 10%

of medical costs for digestive diseases (WHO, 2003). In the last two decades, major advances

have been made in the understanding of the pathophysiology of peptic ulcer disease, particularly

regarding the role of Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs).

This has led to important changes in diagnostic and treatment strategies, with potential for

improving the clinical outcome and for decreasing health care costs (CDC, 2006)

The geographical distribution of a disease may provide valuable clues with regard to its

aetiology. Likewise any historical changes in prevalence, associated with changes in the mode of

living, may give additional information.

The worldwide ulcer prevalence differs, with duodenal ulcers dominating in Western populations

and gastric ulcers being more frequent in Asia, especially in Japan (Park et al, 2011). Although

the incidence of peptic ulcer disease in Western countries has declined over the past 100 years,

around 1 in 10 Americans are still affected (Dwayne et al, 2010). The annual financial burden of

peptic ulcer disease in the US, including direct and indirect costs, is estimated as US$3.4 billion

(CDC, 2010). Since peptic ulcer disease is still common, and peaks in the elderly, it is expected

that its impact on human health and health economics will remain an important issue in the

future.

Tovey&Tunstall, (2005)have shown that there is a definite geographical pattern to the

distribution of duodenal ulcer in sub‐Saharan Africa, with a high incidence being reported in the

Nile/Congo watershed and coastal regions of West Africa. High incidence rates of duodenal

ulcer have also been reported in a number of major cities of Africa (Johannesburg, Durban,

(Robbs&Moshal, 2009)Nairobi, and Mombasa) (Tovey&Tunstall, 2005). In a recent study by

Kidd et al, (2009) 26% of patients with dyspepsia had DU, and of these H. pylori was present in

90%.

Gastric ulcer is uncommon in Africa, occurring 6–30 times less commonly than DU

(Tovey&Tunstall, 2005). In developed nations, the ratio of DU:GU is between 3:1 and 4:1. In

Africa, a wide range of DU:GU ratios has been reported varying from 3:1 to 15–20:1 (Mohamed

et al, 2010). A retrospective endoscopic review of dyspeptic patients from 12 African countries

found that 7% had GU, and that H. pylori was present in 75% of these patients (Kidd et al,

2009).

1.2 PROBLEM STATEMENT

In Africa, the highest prevalence was reported to be in the great lakes region, (Borin et al, 2004),

where duodenal ulcer surgery forms the major part of all abdominal surgery.

The area includes Rwanda and Burundi, eastern DRC around Lake Kivu, extreme western

Tanzania adjacent to Burundi, and south-western Uganda (Taylor, 1965), where Bushenyi

district, Kampala International University teaching Hospital (KIUTH) in particular are located.

In Uganda, PUD prevalence is estimated to range between 12% and 25% (UBOS, 2010).

PUD is common in developing countries in general and Uganda in particular (Opoiet al, 2009).

There is a higher prevalence of Helicobacter pylori infection (MoH, 2006). There are many

difficult problems to overcome in trying to establish the prevalence of a disease with a low

mortality such as PUD. These problems are considerable in developed countries and much

greater in developing countries.

Despite the scarcity of recent accurate data on prevalence and the reported increase in PUD cases

in Uganda, (MOH, 2006) many health facilities including hospitals are without x-ray facilities.

Surgical statistics can be selective and misleading. As a result, very little has been done to

document the prevalence of PUD in various populations including the predictors for

susceptibility.

There this study on prevalence of peptic ulcer disease among patients attending KIUTH will

bridge the existing information gap.

1.3 OBJECTIVES

1.3.1 Broad objective

i. To estabish the prevalence of peptic ulcer disease among patients attending of Kampala

International University Teaching Hospital.

1.3.2 Specific objectives

This includes the following;

1. To find out the gender distribution of peptic ulcer disease among patients attending

Kampala International University Teaching Hospital

2. To find out which age group is more affected by peptic ulcer disease among patients

attending of Kampala International University Teaching Hospital.

1.4 Research questions

1. What is the gender distribution of peptic ulcer disease among patients attending

Kampala International University Teaching Hospital?

