Title: Prevalence and factors associated with Helicobacter pylori infection in children aged 2 months to 12 years with Severe Acute Malnutrition (SAM) at Mulago Hospital. Background: H. pylori infection is widespread all over the world and is currently estimated to affect more than 50% of the world’s population. Globally, the prevalence of childhood H. pyloriis high, especially in low income countries. In children, H. pylori infection can initiate a vicious cycle of events that leads to malnutrition and growth retardation that impacts both morbidity and mortality. SAM affects about 20 million children under the age of five and is associated with 1-2 million preventable deaths. Children with SAM are nine times at increased risk of dying. Several studies have shown an association between H. pylori and SAM with gastric colonization with H. pylori being associated with suboptimal nutrition and growth in childhood. The magnitude of this infection among malnourished children in Uganda remains largely unknown. Objectives: This study sought to determine the prevalence and factors associated with H. pylori infection among children aged 2 months to 12 years with severe acute Malnutrition at Mulago hospital. Methods: A cross-sectional study was conducted among 354 children 2 months to 12 years with SAM at Mwanamugimu Nutrition Unit (MNU) of Mulago National Referral Hospital in Uganda over a 4-month period. Consecutive sampling was used to enroll the children who had assented and whose parents had given informed consent. Sociodemographic, clinical and laboratory data was collected using semi-structured questionnaires and stool samples were collected from the children and tested for H. pylori stool antigen. The data was entered into Epi data 3.1 and analyzed in STATA version 15. To assess the factors associated with H. pylori in SAM, a generalized linear model of the Poisson family with a log link and robust variance estimation was used. Selected variables were included in the multivariate model based on previous literature. Other factors were included at multivariate analysis if they had a p value less than 0.25. All variables included in the model were assessed for collinearity and in the case of collinearity, the variable with greater biological plausibility and/ or measure of association was retained. Adjusted prevalence ratios were presented. Results: Of the 354 children with SAM, the mean age was 23.8 (SD 1.5) months; the majority were males and one hundred fifty-four of the 354 or 44% (95% CI: 38.3 – 48.8) had H. pylori infection. The factors associated with H. pylori in severe acute malnutrition were: age of the child; children who were 24 to 60 months (APR: 0.47; 95% CI: 0.24-0.91, p= 0.02)and 6 to < 24 months of age (APR: 0.66; 95% CI: 0.46-0.98, p=0.04) were less likely to have H. pylori infection compared to those 2 to < 6months of age; Children who reported no vegetable consumption (APR: 1.67; 95% CI: 1.16-2.41, p= 0.01), those who were vomiting (APR: 1.48; 95% CI: 1.10-2.02, p=0.01) and those with acidic stool pH (APR: 1.42; 95% CI: 1.03-1.94, p =0.03) were more likely to have H. pylori. Conclusions and Recommendations: The prevalence of H. pylori infection in children with SAM is high. Children with SAM who are 2 to <6 months of age, those with vomiting, no vegetables in their diet and those with an acidic stool pH are more likely to have H. pylori infection. Clinicians should screen all children with SAM who are 2 to <6 months of age, vomiting and have acidic stool pH for H. pylori and infected children should be given its treatment.

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