PREVALENCE OF PEPTIC ULCER DISEASE AND ASSOCIATED RISK FACTORS

AMONGST UNDERGRADUATE STUDENTS AT MUNI UNIVERSITY, UGANDA.

BY

MOLO JAMES

2021/U/SMB/00044

2101200044

A RESEARCH REPORT SUBMITTED TO THE DEPARTMENT OF BIOLOGY,

FACULTY OF SCIENCE IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE AWARD OF A BACHELOR OF SCIENCE WITH
EDUCATION
(BIOLOGICAL) OF MUNI UNIVERSITY

SUPERVISOR

DR. GODFREY WOKORAC (PhD)

AUGUST, 2024.
 DECLARATION
I, MOLO JAMES declare that this research report is my own work and has not been submitted
to any institution of learning for academic award. The sources of literature cited are referenced
and acknowledged.

Sign: ………………………………

Date: ………………………………

i
 APPROVAL
This research report was prepared under my guidance and supervision, and I approve it for
submission to the Department of Biology for review and examination.

Supervisor: Dr. Godfrey Wokorach (PhD).

Sign: ……………………………

Date: …………………………....

ii
 DEDICATION.
This research report is dedicated to my beloved parents Mr. Charles Ebong and Mrs. Mary Awor
Ebong, and to my siblings Mr. Fred Ongom, Mr. Francis Ewel, Kica Isaac, Sarah Adong and
Rebecca Aceng. Am very grateful indeed for your continued support and belief in me that kept
me moving forward in my academic journey. May the Almighty God bless you and reward you
abundantly.

iii
 ACKNOWLEDGEMENT.
First of all, I would like to thank the ALMIGHY GOD for his protection and providence during
the course of the study. Secondly, would like to thank my research supervisor, Dr. Godfrey
Wokorach, for his exceptional guidance, expertise and unwavering support throughout the
research process. Your constructive feedback was instrumental in shaping this research report,
and I am deeply grateful for your mentorship. Thirdly, I thank all the lecturers of Biology at
Muni University for their support during the academic journey, most especially, Assoc. Prof.
Morgan Andama and Dr. Robert Opoke, the Head of Department Biology, Muni University. And
finally, to all my beloved classmates who assisted me in one way or another during the studies.
May the good LORD bless you abundantly.

TABLE OF CONTENTS.

iv
Contents
DECLARATION............................................................................................................................i

APPROVAL...................................................................................................................................ii

DEDICATION..............................................................................................................................iii

ACKNOWLEDGEMENT............................................................................................................iv

TABLE OF CONTENTS..............................................................................................................v

LIST OF TABLES......................................................................................................................viii

LIST OF FIGURES......................................................................................................................ix

LIST OF ABBREVIATIONS.......................................................................................................x

ABSTRACT...................................................................................................................................xi

CHAPTER ONE............................................................................................................................1

1.0 INTRODUCTION....................................................................................................................1

1.1 BACKGROUND......................................................................................................................1

1.2 PROBLEM STATEMENT.....................................................................................................2

1.3 OBJECTIVES OF THE STUDY............................................................................................3

1.3.1 Main Objective..................................................................................................................3

1.3.2 Specific objectives.............................................................................................................3

1.4 RESEARCH QUESTIONS.....................................................................................................4

1.5 SCOPE OF THE STUDY........................................................................................................4

1.6 SIGNIFICANCE AND JUSTIFICATION OF THE STUDY.............................................5

1.7 LITERATURE REVIEW.......................................................................................................6

1.7.1 Definition of peptic ulcer disease.....................................................................................6

1.7.1 Global prevalence of Peptic Ulcer Disease......................................................................6

1.7.2 Symptoms of PUD (Clinical Manifestations)..................................................................7

1.7.3 Causes of Peptic Ulcer Disease and risk factors.............................................................7

1.7.4 Pathology of the Causative Agents..................................................................................8

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 1.7.5 Complications of Peptic Ulcer Disease............................................................................8

1.7.6 Diagnosis of Peptic Ulcer Disease....................................................................................9

1.7.8 Treatment........................................................................................................................10

CHAPTER TWO.........................................................................................................................11

2.0 MATERIAL AND METHODS............................................................................................11

2.1 STUDY AREA........................................................................................................................11

2.2 Study Design...........................................................................................................................12

2.3 Target population...................................................................................................................12

2.4 Sample Size and Selection.....................................................................................................12

2.4.1 Sample size estimation........................................................................................................12

2.4.2 Sample selection..................................................................................................................12

2.4.4 Sampling procedures..........................................................................................................12

2.4.5 Inclusion criteria.................................................................................................................13

2.4.6 Exclusion principles............................................................................................................13

2.5 Data collection........................................................................................................................13

2.6 Study variables.......................................................................................................................14

2.6.1 Independent variables....................................................................................................14

2.6.2 Dependent variable.........................................................................................................14

2.7 DATA ANALYSIS AND DATA MANAGEMENT............................................................14

2.7.1 Data management...............................................................................................................14

2.7.2 Data analysis........................................................................................................................14

2.8 Ethical Considerations...........................................................................................................15

CHAPTER THREE.....................................................................................................................16

3.0 PRESENTATION OF RESULTS........................................................................................16

3.1. General characteristics of the respondents.........................................................................16

3.2. Retrospective trend of PUD prevalence..............................................................................20

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3.3 PUD risk factor analysis........................................................................................................20

CHAPTER FOUR........................................................................................................................29

4.0. DISCUSSION OF RESULTS..............................................................................................29

CHAPTER FIVE:........................................................................................................................31

5.0. CONCLUSION AND RECOMMENDATIONS................................................................31

5.1. Conclusion.............................................................................................................................31

5.2. Recommendations.................................................................................................................31

5.3. Limitations.............................................................................................................................31

5.4 References...............................................................................................................................32

6.0 Appendix 1..............................................................................................................................34

6.1 Sample Questionnaire............................................................................................................34

LIST OF TABLES.
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Table 1. General characteristics of the respondents surveyed. Significant p values in bold.........17
Table 2 Bivariate analysis of factors associated with PUD development among Muni university
students..........................................................................................................................................21
Table 3 Multivariate analysis of factors associated with PUD development among Muni
university students.........................................................................................................................25

LIST OF FIGURES.

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Figure 1 Endoscopic images a) Active ulcer, b) Ulcer scar, c) Last stage of the mucosal healing
in benign peptic gastric ulcers.........................................................................................................9
Figure 2. Map of Arua City showing the study area (Muni University)........................................10

LIST OF ABBREVIATIONS
aOR Adjusted Odd Ratio

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CI Confidence Interval

cOR Crude Odd Ratio

GI Gastro Intestinal

NSAIDs Non-Steroidal Anti-inflammatory Drugs.

PPIs Proton Pump Inhibitors.

PUD Peptic Ulcer Disease.

SPSS Statistical Package for Social Scientists.