2. Which age group is most affected by peptic ulcer disease among patients attending of

Kampala International University Teaching Hospital

1.5 STUDY JUSTIFICATION

This study wasdesigned to determine the prevalence of PUD among patients of KIUTH so that

the prevalence & predictors are better documented in the study population. This study is

therefore expected to contribute to the building of the much needed data on prevalence of PUD.

1.6 SCOPE OF THE STUDY

1.6.1 Geographical scope

The study was meant to find the prevalence of PUD among patients who attended KIUTH during

the months of April 2017 to May 2017.

1.6.2 Content scope

PUD which is Ulceration of gastro-duodenal mucosa tends to be chronic and recurrent if

untreated, caused by Helicobacter pylori infection and hyperacidity due to drugs (NSAIDS e.g.

acetylsalicylic acid, corticosteroids), irregular meals among others. It is characterized by

epigastric pain typically worse at night and when hungry(duodenal ulcer) alleviated by food,

milk, or antacid, epigastric pain, worse with food (gastric ulcer), vomiting, nausea, regurgitation

and discomfort on palpation of the upper abdomen

1.6.3 Time scope.

The study was meant to be conducted from March 2017 to June 2017

CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

This chapter reviews the available literature about PUD, epidemiology and gender differences

and its distribution between rural and urban areas

2.1 EPIDEMIOLOGY OF PUD

The lifetime risk for developing a peptic ulcer is approximately 10% (Hein et al, 2007).

Globally, as of 2010, approximately 250,000 people died of peptic ulcer disease down from

320,000 in 1990 (Kang et al, 2011)

In Western countries the prevalence of Helicobacter pylori infections roughly matches age (i.e.,

20% at age 20, 30% at age 30, 80% at age 80). Prevalence is higher in third world countries

where it is estimated at about 70% of the population, whereas developed countries show a

maximum of 40% ratio. Overall, H. pylori infections show a worldwide decrease, more so in

developed countries. Transmission is by food, contaminated groundwater, and through human

saliva (such as from kissing or sharing food utensils) (Thomson et al, 2003).

Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of

the 20th century, when epidemiological trends started to point to an impressive fall in its

incidence (Kaltz et al, 2008). The reason that the rates of peptic ulcer disease decreased is

thought to be the development of new effective medication and acid suppressants and the

discovery of the cause of the condition, H. pylori.

In the United States about 4 million people have active peptic ulcers and about 350,000 new

cases are diagnosed each year. Four times as many duodenal ulcers as gastric ulcers are

diagnosed. Approximately 3,000 deaths per year in the United States are due to duodenal ulcer

and 3,000 to gastric ulcer (Jeffers et al, 2009). The literature on the epidemiology of PUD shows

that PUD remains a relatively common condition worldwide, with annual incidence ranging from

0.10% to 0.19% for physician-diagnosed PUD and from 0.03% to 0.17% for PUD diagnosed

during hospitalization. The 1-year prevalence of physician diagnosed PUD was 0.12–1.5%, and

the 1-year prevalence of PUD diagnosed during hospitalizations was 0.10–0.19%.

The data show that the incidence of PUD has decreased over recent decades in many countries,

most likely as a result of the decrease in H. pylori infection, particularly in Western populations.

However, it is possible that the situation may be different in Asian countries; a recent study in

Korea revealed that the prevalence of H. pylori infection in association with GU was increasing

with time, whereas H. pylori infection in DU was decreasing (Jang et al, 2008). Further work is

required to confirm if the results of this study can be extrapolated to the Asian population in

general.

The most reliable study of physician-diagnosed prevalence was from Sweden, reporting cross-

sectional data representative of the general population (Aro et al, 2006) the study thus included

both symptomatic and asymptomatic PUD. The overall prevalence of PUD observed in this study

was 4.1%; 19.5% of all PUD cases identified were asymptomatic. Comparing this prevalence

with the lower rates obtained from other studies of physician-diagnosed PUD in primary care

suggests that a proportion of individuals with PUD remain undiagnosed. In individuals with

asymptomatic PUD, severe complications, such as gastrointestinal haemorrhage, may be the first

signs of the disease. Haemorrhage is associated with mortality approaching 10% and high

recurrence (Christensen et al, 2007). This is particularly relevant for elderly patients who are less

likely to have symptoms, possibly because of the analgesic effects of ASA and NSAIDs.

