Helicobacter pylori (H. pylori) is a spiral-shaped, microaerophilic, gram-negative bacterium that has been recognized as a significant human pathogen since its discovery by Warren and Marshall in 1983. This organism colonizes the gastric mucosa and is known for its role in the development of chronic gastritis, peptic ulcer disease, and gastric malignancies, including mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma ( Warren & Marshall, 1983 ; FitzGerald et al., 2021 ). The bacterium’s pathogenicity is facilitated by several virulence factors, including urease enzyme production, flagella-mediated motility, and the ability to adhere to gastric epithelial cells. These mechanisms enable the bacterium to survive in the harsh acidic environment of the stomach and initiate inflammation that can progress to more serious gastric conditions if untreated ( Hooi et al., 2017 ).

The diagnosis of Helicobacter pylori infection can be achieved through non-invasive and invasive methods. Non-invasive tests include the Urea Breath Test (UBT) and Stool Antigen Test, both of which are highly accurate for initial diagnosis and post-treatment confirmation, while serological tests detect antibodies but cannot distinguish between current and past infections ( Chey & Wong, 2007 ; Vaira et al., 1999 ). Invasive methods, typically used during endoscopy, include the Rapid Urease Test (RUT), histological examination, culture, and PCR testing. RUT provides quick results by detecting urease activity, histology allows direct visualization of the bacteria and associated gastric pathology, culture enables antibiotic susceptibility testing, and PCR detects bacterial DNA with high sensitivity and specificity ( Genta & Graham, 1994 ; Dixon et al., 1996 ; Mégraud, 1997 ; Mapstone et al., 1993 ). The choice of test depends on clinical context, availability, and prior treatment history.

Globally, the prevalence of H. pylori infection is estimated to affect over half of the population, although rates vary significantly depending on geographic location, socioeconomic status, and public health infrastructure. Developed countries tend to have lower prevalence rates due to better sanitation, clean water access, and healthcare availability, whereas developing regions, particularly in Africa, Asia, and South America, report much higher prevalence ( Hooi et al., 2017 ). In Africa, infection rates often exceed 70%, influenced by factors such as poor hygiene, inadequate sanitation, and densely populated living conditions. For instance, Nigeria has reported prevalence as high as 81.7% ( Khalifegholi et al., 2013 ), while Tanzania reported 39.1% ( Jakah et al., 2016 ).

In Cameroon, data show regional variation in H. pylori prevalence, ranging from 47.4% in Bafoussam ( Agbor et al., 2018 ) to 63.4% in Bonamousadi, Douala ( Kpossou et al., 2021 ). A study conducted in Buea and Limbe found a prevalence of 52.3% ( Laure Brigitte et al., 2021 ). These figures underscore the widespread nature of the infection and the importance of targeted research in local healthcare settings to guide public health policies and interventions.

Transmission of H. pylori typically occurs through oral-oral or fecal-oral routes, often during childhood. Inadequate sanitation, consumption of contaminated food or water, and close contact in overcrowded households are recognized risk factors for transmission ( Hooi et al., 2017 ; Torres et al., 1998 ). Despite the availability of effective antibiotics and diagnostic tests, challenges persist in managing H. pylori infections, particularly due to antibiotic resistance and high rates of reinfection in low-resource settings ( McColl, 2010 ).

Understanding the prevalence and associated risk factors of H. pylori is essential for informing clinical practice and developing appropriate public health strategies. This study seeks to fill this gap by examining the prevalence and key risk factors of H. pylori infection among individuals consulting at the Laquintinie Hospital in Douala, Cameroon. Although there is epidemiological evidence of H. pylori in many African settings, most patients neglect its morbidity and the possible risk factors. The findings from this research can provide a foundation for better diagnostic, preventive, and treatment strategies tailored to the Cameroonian context.

This study was to determine the prevalence of Helicobacter pylori infection and its associated risk factors among consulting patients at the Lacantinie Hospital Douala.

This study revealed a high prevalence of Helicobacter pylori (H. pylori) infection (64.0%) among consulting patients at Laquintinie Hospital, Douala. This finding is consistent with previous studies in Cameroon and other parts of Africa, where infection rates remain high due to persistent environmental and socioeconomic risk factors ( Agbor et al., 2018 ; Hooi et al., 2017 ).