VacA Vacoulating Cytotoxin A

CagA Cytotoxin Associated Gene A

x
 ABSTRACT.
Ulcers, particularly peptic ulcers, are prevalent worldwide and can significantly impact the
quality of life and academic performance of university students. University settings provide a
unique set of conditions that put students at a higher risk of developing Peptic Ulcer Disease.
Despite the recognition of ulcers as a common health issue, there is a paucity of research
investigating their prevalence and associated risk factors among university students in Uganda.
This research aimed address this gap by investigating the prevalence of PUD and associated risk
factors amongst undergraduate students at Muni University. A cross-sectional study was carried
out at Muni University, Arua city to assess the prevalence and risk factors associated with PUD
amongst undergraduate students. Questionnaires were used to collect data about the risk factors
associated with PUD and information on prevalence was collected from the Muni University
clinic records between 30th, August, 2023 and 12th, April, 2024. Descriptive statistics were
presented for independent and dependent variables. Bivariate and multivariate analyses were
used to model the independent predictors of PUD prevalence. P-values < 0.05 were taken
significant at 95% CI.

Overall PUD prevalence was 36.4%, (n=276), which is higher than prevalence in Uganda and the
world generally. Risk factors of PUD such as eating of spicy foods, NSAIDs use, the frequency
of NSAIDS, taking of carbonated beverages, taking of alcohol were found to be significantly
associated with PUD prevalence (p < 0.05) (Table 3). However, smoking which is one of the
known risk factors according to research had a p-value>0.05 and thus not significantly associated
with PUD. The prevalence of 36.4% suggest that PUD is a serious public health problem
amongst university students and the major contributing factors were eating spicy foods, taking of
alcohol, NSAIDs use and taking of carbonated beverages especially with the intermittent eating
habits of university students. The study findings are important to inform prevention strategies of
PUD amongst the vulnerable students’ community and the general public. Students therefore,
needs to be aware of these risk factors and regulate the use of NSAIDs, alcohol consumption and
taking of carbonated beverages and adopt more healthy lifestyles.

xi
 CHAPTER ONE

1.0 INTRODUCTION.

1.1 BACKGROUND.
Peptic ulcer disease (PUD) is now considered one of the most common disorders in the world,
accounting for a significant portion of hospital visits and is known as one of the leading causes
of death in the world. Peptic ulcer disease is a global health concern affecting millions of people
worldwide. In Uganda, PUD is a significant health issue, with high prevalence rate. However,
there is paucity of research on the prevalence of PUD among undergraduate students, a critical
population that is often neglected in health research.

Several factors contribute to the development of peptic ulcer disease in individuals that include
among others infection with Helicobacter Pylori, use of Non-Steroidal Anti-inflammatory Drugs
(NSAIDs), smoking, stress, alcohol and caffeine, and poor dietary habits. However, no single
factor is sufficient to account for peptic ulcer development in people.

PUD may have a negative effect on a person's health at any age, but they are also avoidable with
the right level of awareness. It can significantly impact the quality of life and academic
performance of university students and yet there is a paucity of research investigating their
prevalence and associated risk factors among university students in Uganda. This have hindered
the development of intervention strategies that aim to reduce the incidences of PUD among this
population. This called for a research such as this to investigate the prevalence and risk factors
associated with peptic ulcer disease amongst this population.

This research therefore aimed to address the gap that exists in the information or data on peptic
ulcer disease in this population. By doing this, it has created awareness in the student population
for suitable intervention measures to be developed. It has also contributed to the already existing
body of knowledge on this problem.

1
1.2 PROBLEM STATEMENT.
A large number of full-time university students often go without food or other necessities to
make ends meet. The irregular eating habits of university students can be attributed to the
following; limited financial support, poverty at home, shortages of food, school stressful
conditions and psychological disorder like Anorexia nervosa among students. Many students
have limited financial support, finding it challenging to balance study, and a significant number
are even skipping meals. This results to stress, irregular eating habits, and changing lifestyle
choices that aggravate the chances of developing ulcers. The stressful conditions at campus can
lead to some students resorting to smoking and taking alcohol as copying mechanisms that all
exacerbate the peptic ulcer conditions. Taking of non-steroidal anti-inflammatory drugs such as
Aspirin, Piroxicam, Ibuprofen and others among student population is also common. These drugs
are normally used as pain reliever, and for reducing fever. Peptic ulcer disease can have a
significant negative impact on students' academic performance and overall well-being due to
symptoms such as pain, discomfort, and potential complications like bleeding. It can also lead to
serious economic burden on the students and the government due to medical expenses related to
ulcers. Risk factors such as stress, irregular eating habits, and lifestyle choices prevalent among
students exacerbate the likelihood of developing ulcers. Therefore, research such as this has
helped to create awareness among students of the impending dangers of some unhealthy
lifestyles at campus. By doing this, they can take steps and precautions to avoid exposure to the
risks that exacerbate the chances of developing PUD. Once this is done at individual level, it can
reduce the burden of medical expenses of PUD treatment and prevent the possibility of
developing complications related to Peptic ulcers that can eventually lead to death. This research
finding also applies to the general population since these risk factors are also prevalent outside
university setting, especially the young adults.

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1.3 OBJECTIVES OF THE STUDY.
1.3.1 Main Objective.
To investigate the prevalence of peptic ulcer disease (PUD) and its associated risk factors among
Muni University students in Arua city, Uganda.

1.3.2 Specific objectives.

To determine the prevalence of PUD among Muni University students.

To identify the key risk factors associated with PUD in this population group, including, NSAID
use, smoking, alcohol consumption, dietary habits, and stress levels.

1.4 RESEARCH QUESTIONS.

What is the prevalence of PUD among Muni University students in Arua, Uganda?

What are the main risk factors associated with PUD in this population group?

1.5 SCOPE OF THE STUDY.

The study investigated the prevalence of ulcers and associated risk factors among undergraduate
students at Muni university. Only those who were tested for PUD and are enrolled at Muni
University in 2024 were included in the study. The secondary data was got from the university
clinic for those who sought treatment or were screened for PUD between 30 th, August 2023 to
12th, April 2024. The research aimed to assess the extent of ulcer occurrence within the
university population and identify factors contributing to their development. The risk factors that
were assessed include use of nonsteroidal anti-inflammatory drugs, and lifestyle habits like
smoking, stress, dietary habits. The data obtained will inform future interventions to address
ulcer-related issues within the university setting.

1.6 SIGNIFICANCE AND JUSTIFICATION OF THE STUDY.

This research can be significant across multiple domains, making valuable contributions to
knowledge, policy considerations, and practical applications.

Contribution to Knowledge: This study can be used to advance understanding of ulcer

epidemiology among university students, providing insights into the interaction between lifestyle
factors, stress levels, and health outcomes in young adults.

3
Policy Considerations: The findings can be used to inform evidence-based policies and
interventions to promote student health, guiding the development of targeted initiatives to
mitigate modifiable risk factors and reduce the burden of ulcers within the university community.

Practical implications for practitioners: Healthcare practitioners can benefit from tailored
guidance for preventive care and health promotion efforts, enabling them to implement proactive
strategies such as enhanced screening protocols and personalized interventions to support student
well-being and improve health outcomes.

4
 1.7 LITERATURE REVIEW.

1.7.1 Definition of peptic ulcer disease.

Peptic Ulcer Disease (PUD) is a common gastrointestinal condition characterized by a mucosal
defect, with a depth of penetration into the submucosa of at least 3-5 mm, primarily affecting the
stomach and the initial portion of the small intestine (duodenum) (Xie et al., 2022). Peptic Ulcer
can also be defined as a lesion, similar to a sore, that occurs in the lining of the stomach or the
initial portion of the small intestine, characterized by a breach with a minimum diameter of 0.5
cm that extends through the muscularis mucosa, which is the thin layer of muscle surrounding
the digestive tract (Maniragaba, 2018). Peptic ulcer, also known as stomach ulcer, is a break in
the lining of stomach, first part of the small intestine and sometimes in the lower esophagus
(Sayehmiri et al., 2018).