Overall, a review of the literature shows that the reported incidence and prevalence of PUD have

decreased over time in recent decades. However, temporal trends in the rate of hospitalizations

for complications of PUD varied in studies, remaining unchanged or increasing in recent decades

in two studies in Finland and the Netherlands, (Post et al, 2006) but declining over time in one

study in Scotland (Kang et al, 2006).

Management of PUD has improved substantially following the introduction of PPIs and therapy

for H. pylori eradication. This is reflected in the decrease in prevalence of H. pylori-associated

PUD, the change in the proportion of H. pylori-positive PUD, and the lower proportion of H.

pylori infection, particularly in complicated PUD. The continued occurrence of PUD is probably

due, at least in part, to the widespread use of low-dose ASA and NSAIDs, especially in Western

countries and among older patients and those with comorbidities. Use of these medications may

also explain why the rate of hospitalizations for PUD complications has not decreased in some

studies (Post et al, 2006) and the general lack in reduction of mortality from PUD bleeding

(Thomopoulos et al, 2004). Use of traditional NSAIDs in Western countries has increased since

the withdrawal of some cyclooxygenase-2-selective inhibitors and PPIs have been shown to

produce a marked and consistent reduction in the risk of gastrointestinal symptoms in patients

receiving NSAIDs and non-ASA anti-platelet agents (Goldstein et al, 2006). The common

occurrence of PUD in users of NSAID or low-dose ASA, despite wide availability of guidelines

on the use of gastroprotective agents in NSAID users, is likely to be due to incomplete

application of these guidelines in clinical practice and incomplete adherence of patients to

prescribed gastroprotective medication (Van Soest et al, 2007)

Our review has several strengths, including the wide and comprehensive set of data identified

and the focus on publications from the last decade or so, which provides an update on current

status. Limitations include a lack of capture in most studies of asymptomatic patients with PUD

and the range of methodologies used in the publications identified, including the different

definitions of peptic ulcer used by the different studies. Also, the secondary care studies may

miss a large number of PUD patients, especially if they only counted the number of inpatients.

In terms of future work, an estimate of the global population prevalence of symptomatic as well

as asymptomatic PUD, including the associated risk symptoms and potential risk factors, would

yield important information on burden of the disease and aid its management. Such data,

although scarce, are available from Europe, whereas similar data from Asia are still lacking.

2.2 GENDER DISTRIBUTION

In the United Kingdom the incidence of peptic ulcers in men has fallen in recent years and in

2007 the sex ratio (male: female) was only 19:1.126 (Cole, 2005). In India the ratio of male to

female in 11 reported series was as high as 17.6:1 (range 9:1 to 33:1). In the high-incidence areas

of black Africa the ratio (male: female) in 18 reported series is 9:1 (range 2 1:1 to 30:0). In

addition 25 out of 26 replies from these areas in response to enquiries,in which the sex

distribution is specifically mentioned, say that male patients greatly predominate without giving

exact figures (Almer et al, 2004)

In developing countries men tend to come to hospital more readily than women (although in

India many hospitals were founded specifically for women and still admit a greater percentage of

females), but even allowing for this tendency the marked male predominance is probably real.

2.3 AGE DISTRIBUTION.

In the United Kingdom the peak age incidence at present is between 45 and 55 years. the reports

from East Africa give the peak age as a decade earlier. The mean peak age of six published

reports from Uganda is 34 years and in 22 replies to their enquiries from the same area the mean

peak age is 25.Many reports mention the occurrence of duodenal ulcer in teenagers, not

infrequently associated with pyloric stenosis. (Kang JY, 2011).

