Helicobacter pylori infections in Ethiopia; prevalence and associated factors: a systematic review and meta-analysis

Abstract

Background: Helicobacter pylori (H.pylori) infections are prevalent and recognized as major cause of gastrointestinal diseases in Ethiopia. However, Studies conducted on the prevalence, risk factors and other clinical forms of H.pylori on different population and geographical areas are reporting conflicting results. Therefore, this review was conducted to estimate the pooled prevalence of H.pylori infections and associated factors in Ethiopia.

Methods: PubMed, Embase, Google scholar, and Ethiopian Universities' repositories were searched following the Preferred Items for Systematic review and Meta-analysis (PRISMA) guideline. The quality of included studies was assessed using the Newcastle-Ottawa Scale in meta-analysis. Heterogeneity between studies was assessed using Cochrane Q test and I² test statistics based on the random effects model. Comprehensive meta-analysis (CMA 2.0) and Review Manager (RevMan 5.3) were employed to compute the pooled prevalence and summary odds ratios of factors associated with of H.pylori infection.

Results: Thirty seven studies with a total of 18,890 participants were eligible and included in the analysis. The overall pooled prevalence of H.pylori infection was 52.2% (95% CI: 45.8-58.6). In the subgroup analysis by region, the highest prevalence was found in Somalia (71%; 95% CI: 32.5-92.6) and the lowest prevalence was reported in Oromia (39.9%; 95% CI: 17.3-67.7). Absence of hand washing after toilet (OR = 1.8, 95% CI; 1.19-2.72), alcohol consumption (OR = 1.34, 95% CI; 1.03-1.74) and gastrointestinal (GI) symptoms (OR = 2.23, 95% CI; 1.59-3.14) were associated with H.pylori infection. The trend of H.pylori infection showed a decreasing pattern overtime from 1990 to 2017 in the meta-regression analysis.

Conclusion: The prevalence of H.pylori infection remains high; more than half of Ethiopians were infected. Although the trend of infection showed a decreasing pattern; appropriate use of eradication therapy, health education primarily to improve knowledge and awareness on the transmission dynamics of the bacteria, behavioral changes, adequate sanitation, population screening and diagnosis using multiple tests are required to reduce H.pylori infections. Recognizing the bacteria as a priority issue and designing gastric cancer screening policies are also recommended.

Keywords: Ethiopia; Helicobacter pylori; Meta-analysis; Systematic review.

Fig. 1

PRISMA flow chart of article selection

Fig. 2

Forest plot of the pooled prevalence of helicobacter pylori infection in Ethiopia from 37 studies

Fig. 3

Publication bias assessment funnel plot; Egger’s regression test (p = 0.172) and Begg’s rank correlation (p = 0.367)

Fig. 4

Sociodemographic factors associated with H.pylori infection by sex (a); by age group (b); by educational level (c) and by residency (d)

Fig. 5

Environmental factors associated with H.pylori infection by type of water source for drinking (a); and by hand washing habit after toilet (b)

Fig. 6

Behavioral factors associated with H.pylori infection chat chewing (a); by cigarette smoking (b) and by alcohol consumption (c)

Fig. 7

Clinical factors associated with H.pylori infection by gastrointestinal (GI) symptoms

Fig. 8

Meta-regression of the prevalence H.pylori infection by year of study (B = −0.067, p = 0.00004) (a); and sample size of studies (B = −0.00079, p = 0.193) (b)