1.7.1 Global prevalence of Peptic Ulcer Disease.

Peptic ulcer disease represents a serious medical problem and approximately 500,000 new cases
are reported each year, with 5 million people affected in the United States alone (States &
Ellison, n.d.). Peptic ulcer disease (PUD) affects 10% of the world population (Zapata-colindres
et al., 2006) and in 2013, peptic ulcer disease (PUD) caused over 300000 deaths globally (Peiffer
et al., 2020). According to (Me et al., 2015), PUD affects around 5-10% of the general
population worldwide and its prevalence is inversely related to the economic level of the
population, degree of development and level of hygienic social environmental. It’s average
prevalence is between 5-10% of the general population over a lifetime (Me et al., 2015). Also
according to Eniojukan et al 2017, approximately 4 million individuals throughout the world are
affected with PUD each year, (Kron, 2008) with an incidence rate of 10%-19% (Eniojukan JF et
al., 2017). According to 2022 Salari meta-analysis study, the prevalence of this disease in the
world is reported to be 5–10%.

In Africa, the highest prevalence was reported to be in the great lakes region that includes
Rwanda, Burundi, eastern DRC, extreme western Tanzania, and south western Uganda
(Namugerwa, 2017). In Uganda, PUD prevalence is estimated to range between 12% and 25%
(Namugerwa, 2017). Low-income and middle-income countries are disproportionately affected

5
(Peiffer et al., 2020). However, there is no data specific providing the prevalence in the different
countries in the great lake region.

1.7.2 Symptoms of PUD (Clinical Manifestations).

The most typical manifestation of the uncomplicated Peptic Ulcer is the presence of a burning or
corrosive pain, mainly located at the epigastrium. This epigastric pain is relieved by eating any
kind of food or taking antacids pills in few minutes, and reappears cyclically again, within two
hours (Me et al., 2015). Other symptoms of PUD include chronic abdominal pain, vomiting,
heartburn, poor appetite and nausea (Alzahrani et al., 2023), indigestion, bloating, premature
satiety, nausea, and bleeding (Salari et al., 2022). Taking Non-steroidal anti-inflammatory drugs
(NSAIDs) and Helicobacter pylori infections are the most common etiopathogenic symptoms of
bleeding in the PUD (Salari et al., 2022). Sometimes an ulcer can penetrate the muscular wall of
the stomach or Duodenum and causes intense, piercing, persistent pain and final bleeding. It is
one of the leading cause for high morbidity and mortality among all age group throughout the
world (Venkatesan et al., 2017).

However, in some patients, ulcers can be asymptomatic and the first manifestation may be
related to the presence of one ulcer-related complication, especially in elderly patients who take
NSAIDs. It has been proposed that NSAIDs may mask pain of ulcer processes (Me et al., 2015).

1.7.3 Causes of Peptic Ulcer Disease and risk factors.

Helicobacter pylori infection and the use of a nonsteroidal anti-inflammatory drugs (NSAIDs)
are the principal factors associated with PUD (Zapata-colindres et al., 2006). The H. pylori
infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), continuously causes
gastritis and consistently block prostaglandin synthesis in the mucosa, respectively (Alejandra,
2023).

According to Alejandra 2023, PUD develops at a rate of 1% per year in Helicobacter Pylori
infected persons. However, there are significant epidemiological differences worldwide where in
developing countries, the prevalence of H. pylori infection is much higher (two to five times)
than in developed, probably because of the worst existing hygiene and dietary conditions that
favor the transmission of infection (Me et al., 2015).

Consumption of NSAIDs, is the second most common cause of ulcers. Overall, it is estimated
that NSAIDs may cause up to 10% of duodenal ulcers and 20-30% of gastric ulcers (Me et al.,

6
2015). NSAIDs use is also related to an increased risk of complications from peptic ulcer
disease, such as gastrointestinal bleeding, perforation, and gastric outlet obstruction.

However, the presence of Helicobacter pylori (H. pylori) or the use of nonsteroidal anti-
inflammatory medicines (NSAIDs) is unlikely to be sufficient to cause ulcer development
(Alejandra, 2023). There are other less common risk factors that can cause a PUD, which are
considered together, account for less than 5% of cases (Me et al., 2015). Other contributing
factors includes smoking tobacco which alters the balance of aggressive and defensive elements
in the mucosa.

Research indicates a robust positive correlation between cigarette smoking and the occurrence of
ulcer disease, as well as increased mortality, complications, recurrences, and slower healing
rates. Smokers are approximately twice as likely to develop ulcer disease compared to
nonsmokers. Smoking may heighten susceptibility by weakening gastric mucosal defenses or
creating a more conducive environment for H. pylori infection (States & Ellison, n.d.).

1.7.4 Pathology of the Causative Agents.

Helicobacter pylori employ various mechanisms to induce peptic ulcer disease. Infected patients
experience an inflammatory and immunological response in the gastric and duodenal mucosa,
leading to the release of several pro-inflammatory cytokines, such as IL-8 and TNF-α. This
results in both acute and chronic gastritis, which diminishes the thickness and quality of the
mucus layer (Me et al., 2015). They also release toxins (cytotoxic proteins) such as VacA
(Vacoulating Cytotoxin A) and CagA (Cytotoxin Associated Gene A) that disrupt cell function,
increase inflammation and damage the lining (Me et al., 2015).

NSAIDs cause damage to the gastric and duodenal mucosa through two primary mechanisms.
First, as weak non-ionized acids, they can easily penetrate the mucus layer and enter epithelial
cells. Second, and most importantly, NSAIDs inhibit the production of prostaglandins in the
stomach. While prostaglandins promote inflammation, they also protect the stomach lining from
the corrosive effects of stomach acid and help maintain its healthy condition. (Me et al., 2015).

7
1.7.5 Complications of Peptic Ulcer Disease.
Peptic ulcer disease, if untreated can lead to several complications and they are the main reasons
for the high morbidity and mortality associated with this disease worldwide (Me et al., 2015).
The complication associated with Peptic Ulcer Disease include;

Bleeding. While its occurrence has slightly decreased in recent years, it remains the most
prevalent complication, affecting approximately 10-20% of patients and often leading to
emergency admissions. Ulcers associated with NSAIDs are more prone to bleeding compared to
those solely attributed to chronic H. pylori infection. (Me et al., 2015).

Perforation. It occurs in up to 5% of patients with peptic ulcer. Free perforation of a duodenal or

gastric ulcer into the peritoneal cavity may endanger the patient’s life (Me et al., 2015).

Penetration. This complication arises when an ulcer breaches the wall of the stomach or
duodenum and instead of perforating freely into the peritoneal cavity, it infiltrates an adjacent
organ. It manifests in roughly 25% of duodenal ulcers and 15% of gastric ulcers, with common
adjacent organs including the pancreas, liver, or omentum. Clinical presentation may resemble
that of an uncomplicated ulcer, but typically exhibits more intense and persistent pain (Me et al.,
2015).