A study by Aro P, Storskrubb T, Ronkainen et al in 2006on prevalence of PUD among the

nomadic pastolists of Ethiopia , in which 800 participants were recruited found out that PUD was

3.4 % higher in young adult women above 30 to 35 years than in eldery and adolescents parts,

similary the young adult men of above had a higher prevalence at 0.8 % PUD prevalence higher

in eldery men and adolscents.

CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter included the study area, study population, sample size determination, sampling

technique, study variables, data collection tools, data analysis and presentation, sample size

determination, ethical considerations and limitations.

3.1 Study Design

A retrospective study was carried out to determine the prevalence of peptic ulcer disease among

patients attending KIUTH. Quantitative methods will be used to collect data from the patients

and later described, compared and analyze different variables.

3.2 Study Area

Kampala International University's Western Campus [KIU-WC] is situated on about 70 acres of

land at Ishaka town in Bushenyi District, along Mbarara –Kasese Road in Western Uganda. This

spacious campus was opened in November 2004. The School Allied of Health Sciences [SAHS]

is located at the KIU-WC. It offers a number of courses in bachelors, diplomas and certificates.

The presence of the university has strongly led to the development of various businesses in

Ishaka town, with the students and staff of the university comprising of the major clientele of

these businesses. Businesses range from boutiques, restaurants, supermarkets, bars, and night

clubs.

Bushenyi District is one of the oldest districts in Uganda. It was created in 1974, curved out of

Mbarara District Administration then. In 2009, it was split into five districts (4 new districts of

Buhweju, Mitooma, Sheema and Rubirizi districts) with one new Municipal Council of

Bushenyi- Ishaka. This has drastically reduced the size of Bushenyi District from five counties to

one of Igara that includes the municipality. Bushenyi District lies between 0 0 N and 0 0 46’ S of

the equator and 29 0 41’ East and 30 0 30’ East of Greenwich.

Bushenyi District headquarters is located 340 kms from Kampala in the South Western part of

Uganda. Bushenyi District is neighboring with the districts of Rubirizi in theNorth, Buhweju and

Sheema in the North East, Sheema in the East, Mitooma in the South West and Sheema in the

South. The district has a land area of 3’949 square kilometers and lying between 910 – 2,500

meters above sea level. The main physical features within the district include natural tropical

forests of Karinzu and Imaramagambo covering an area of 784 km. Arable land covers 2,215

square kms, open water bodies cover 372 square kms and wetlands covering 183 square kms.

Bushenyi District has a population of 241,500 people made up of 117,000 males and 124,000

according to the projected population estimates of 2010.

The economy of the district depends mainly on agriculture. Agriculture is a source of food for

the population, subsistence income for most families, and provides direct employment to 86.7%

of the district population, as well as supplying raw materials for industries.

3.3 Study Population

KIUTH serves a population of about 252000 people from districts of Ankole sub region and

neighboring area but the target population study was patients attending KIUTH from the month

of May to June 2017.

3.4 Sample Size

To get the sample size, fisher’s statistical formula was used,

n=Z2 PQ

D2

Where n= desired sample size

Z= standard deviation at the desired degree of accuracy which was 1.96

P= proportion of target population estimated to have the same characteristics, therefore p

was taken to be 50% (constant) or 0.5

Q= 1-P

D= degree of error

N= (1.96)2 X 0.5 X (1-0.5)/0.052

=3.8416 X 0.5 X (0.5)/0.0025

= 0.9604/0.0025

=384.16

n = 384.16

3.5 Sampling Method

Simple random sampling method was used for this study where by one respondent was randomly

selected and a process repeated upto when a desired sample size was obtainsed.

3.6 Inclusion Criteria

Current patients attending KIUTH were the target for this study

3.6.1 Exclusion criteria

Patients who declined to consent for the study

Patients who were severely ill and needed urgent medical attention

3.7 Ethical considerations

i. An introductory letter was sought from the SAHS administrator.

ii. All results were treated with utmost confidentiality by ensuring that only authorized

people have access to them.

3.8 Data collection

A data was got from the KIUTH records within the months of April 2017 to May 2017.

