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.
ss
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