And lastly, obstruction is an uncommon complication, which represents approximately 5% of

ulcer-related complications (Me et al., 2015).

1.7.6 Diagnosis of Peptic Ulcer Disease.

There are many diagnosis tests for PUD but the most commonly used are Serologic Tests and
Endoscopic findings. Serologic antibody testing detects immunoglobulin G specific to H. pylori
in serum and cannot distinguish between an active infection and a past infection. Serologic tests
may be most useful in mass population surveys and in patients who cannot stop taking Proton
Pump Inhibitors (PPIs) (e.g., those with gastrointestinal bleeding or continuous NSAID use)
because the tests are not affected by PPI or antibiotic use (Fashner & Gitu, 2015).

Endoscopic findings. The Upper GI endoscopy is the most accurate diagnostic test for PUD. It
gives information about the size and the location of the lesion (Me et al., 2015). In upper GI
endoscopy, a flexible tube with camera is used to see the lining of the upper GI tract, including
the esophagus, stomach and duodenum.

8
 a b c

Figure 1 Endoscopic images a) Active ulcer, b) Ulcer scar, c) Last stage of the mucosal healing
in benign peptic gastric ulcers.
1.7.8 Treatment.
The combination of herbal products and standard anti-gastric ulcer drugs might present a
synergistic effect against H. pylori and gastric ulcer disease and improve the outcome for
patients with gastric ulcer (Kuna et al., 2019). Use of probiotics which are living organisms that
help restore balance to the bacteria in the digestive tract helps in management and treatment of
ulcers. As well as helping achieve optimal gut health, they can help with treating ulcers.
Probiotics can be found in yogurts, fermented foods, and probiotic supplements. According to
Dambya Kenneth Eldad 2021, a number of traditional medicines are available for treatment of
PUD in Uganda. These local herbs include among others Bidens pilosa, Mimosa pigra, Parinam
curtelliforlia, Aspila apricana, Rubia cardiofolia, Cestrum nocturnun, Gnaphahizum
purpuraum, and Ageratum compoides among others. Extracts from the leaves, stems, flowers,
barks, bulbs, fruits, peels and roots of these plants are used in the treatment and management of
ulcers.

9
 CHAPTER TWO

2.0 MATERIAL AND METHODS

2.1 STUDY AREA.

This research was conducted at Muni University, located in Muni village, Oluko sub-county
Arua City, Uganda. Muni university is 4.9km southeast of Arua city. Arua is situated in the
northwestern region of the country, bordering South Sudan and the Democratic Republic of the
Congo. Oluko sun-county is bordered by Pajulu sub-county in the west and River Oli division in
the northwest.

10
Figure 2. Map of Arua City showing the study area (Muni University).

2.2 Study Design

This research employed a quantitative cross-sectional study design to investigate the prevalence
of PUD and associated risk factors among Muni University students. This design allowed for
assessing the characteristics of a population at a specific point in time.

2.3 Target population.

Muni university caters for approximately 1200 undergraduate students enrolled in different
courses such as Bachelor of Science with Education, Bachelor of Nursing Science (NSM),
Bachelor of Business Administration (BBM), Bachelor of Information Systems (ISM), Bachelor
of Information Technology (ITM) and Higher Access Education Certificate (HAEC) in different
years of study. This study targeted only fill-time undergraduate student who have visited the
university clinic from 30th August 2023 to 12th April 2024 and were screened for PUD.

2.4 Sample Size and Selection.

2.4.1 Sample size estimation.

75 numbers of participants were calculated from the total population of 276 students who were
screened for PUD at Muni University clinic using Morgan and Krejcie formula.

2.4.2 Sample selection.

A purposive sampling method was employed to get a section of students who had tested for PUD
from the university beginning from 30th August 2023 to 12th April 2024 for the study. Based on
the total of 276 students who had diagnosis of PUD, a sample of 75 students was sampled for
this study.

2.4.4 Sampling procedures.

Students who were screened for PUD between 30th, August, 2023 and 12th, April 2024, from
Muni University clinic were sampled. Purposive sampling was used to get the participants to
answer the questionnaires. Information on the test status of the participants was collected from
the University clinic as secondary data on which PUD prevalence was calculated. The names of
the students who were screened for PUD were generated from the clinic records between 30th,
August, 2023 and 12th, April 2024 and representative sample got using purposive sampling

11
method. A comprehensive list of all undergraduate students who visited the University clinic
from 30th August 2023 to 12th April 2024 and were enrolled at Muni University during the
2023/2024 academic year was used as a sampling frame.

2.4.5 Inclusion criteria

Students who were enrolled in the university system for the semester two (2023/2024 academic
year) had a chance of being included in the sample used. However, only those who were
diagnosed for PUD from the university clinic from 30th, August, 2023 to 12th, April 2024 were
included in the sampling frame.

2.4.6 Exclusion principles.

Those students who took their tests for PUD from outside clinics or health facilities and have
never sought treatment from the university clinic were not part of the sampling frame. Students
who were diagnosed with other ulcers different from PUD were excluded from the sampling
frame. The students who had already graduated or left the university were excluded from the
study and those that did not visit the university clinic from 30th August 2023 to 12th April 2024
were also excluded.

2.5 Data collection.

Sampled students completed anonymous physical questionnaires designed to collect data on
demographic information (age, sex, academic year of study), PUD symptoms (using validated
symptom scales), potential risk factors (NSAID use, smoking habits, alcohol consumption,
dietary habits, stress levels) and knowledge and awareness of PUD (symptoms, risk factors,
preventive measures). The confidentiality and privacy of the respondents was strictly kept.
Secondary data on the record of diagnosis of Peptic Ulcer Disease amongst the students was got
from the University clinic. This helped determine the proportion of the students with positive
tests for PUD based on standard clinical tests.

12
2.6 Study variables
Several factors within the university environment might influence peptic ulcer disease (PUD)
prevalence among students, such as academic stress due to high workloads, tight deadlines,
dietary habits due reliance on convenient but potentially unhealthy fast-food options and
irregular meals as a result of busy schedules, limited access to healthcare where they delay
seeking medical attention due to cost or lack of readily available services. Smoking and alcohol
consumption habits that might be more prevalent among certain student groups as coping
mechanisms to stress and socioeconomic status where students from disadvantaged backgrounds
might have limited access to healthy food choices or preventive healthcare.

2.6.1 Independent variables

These included the risk factors such as use of non-steroidal anti-inflammatory drugs, dietary
habits, smoking.

2.6.2 Dependent variable

This was the peptic ulcer disease prevalence among Muni University undergraduate students,
which was got from the clinic records.

2.7 DATA ANALYSIS AND DATA MANAGEMENT.

2.7.1 Data management

Data was coded, entered, edited, and cleaned in SPSS version 26. This data entered was kept safe
using a password to prevent an unauthorized access to the research information and backups was
be done to avoid loss of the coded data. The answered questionnaires were kept and locked in the
cupboard to prevent unauthorized access.

2.7.2 Data analysis

The study utilized SPSS for data analysis, starting with descriptive statistics to outline ulcer
prevalence and demographics among Muni University students. Descriptive measures like
frequency counts and percentages were used to get the general characteristics of the respondents.
Bivariate analysis followed, exploring associations between ulcer prevalence and factors like
gender, smoking, and diet using chi-square tests for categorical variables. Lastly, multivariate

13
logistic regression was employed to identify independent predictors of ulcer prevalence,
considering multiple risk factors simultaneously and controlling for confounding variables.