3.9 Data analysis and presentation

Data was analyzed using simple calculators, windows Excel-2007, and presented in form of

tables, graphs and charts.

3.10 Study Limitations

The following limitations will be encountered during the study;

Poor recording keeping hence limited data available

Some patients were not willing to give some important information during the study.

CHAPTER FOUR

STUDY FINDINGS

4.0 Introduction

This chapter consists of findings from the study on social demographic characteristics,

prevalence of PUD, PUD diagnosis, gender and age distribution.

Out of 385 patients records whose record was reviewed presented with peptic ulcer disease

(PUD) during the study period, 6 patients underwent emergency laparotomy for perforated peptic

ulcers.

4.1 Socio-demographic characteristics

Of the total record reviewed 151 (39.2%) were males and females were 234 (60.8%). The

patient's age ranged from 12 to 72 years with a median of 32.4 years. The peak incidence was in

the 4th decade (31-40 years).

4.2 Clinical presentation

The duration of symptoms ranged from 1 to 12 days with a mean duration of 6.5 ± 2.3days. The

median was 5.8 days. 28.6% presented within twenty-four hours of onset of symptoms, 29.8%

between 24 and 48 hours and 35.7% over 48 hours afterwards. The commonest presenting

symptoms were sudden onset of severe epigastric pain in 97.6%, abdominal distention in 76.2%

and vomiting in 36.9% PUD patients.

4.3 Respondents’ gender distribution

FIGURE 1: GENDER DISTRIBUTION

60.8% of the patients were female and 39.2% were males

4.4 Respondents’ age distribution

FIGURE 2:AGE DISTRIBUTION OF PUD

In this case, the majority of the patients were between the ages of 31-40 (32.7%) followed by 21-

30 (20.3%) likewise above 60 (15.8%) in that order and the least being between the ages of 11-

20(5.5%).

60.8%

39.2%Female

Male

5.5%

20.3%

32.7%12.7%

13.0%

15.8% 11 to 20

21-30

31-40

41-50

51-60

above 60

4.5 Diagnosis of PUD

FIGURE 3: PUD DIAGNOSIS

For this case, those who were found to have PUD were 14.8% and those without PUD were

85.2%

4.6 PUD specific gender distribution

4: GENDER SPECIFIC DISTRIBUTION OF PUD (n=57)

66.7% of PUD were found in females and 33.3% of PUD found in males.

14.8%

85.2%

PUD

NO PUD

66.7%

33.3%

FEMALE

MALE

4.7 PUD specific age distribution.

FIGURE 5: AGE SPECIFIC DISTRIBUTION OF PUD

This shows that the age specific distribution of PUD is higher in the age group between 31-40,

followed by 51-60 in that order and the least affected age group being between 11-20.

4.8 PUD main symptoms.

FIGURE 6: MAIN PRESENTING SYMPTOMS

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

11 to 20 21-30 31-40 41-50 51-60 above60

5.3%

10.5%

33.3%

8.8%

22.8%19.3%

97.6%

76.2%

36.9%Sudden severeepigastric pain

Abdominaldistension

Vomiting

The main presenting symptoms were sudden severe epigastric pain (97.6%) followed by

abdominal distension (76.2%) and finally vomiting (36.9%).

CHAPTER FIVE

DISCUSSION

5.0 Introduction

This chapter consists of the discussion of the study findings which include the prevalence of

PUD, gender and age distribution among patients who were attending KIUTH during the period

of study

5.1 Prevalence of PUD

In this review, a total of 57 (14.8%) patients were found to have been diagnosed with PUD. This

figure is similar to what was reported by Schein et al 2007. In their study, 15.1% of the patients

were reported to have been diagnosed with PUD. Mienyet al 2006 in South Africa reported a low

incidence of PUD. They reported a 6.3 prevalence of PUD in their study population. These

differences reflect differences in the rate of risk factors for perforated peptic ulcer disease from

one country to another. The figures in our study may actually be an underestimate and the

magnitude of the problem may not be apparent because of high number of patients excluded

from this study.