Globally, H. pylori prevalence is notably higher in developing regions due to limited access to clean water, poor sanitation, and crowded living conditions ( Eusebi et al., 2014 ; Zamani et al., 2018 ). The significant association between the source of drinking water and H. pylori infection in this study reinforces the role of waterborne transmission, particularly when public water supplies are inadequately treated. Participants who drank tap water had markedly higher infection rates compared to those consuming bottled or treated water. This aligns with findings from studies in Nigeria and Ethiopia, where untreated water consumption was a major predictor of infection ( Omar et al., 2014 ). Nonetheless in Cameroon, a study from the West region of Cameroon revealed a contrary view that, individuals drinking spring water had a higher prevalence of H. pylori (50%) compared to those who drank tap water (43.8%) ( Agbor et al., 2018 ). This may suggest that source of drinking water may not be the only risk factor of being infected with H. pylori. As a result of limited drinking water sources in Douala, some tap water sources may have been constructed from boreholes or nearby streams which are not properly treated and tested for contamination and therefore can harbor H. pylori.

Another critical observation was the strong association between poor hand hygiene practices and H. pylori infection. Participants who did not wash their hands before and after meals were universally infected, underscoring the fecal-oral route as a major transmission pathway ( Brown, 2000 ). This finding highlights the importance of promoting basic hygiene interventions as cost-effective measures to prevent infection. Alcohol consumption was also significantly associated with H. pylori infection. Though some studies suggest that moderate alcohol intake might have a protective effect by inhibiting bacterial colonization due to its antimicrobial properties ( Zhang et al., 2015 ), heavy or irregular drinking may disrupt gastric mucosal defenses and promote infection, which could explain the increased prevalence among alcohol consumers in this cohort. Also, alcohol drinking is always associated with other lifestyle habits like smoking, poor diets and stress which may indirectly affect H. pylori risk.

Unexpectedly, lower income was found to be protective against H. pylori infection compared to higher income levels. While poverty is traditionally linked to higher H. pylori infection rates ( Khalifegholi et al., 2013 ), this result might reflect behavioral differences, such as the tendency of lower-income households to use boiled water or be more cautious with food hygiene, possibly due to a heightened awareness of disease risks. Also, this study found out that, 77.1% of the individuals were individuals with low income level (≤5000 fr), so this may have undermined the findings of this study and making low income protective. Nonetheless, low income is known to be associated with poor hygiene and sanitation which is a predictor of H. pylori infection. Religious affiliation was another significant predictor, with Christians and Muslims showing higher odds compared to other groups. Although religion itself is unlikely to be a direct risk factor, associated cultural practices (such as communal eating, ablution practices, and dietary habits) could influence exposure levels ( Abebaw et al., 2014 ). Although there is no direct link between Christian fasting an H. pylori infection, Christians are known to practice fasting which entails eating once a day or going several days without eating. This practice may promote gastric juice production which may cause irritation of the stomach mucosa and weakening of the gastric mucosal barrier, making the stomach lining more susceptible to H. pylori colonization. Meanwhile in Muslims, the practice of ablution before prayers can be a major source fecal-oral contamination with H pylori.

Other demographic factors, such as age, sex, education level, household occupancy, and urban vs semi-urban residence, were not significantly associated with infection, consistent with some studies in Sub-Saharan Africa ( Miftahussurur et al., 2017 ). This suggests that environmental exposures and individual hygiene practices may play more critical roles than socio-demographic variables in determining infection risk. This study confirmed that despite improvements in healthcare accessibility, behavioral and environmental factors remain primary drivers of infection transmission in Douala. This is consistent with calls from the World Gastroenterology Organization for integrated strategies focusing on sanitation, public education, and screening to control H. pylori infections in developing countries ( WGO Global Guidelines, 2022 ).

This study demonstrated a high prevalence of Helicobacter pylori infection (64.0%) among consulting patients at Laquintinie Hospital Douala, with significant associations to modifiable environmental and behavioral factors, particularly the source of drinking water, poor hand hygiene, and alcohol consumption. Socio-demographic factors such as religion and income level also showed associations, although traditional predictors like age, sex, and education level were not significant in this cohort. These findings emphasize that despite advances in healthcare services, infection control remains challenged by inadequate sanitation and personal hygiene practices. Targeted public health interventions, enhanced sanitation infrastructure, and behavior change communication campaigns are urgently required to reduce the burden of H. pylori and its associated morbidities in Cameroon.

HFM conceived, designed, supervised the study and major contributions, performed statistical analysis and drafted manuscript, NNA participated in designing the project and carried out data collection in the field. AWC, TBF, WDS and ALB contributed in the revision of the manuscript. All authors read and approved the final manuscript.

No special funding was received for this research.

All datasets generated and analyzed during the study are presented in the paper.

The authors appreciate the support and cooperation of all the patients who participated in the study. We also appreciate the Cornerstone University and Theological Seminary, Cameroon for giving us the opportunity to carry out this project.