Objective 1: Determine the prevalence of PUD among Muni University students.

Analysis: Prevalence was calculated as the proportion of students who had positive tests for
PUD, got from the university clinic out of the total number who took the tests for PUD.

Objective 2: Identify the key risk factors associated with PUD in this population group.

Analysis: Bivariate analyses (Chi-square tests for categorical variables) was conducted to assess
the association between each potential risk factor (NSAID use, smoking, alcohol consumption,
dietary habits, and stress levels) and PUD diagnosis.

Multivariate analysis: Logistic regression was employed to identify the independent predictors of
PUD diagnosis while controlling for potential confounding variables.

Level of Significance:

A p-value of less than 0.05 was considered statistically significant for all analyses.

2.8 Ethical Considerations

Informed consent was sought from all participants after providing a detailed explanation of the
study objectives, procedures, and benefits. Confidentiality of participant information was strictly
maintained throughout the research process. Ethical approval was sought from the relevant
authorities at Muni University.

14
 CHAPTER THREE

3.0 PRESENTATION OF RESULTS.

3.1. General characteristics of the respondents.

The data for risk factors associated with PUD prevalence were collected from 75 study
participants. Males comprised 48.0% (n=36) while females were 52% (n=39) (Table 1). Of the
75 respondents, year one students consisted 21.3% (n=16), year two students consisted 30.7%
(n=22), year three students consisted 29.3% (n=23) and finally year four students were 18.7%
(n=14) (Table 1). There were 41.3% (n=31) government sponsored students and 58.7% (n=44)
privately sponsored students who were part of the sample size. The proportion of the respondents
that were not knowledgeable on PUD at all were 13.3% (n=10), those who were somewhat
knowledgeable were 53.3% (n=40) and those who were very knowledgeable were 33.3% (n=25).
Out of those who had some knowledge on PUD, the source of information were doctors, which
comprised 34.7% (n=26), friends and family, which comprised 42.7% (n=32) and internet, which
comprised

22.7% (n=17). 73.3% (n=55) of the respondents experienced symptoms related to ulcers and
17.3% (n=13) of the respondents did not experience symptoms related to ulcers but did the tests
during general check up at the university clinic. Of those who experienced symptoms related to
ulcers, 73.3% (n=55) experienced burning sensations in the stomach, 17.3% (n=13) experienced
bloating stomach after eating, 4% (n=3) experienced nausea or vomiting and 5.3% (n=4) had
dark bloody stools. Those who tested positive for PUD and got treatment were 42.7% (n=32) and
those who never go treatment (both those with positive tests and those with negative tests) were
57.3% (n=43). 9.3% (n=7), 48.0% (n=36) and 42.7% (n=32) of the respondents were not stressed
at all, moderately stressed and very stressed respectively. In the semester activities that
contributed to the stress of the respondents, 48.0% (n=36) were attributed to academic deadlines,
34.7% were attributed to financial difficulties and 17.3% were attributed to health concerns.

15
Table 1. General characteristics of the respondents surveyed. Significant p values in bold

Variable Frequenc Percentage 95% CI P value χ2

y value

Lower Upper

Gender of the 0.041 0.049 0.055 8.254

respondents

Male 36 48

Female 39 52

Year of study of the 0.012 0.521 0.826 0.048

respondents

Year 1 16 21.3

Year 2 22 30.7

Year 3 23 29.3

Year 4 14 18.7

Type of sponsorship 0.278 0.404 0.333 3.406

Government 31 41.3
sponsored

Privately sponsored 44 58.7

Knowledge level on 0.139 0.119 0.190 3.321

PUD

Not knowledgeable at 10 13.3

all

16
Somewhat 40 53.3
knowledgeable

Very knowledgeable 25 33.3

Source of information 0.124 1.602 0.518 1.317

on PUD

Doctors 26 34.7

Friends and family 32 42.7

Internet 17 22.7

Experiencing <0.001 0.029 <0.001 31.945

symptoms of PUD

Yes 58 77.3

No 17 22.6

Symptoms 0.389 0.520 0.633 1.718

experienced

Burning pain in the 55 73.3

stomach

Feeling bloated or full 13 17.3

after eating

Nausea or vomiting 3 4.0

Dark or bloody stools 4 5.3

Receiving treatment 0.001 0.036 <0.001 33.787

Yes 32 42.7

No 43 57.3

Perceived stress level 0.011 0.423 0.586 1.068

17
Not stressed at all 7 9.3

Moderately stressed 36 48.0

Very stressed 32 42.7

Stressful events in the 0.299 0.576 0.537 1.245

semester

Academic deadlines 36 48.0

Financial difficulties 26 34.7

Health concerns 23 17.3

18
3.2. Retrospective trend of PUD prevalence.
Overall, out of 759 students who sought for PUD diagnosis or treatment from the university
clinic between 30th, August, 2023 to 12th, April, 2024, there were 36.4% (n=276) positive cases
for PUD.

3.3 PUD risk factor analysis.

Bivariate and multivariate analysis indicated that risk factors such as eating of spicy foods,
NSAIDs use, the frequency of NSAIDS use, consumption of spicy foods, consumption of
alcohol and taking of carbonated beverages were significantly associated with PUD prevalence
(p < 0.05) (Table 2). However, factors like gender of the respondents, year of study of the
respondents, type of sponsorship, knowledge level of the respondents on PUD, source of
information on PUD, frequency of meals, breakfast, lunch, supper, smoking habits and perceived
stress level were all not significantly associated with PUD prevalence (p-value >0.05) Table 2.

Respondents who consumed spicy foods regularly and daily were 1.4 (aOR: 1.403; 95% CI
1.0012.484)) and 1.01 (aOR: 1.095; 95% CI 0.011-4.705) times more likely to develop PUD than
those that do not take spicy foods. Respondents that used Non-steroidal anti-inflammatory drugs
(NSAIDs) are 4 (aOR: 3.955; 95% CI 1.010-9.281) times more likely to develop PUD than those
that do not take the drugs. On the other hands, respondents that take NSAIDs occasionally and
frequently are 1.01 times (aOR: 1.019; 95% CI 1.091-2.311) and 1.02 times (aOR: 1.02395% CI
0.901-1.509) more likely to develop PUD than those who never took NSAIDs. Respondents who
took alcohol occasionally were more likely to develop PUD (aOR: 1.301 95% CI (1.019-2.311)
to develop PUD up to 1.3 times. Those who took carbonated beverages occasionally were 1.1
times (aOR: 1.103 95% CI 0.697-0.453) more likely to develop PUD than those who never took
carbonated beverages. The respondents who took alcohol occasionally were 1.3 times (aOR:
1.301; 95% CI (0.004-0.435) more likely to develop PUD than those who do not take alcohol.