5.2 PUD gender distribution

In the present study, peptic ulcer disease were found to be most common in the fourth decade of

life and tended to affect more females (66.7%) than males (33.3%). This finding is however not

comparable with other studies in developing countries. For example Opolot et al, 2004 reported a

59.2% prevalence of PUD among males and 40.8% in females. Similarly Camara et al, 2009 in

their study of PUD among a Senegalese rural population found a higher PUD prevalence among

male (61.4%).

5.3 PUD age distribution

PUD predominance in this age group (31-40) could be attributed to excessive alcohol

consumption and smoking which is common in the study environment. Alcohol consumption and

smoking have been reported to be associated with increased risk for peptic ulcer. Alcohol, as a

noxious agent causes gastric mucosal damage, stimulates acid secretion and increases serum

gastrin levels (Ray et al, 2003) and smoking inhibits pancreatic bicarbonate secretion, resulting

in increased acidity in the duodenal bulb. It also inhibits the healing of duodenal ulcers (CDC,

2006).

These study findings are in agreement with a study by Kang JY in 2011 whereby in the United

Kingdom the peak age incidence at present is between 45 and 55 years. the reports from East

Africa give the peak age as a decade earlier. The mean peak age of six published reports from

Uganda is 34 years and in 22 replies to their enquiries from the same area the mean peak age is

25.Many reports mention the occurrence of duodenal ulcer in teenagers, not infrequently

associated with pyloric stenosis.

The result indicates that the rate of H. pylori infection in patients with peptic ulcers ranges from

50%-80% and H. pylori infection, as a risk factor for PUD, appears to be more relevant in

younger patients (Geogezet al, 2010).

This is in sharp contrast to Nuhuet al, 2008 in Nigeria who reported that 71% of cases had

previous history of peptic ulcer disease. It has been reported that in many developing countries,

the diagnosis of PUD is first made in many instances after perforation (Freyers et al, 2004). The

present study confirms this observation because more than sixty percent of the patients with

perforation were not diagnosed previously as cases of PUD and therefore were not on treatment.

Patients with no previous diagnosis of peptic ulcer have a higher risk of PUD perforation than

patients with a known history of ulcer disease. This may be because preventative measures are

more likely to have been taken in patients with a known history of ulcer. Furthermore, these

patients are perhaps more likely to seek treatment earlier.

5.4 Conclusion

PUD is highly prevalent among patients attending KIUTH (14.8%) and is highest among the

middle age group of 31-40 years (32.7%), with females (66.7%) being more affected than males

(33.3%).

5.5 Recommendations

i. Community sensitization on causes of PUD should be enforced at hospitals.

ii. Better diagnostic techniques should be used for early diagnosis of PUD

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APPENDICES

APPENDIX I

WORK PLAN

ACTIVITY TIME FRAME REQUIREMENTS PERSON

RESPONSIBLE

Proposal writing FEBRUARY 2017 Computer, stationery,

internet access

Researcher

Presentation of proposal,

Corrections

March-April 2017 Researcher

Supervisor

Letter from SAHS

Administrator

April 2017 Researcher

Data collection May 2017 Questionnaire Researcher / assistant

Data analysis and

presentation of results

May-June 2017 Stationery, computer Researcher

Research Defence June 2017 Research Book Researcher

Printing and Submission

of Corrected Research

Report

June 2017 Stationery, computer Researcher

APPENDIX II

BUDGET

ITEM UNIT UNIT COST (UGX) TOTAL (UGX)

Pens 06 700 4,200

Pencils 03 400 1200

Paper 02 reams 13,500 27,000

Secretarial work 60 pages 500 30,000

Printing 60 pages 500 30,000

Internet bundles 04 months 25,000 100,000

Airtime 20,000 20,000

Research assistant 100,000

Consumables 30,000

Miscellaneous 100,000

GRAND TOTAL 442,400

APPENDIX: III

MAP OF MBARARA – BUSHENYI ROAD, ISHAKA, UGANDA SHOWING THE

STUDY SITE.

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