19
Table 2 Bivariate analysis of factors associated with PUD development among Muni university
students.

Variables Category N Positive cOR (95% CI) p-value

(%)

Gender. Male 36 17(47.2) 1

Female 39 18(46.2) 0.958(0.386-2.375) 0.926

Year of study Year 1 16 11(68.8) 1

Year 2 23 7(30.4) 5.029(1.264-20.002) 0.022

Year 3 22 8(36.4) 3.850(0.980-15.124) 0.053

Year 4 14 9(64.3) 1.222(0.267-5.592) 0.796

Type of Government 31 14(45.2) 1

sponsorship.
Private 44 21(47.7) 0.902(0.359-2.268) 0.826

Knowledge Not knowledgeable 10 2(20.0) 1

level on PUD
Somewhat 40 20(50.0) 0.250(0.047-1.327) 0.103
knowledgeable

Very knowledgeable 13(52.0)

25 0.231(0.041-1.311) 0.098

Source of Doctors 26 11(43.2) 1

information on
Friends and family 32 14(43.8) 0.943(0.331-2.682) 0.882
PUD
Internet.

17 10(58.8) 0.513(0.149-1.774) 0.899

Symptoms of Yes 55 25(45.5) 1

PUD
No. 20 10(50.0) 22.786(6.869- <0.001
75.585)

20
Symptoms Burning pain in the 38 17(44.7) 1
experienced stomach.

Feeling bloated after

14 6(42.9) 1.659(0.482-5.711) 0.422
eating

Nausea or vomiting

Dark or bloody stools

3 1(33.3) 2.074(0.178-24.228) 0.561

4 1(25.0) 3.111(0.304-31.788) 0.338

Frequency of Less than 2 meals 25 13(52.0) 1

meals per day
2 meals

3 meals 18 11(61.1) 0.689(0.201-2.359) 0.096

More than 3 meals 22 7(31.8) 2.321(0.705-7.645) 0.166

10 4(40.7) 1.625(0.367-7.2010) 0.523

Frequency of Never 18 11(61.1) 1

breakfast
Occasionally 26 12(46.2) 1.833(0.540-6.220) 0.331

Daily 31 12(38.7) 2.488(0.756-8.193) 0.134

Frequency of Never 13 8(61.5) 1

lunch
Occasionally 50 25(50.0) 1.600(0.460-5.570) 0.460

Daily 12 2(16.7) 8.000(1.215-52.693) 0.057

Frequency of Never 7 4(57.1) 1

eating supper
Occasionally 37 17(45.9) 1.569(0.307-8.011) 0.588

21
 Daily 31 14(45.2) 1.619(0.309-8.478) 0.568

Taking of Never 47 22(46.8) 1

carbonated
Occasionally 28 13(46.4) 0.253(0.097-0.663) 0.005
beverages
Daily 0

Frequency of Never 22 13(59.1) 1

eating spicy
Regularly 43 18(41.9) 0.120(0.040-0.364) <0.001
foods
Daily 10 4(40.0) 0.385(0.083-1.785) 0.222

Alcohol Never 55 25(45.5) 1

consumption.
Occasionally 20 10(50.0) 0.170(0.054-0.535) 0.002

Daily. 0

Smoking habits Never smoked 63 31(49.2) 1

Former smoker 11 4(36.4) 1.695(0.451-6.372) 0.435

Current smoker

NSAIDs use Yes 45 27(60.0) 1

No 30 8(26.7) 4.125(1.510-11.272) 0.006

NSAIDs use Never. 28 8(28.6) 1

frequency
Occasionally. 33 19(57.6) 0.042(0.010-0.173) <0.001

Frequently 14 8(57.1) 0.036(0.006-0.209) <0.001

Perceived stress Not stressed. 7 2(28.6) 1

level
Moderately stressed 36 17947.2) 0.447(0.076-2.613) 0.371

Very stressed

22
 30 16(53.3) 0.400(0.067-2.372) 0.313

Stressful events Academic deadlines 36 19(52.8) 1

Financial difficulties

Health concerns 26 10(38.5) 1.788(0.641-4.988) 0.267

13 6(46.2) 1.304(0.366-4.651) 0.683

* Indicates significant values at p≤0.05 in multivariate analysis.

N is the number of individuals

Variables Category N Positive % cOR (95% p-value

CI)

23
Table 3 Multivariate analysis of factors associated with PUD development among Muni
university students.

Variables Category N Positive aOR (95% CI) p-value

(%)

Gender. Male 36 17(47.2) 1

24
 Female 39 18(46.2) 0.0.853(0.308-2.359) 0.759

Year of study Year 1 16 11(68.8) 1

Year 2 23 7(30.4) 0.760(0.154-3.763) 0.737

Year 3 22 8(36.4) 4.027(0.977-16.588) 0.054

Year 4 14 9(64.3) 3.004(0.720-12.534) 0.131

Type of Government 31 14(45.2) 1

sponsorship.
Private 44 21(47.7) 1.006(0.375-2.696) 0.990

Knowledge level Not 10 2(20.0) 1

on PUD knowledgeable

Somewhat
40 20(50.0) 9.465(0.880-101.806) 0.064
knowledgeable

Very
13(52.0)
knowledgeable 25 1.294(0.311-5.392) 0.723

Source of Doctors 26 11(43.2) 1

information on
Friends and 32 14(43.8) 1.264(0.192-8.312) 0.807
PUD
family

Internet.
17 10(58.8) 1.127(0.208-6.115) 0.890

Symptoms of PUD Yes 55 25(45.5) 1

No. 20 10(50.0) 0.026(0.006-0.118) * <0.001

Symptoms Burning pain 38 17(44.7) 1

experienced in the stomach.

Feeling
14 6(42.9) 0.663(0.013-32.723) 0.392
bloated after
eating

Nausea or

25
 vomiting 3 1(33.3) 3.054(0.052-234.973) 0.559

Dark or bloody
stools
4 1(25.0) 1.327(0.005-388.469) 0.922

Frequency of Less than 2 25 13(52.0) 1

meals per day meals

2 meals
18 11(61.1) 2.02100(2.139-5.379) 0.095
3 meals
22 7(31.8) 2.113(0.505-4.880) 0.109
More than 3
10 4(40.7)
meals

Frequency of Never 18 11(61.1) 1

breakfast
Occasionally 26 12(46.2) 0.411(0.160-4.001) 0.219

Daily 31 12(38.7) 6.112(1.015-45.66) 0.081

Frequency of Never 13 8(61.5) 1

lunch
Occasionally 50 25(50.0) 1.501(0.260-3.001) 0.221

Daily 12 2(16.7) 6.112(1.015-45.66) 0.056

Frequency of Never 7 4(57.1) 1

eating supper
Occasionally 37 17(45.9) 0.199(0.207-9.015) 0.521

Daily 31 14(45.2) 0.699(0.179-8.009) 0.519

Taking of Never 47 22(46.8) 1

carbonated
Occasionally 28 13(46.4) 1.103(0.697-0.453) * 0.003
beverages
Daily 0

Frequency of Never 22 13(59.1) 1

eating spicy foods

26
 Regularly 43 18(41.9) 1.403(1.001-2.484) * <0.001

Daily 10 4(40.0) 1.095(0.011-4.705) 0.199

Alcohol Never 55 25(45.5) 1

consumption.
Occasionally 20 10(50.0) 1.301(0.004-0.435) * 0.002

Daily. 0

Smoking habits Never smoked 63 31(49.2) 1

Former smoker 11 4(36.4) 1.314(0.351-4.112) 0.371

Current
smoker
1

NSAIDs use Yes 45 27(60.0) 1

No 30 8(26.7) 3.955(1.010-9.281) * 0.005

NSAIDs use Never. 28 8(28.6) 1

frequency
Occasionally. 33 19(57.6) 1.019(1.019-2.311) * <0.001

Frequently 14 8(57.1) 1.023(0.001-0.509) * <0.001

Perceived stress Not stressed. 7 2(28.6) 1

level
Moderately 36 17947.2) 0.222(0.051-2.010) 0.291
stressed

Very stressed
30 16(53.3) 0.208(0.003-1.300) 0.301

Stressful events Academic 36 19(52.8) 1

deadlines

Financial
26 10(38.5) 1.480(0.141-2.988) 0.098
difficulties

Health
concerns

27
 13 6(46.2) 1.104(0.213-3.651) 0.569

* Indicates significant values at p≤0.05 in multivariate analysis.

N is the number of individuals

CHAPTER FOUR.

28
4.0. DISCUSSION OF RESULTS.
The result of this study showed that PUD is highly prevalent at Muni University (at 36.4%).
Furthermore, it was evident the use of Non-steroidal anti-inflammatory drugs, the frequency of
use of NSAIDs, and the consumption of spicy foods, alcohol and carbonated beverages amongst
the university students were the major determining factors for the development of Peptic Ulcer
Disease (PUD). This imply there is need to regulate the use of these drugs and consumption of
these foods and beverages. The overall peptic ulcer prevalence from the university clinic records
stands at 36.4% (n=276) which is far above the average overall prevalence in Uganda, which is
estimated to be between 12% and 25% (Namugerwa, 2017) and worldwide prevalence of 10%
(Zapata-colindres et al., 2006). This high prevalence can be due to frequent use of NSAIDs, and
consumption of spicy foods, alcohol, carbonated beverages coupled with intermittent eating
habits of the students.

From the results also, the main determinants of PUD development are use of a nonsteroidal
antiinflammatory drugs (NSAIDs), consumption of spicy foods and Helicobacter pylori infection
(confirmed by the standard clinical laboratory tests). This is in accordance to research done by

(Zapata-colindres et al., 2006) that confirmed the two major determinants of PUD development
as NSAIDs use and infection with Helicobacter pylori. These two ( H. pylori infection and the
use of nonsteroidal anti-inflammatory drugs (NSAIDs), continuously causes gastritis and
consistently block prostaglandin synthesis in the mucosa, respectively (Alejandra, 2023).

The association between NSAID use and the risk of peptic ulcer disease (PUD) is well-
documented and aligns with the findings from this research. The adjusted odds ratio (aOR) of
3.955 with a 95% confidence interval (CI) of 1.010-9.281 indicates a strong and statistically
significant relationship, emphasizing the substantial impact of NSAIDs on PUD risk. NSAIDs,
including common medications such as ibuprofen, naproxen, and aspirin, are known to increase
the risk of developing PUD due to their effects on the gastric mucosa (Me et al., 2015). NSAIDs
inhibit cyclooxygenase enzymes (COX-1 and COX-2), which are crucial for the production of
prostaglandins. Prostaglandins play a protective role in the gastrointestinal (GI) tract by
stimulating mucus and bicarbonate secretion and maintaining gastric mucosal blood flow.
Reduced prostaglandin synthesis weakens the mucosal defense, making the gastric lining more
susceptible to damage from gastric acid.

29
The adjusted odds ratio (aOR) of 1.301 with a 95% confidence interval (CI) of 1.019-2.311
indicates a statistically significant association between occasional alcohol consumption and an
increased risk of developing PUD. This suggests that individuals who consume alcohol
occasionally are about 30% more likely to develop PUD compared to those who do not consume
alcohol. Alcohol can irritate and damage the gastric mucosa directly. This irritation can lead to
inflammation and erosion of the mucosal lining, making it more susceptible to the effects of
gastric acid and increasing the risk of ulcer formation. Alcohol consumption can also stimulate
gastric acid secretion, which can exacerbate mucosal damage and contribute to ulcer formation.
Excessive acid can overwhelm the mucosal defenses, leading to ulcer development.

The aOR of 1.403 with a 95% CI of 1.001-2.484 suggests a statistically significant association
between regular spicy food consumption and an increased risk of developing peptic ulcer disease

(PUD). Specifically, this implies that individuals who consume spicy foods regularly are about
40% more likely to develop PUD compared to those who do not consume spicy foods regularly.

Spicy foods may stimulate gastric acid secretion. While the primary mechanism of ulcer
formation is often related to NSAIDs and Helicobacter pylori infection, increased acid
production can exacerbate mucosal irritation. Higher levels of gastric acid can overwhelm the
protective mechanisms of the gastric mucosa, increasing the risk of ulcer development.

For carbonated beverages, it increases the stomach acid production, due to presence of carbonic
acid. The elevated stomach acid can irritate the stomach lining, potentially leading to
inflammation and ulcers.

CHAPTER FIVE:

30
5.0. CONCLUSION AND RECOMMENDATIONS.

5.1. Conclusion
This study indicate that PUD is a serious public health problem amongst university students
(Muni University), in Arua city. Several factors such as use of NSAIDs, consumption of spicy
foods are found to determine the development of PUD. This study is important to inform the
general students’ body in order to reduce on the risks of developing PUD amongst university
students. Frequent use of NSAIDs as pain killers, consumption of spicy foods, especially with
intermittent eating habits of the university students were found to exacerbate the risk of
developing PUD.

5.2. Recommendations.
The students should prioritize self-care by taking care of their physical and mental health to
avoid fatigue, stress, and other ulcer related risk factors. This can be thorough maintaining
hydration and hygiene.

Health workers needs to encourage the use of NSAIDs only when absolutely necessary. Students
consider alternative medications for pain relief, such as acetaminophen, which generally has a
lower risk of causing ulcers. For patients who need to use NSAIDs regularly, prescribe
gastroprotective agents like proton pump inhibitors (PPIs) or misoprostol to help protect the
gastric mucosa. Educate patients about the risks of NSAID use and the signs and symptoms of
peptic ulcers. Provide information on how to minimize risk, such as taking NSAIDs with food
and avoiding alcohol.

5.3. Limitations.
This study only considered the students who tested for PUD from the university clinic and this
left out those who took diagnosis from other health facilities, potentially underestimating actual
prevalence. Also, the study was done considering only a short period of time and therefore
extensive retrospective study needs to be done so that the average prevalence of PUD can more
accurately be estimated from this particular population.

31
5.4 References.
1. Alejandra, M. G. (2023). Risk Factors for Developing Peptic Ulcer Disease. International
Journal Of Medical Science And Clinical Research Studies, 03(02), 174–176.
https://doi.org/10.47191/ijmscrs/v3-i2-04
2. Alzahrani, M., Alharthi, A., Shanbari, N., Bakry, S., Kambiji, G., Nahar, K., Alqurashi,
A., Alharthi, F., & Elhefny, M. (2023). Profile of Peptic Ulcer Disease and its Risk
Factors amongst Health Science Students at Umm Al-Qura University. Journal of Umm
Al-Qura University for Medical Sciences, 9(2), 16–21.
https://doi.org/10.54940/ms74558041
3. Eniojukan JF, Okonkwo OC, & Adje UD. (2017). Risk Factors, Management and Other
Correlates of Peptic Ulcer Disease in a University Community in South-South Nigeria.
Pharmaceutical and Biosciences Journal, December 2017, 07–15.
https://doi.org/10.20510/ukjpb/5/i6/166561
4. Fashner, J., & Gitu, A. C. (2015). Diagnosis and treatment of peptic ulcer disease and H.
pylori infection. American Family Physician, 91(4), 236–242.
5. Kron, J. (2008). Peptic ulcer disease. Journal of Complementary Medicine, 7(1), 12–19.
https://doi.org/10.1300/j100v01n03_04
6. Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic
ulcer disease: A brief review of conventional therapy and herbal treatment options.
Journal of Clinical Medicine, 8(2). https://doi.org/10.3390/jcm8020179
7. Maniragaba, N. (2018). Factors Contributing to increased cases of Peptic Ulcer Disease
among Patients aged 18-70 years attending Kisoro Hospital Kisoro District . A
Descriptive Cross-sectional Study . 1–13.
8. Me, L., Perez, I., & Rodrigo, L. (2015). Peptic Ulcer Disease. 1–8.
9. Namugerwa, J. (2017). Peptic ulcer prevalence among patient attending Kampala
International University Teaching Hospital in Ishaka Bushenyi Municipality. Kampala
International University, School of Allied Health Sciences, 1(1).
http://hdl.handle.net/20.500.12306/4494

32
10. Peiffer, S., Pelton, M., Keeney, L., Kwon, E. G., Ofosu-Okromah, R., Acharya, Y.,
Chinchilli, V. M., Soybel, D. I., Oh, J. S., & Ssentongo, P. (2020). Risk factors of
perioperative mortality from complicated peptic ulcer disease in Africa: Systematic
review and meta-analysis. BMJ Open Gastroenterology, 7(1), 1–11.
https://doi.org/10.1136/bmjgast-2019-000350
11. Perez Quarte et al. (2020). Knowledge of peptic ulcer disease among health students in a
Ghanaian University. Volume 6; Issue 2;, 6(February), 135–136.
https://www.researchgate.net/publication/339432929_Knowledge_of_peptic_ulcer_disea
se_among_health_students_in_a_Ghanaian_University
12. Salari, N., Darvishi, N., Shohaimi, S., Bartina, Y., Ahmadipanah, M., Salari, H. R., &
Mohammadi, M. (2022). The Global Prevalence of Peptic Ulcer in the World: a
Systematic Review and Meta-analysis. Indian Journal of Surgery, 84(5), 913–921.
https://doi.org/10.1007/s12262-021-03189-z
13. Sayehmiri, K., Abangah, G., Kalvandi, G., Tavan, H., & Aazami, S. (2018). Prevalence
of peptic ulcer in Iran: Systematic review and meta-analysis methods. Journal of
Research in Medical Sciences, 23(1), 4–9. https://doi.org/10.4103/jrms.JRMS_1035_16
14. States, U., & Ellison, Z.-. (n.d.). Peptic Ulcer Disease : Introduction Peptic Ulcer
Disease :
15. Venkatesan, K., Prabhu, R., Alli, P., Balagurunathan, K., Chandra, A. B., & Kumar, M.
S. (2017). A Study of Association Between Dietary Habits And Peptic Ulcer In M.B.B.S
Students in A Private Medical College, Puducherry. IOSR Journal of Dental and Medical
Sciences, 16(8), 82–85. https://doi.org/10.9790/0853-1608038285
16. Xie, X., Ren, K., Zhou, Z., Dang, C., & Zhang, H. (2022). The global, regional and
national burden of peptic ulcer disease from 1990 to 2019: a population-based study.
BMC Gastroenterology, 22(1), 1–13. https://doi.org/10.1186/s12876-022-02130-2
17. Zapata-colindres, J. C., Zepeda-gómez, S., Montaño-loza, A., Vázquez-ballesteros, E.,
Villalobos, J. D. J., & Valdovinos-andraca, F. (2006). The association of Helicobacter
pylori infection and nonsteroidal anti-inflammatory drugs in peptic ulcer disease. 20(4),
277–280.

33
6.0 Appendix 1.

6.1 Sample Questionnaire.

Dear participant,

I’m MOLO JAMES doing Bachelor of Science with education biological option and currently
carrying out my final year research as its part of the requirements for successful completion and
award of the degree of Bachelor of Science with Education. I therefore request you to answer the
questions honestly and to the best of your knowledge.

This questionnaire is part of a research study investigating the prevalence of peptic ulcer disease
(PUD) and its associated risk factors among Muni University students. Peptic ulcers are sores
that develop in the lining of the stomach or duodenum (upper part of the small intestine).
Understanding the factors that contribute to PUD in this population can help develop better
prevention and treatment strategies.

Your participation is completely voluntary and anonymous. All information collected will be
kept confidential and used only for research purposes. There are no right or wrong answers,
please answer honestly to the best of your knowledge.

Gender:

1) Male 2) Female

Year of study:

1) Year 1 2) Year 2 3) Year 3 4) Year 4

Type of sponsorship

1) Government sponsored, 2) Privately sponsored

How concerned are you about developing a peptic ulcer? 1) Not concerned at all 2) Somewhat
concerned 3) Very concerned

How knowledgeable do you feel about peptic ulcer disease?

1) Not knowledgeable at all 2) Somewhat knowledgeable, 3) Very knowledgeable

Where do you get most of your information about peptic ulcer disease?

34
1) Doctors 2) Friends and family, 3) Internet

Have you ever experienced any symptoms that you think might be related to an ulcer?

1) Yes 2) No

Have you ever experienced any of the following symptoms in the past month? (Please select all
that apply)

1) Burning or gnawing pain in your stomach, especially between meals or at night 2) Feeling
bloated or full after eating 3) Nausea or vomiting 4) Loss of appetite 5) Dark or bloody stools

Did you receive treatment?

1) Yes 2) No

What treatment did you receive?

1) Local herbal medicine 2) Medical drugs

Frequency of meals per day:

1) Less than 2 meals 2) 2 meals 3) 3 meals 4) More than 3 meals

How often do you eat breakfast? 1) Never 2) Occasionally 3) Daily How often do you eat lunch?
1) Never 2) Occasionally 3) Daily How often do you eat supper?

1) Never 2) Occasionally 3) Daily

How often do you drink carbonated beverages?

1) Never 2) Occasionally 3) Daily

How often do you consume spicy foods? Consumption of spicy, acidic, or fried foods: (Please
rate the frequency of consumption for each) 1) Never 2) Occasionally 3) Regularly 4) Daily
Alcohol consumption:

1) Never 2) Occasionally 3) Regularly 4) Daily

Smoking habits:

1) Never smoked 2) Former smoker 3) Current smoker

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Do you currently take any nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or
aspirin?

1) Yes 2) No

If yes, how often do you take them?

1) Never 2) Occasionally 3) Frequently

Perceived stress level: (Please choose one)

1) Not stressed at all 2) Slightly stressed 3) moderately stressed 4) Very stressed 5) Extremely
stressed

Stressful events during the past semester: (Please tick all that apply)

1) Academic deadlines 2) Financial difficulties 3) Health concerns

Thank you for your participation!

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