Helicobacter pylori is a globally prevalent pathogen and a major risk factor for gastric cancer. This systematic review and meta-analysis evaluated the burden, clinical impact, and primary antimicrobial resistance profiles of H. pylori infections in Cameroon. The study aimed to produce pooled prevalence estimates, describe clinical associations, and summarize resistance data to inform treatment and stewardship efforts.
The review was registered in PROSPERO (CRD420261375391) and followed PRISMA guidelines. Six electronic databases were searched for relevant studies published between 2000 and 2026. Forty-six studies met inclusion criteria. Pooled proportions were calculated using random-effects models. Sensitivity analyses were performed to explore potential confounding factors. The authors extracted prevalence, subgroup data (by setting, region, age group, and clinical presentation), and antimicrobial resistance rates reported in the included studies.
Across the assembled studies, the pooled proportion of H. pylori infection was 56.7% (95% CI 51.1–62.1%). This estimate represents an average across diverse study populations and diagnostic approaches represented in the included literature. The pooled prevalence provides a national-level baseline estimate derived from studies spanning 2000–2026.
Subgroup analyses identified variation by clinical setting, geographic region, age group, and clinical presentation:
These subgroup findings indicate heterogeneity in H. pylori prevalence within Cameroon and suggest regional and population groups with higher burden.
The burden of infection was positively associated with disease severity. Notably, 64.5% of infection cases were observed in patients with gastric cancer, indicating a strong representation of H. pylori among more severe gastric pathologies in the included studies. The review also reports that H. pylori infections led to adverse clinical effects such as anemia. These observations underline the clinical relevance of H. pylori as both a common infection and a contributor to significant gastrointestinal morbidity.
Pooled resistance estimates from isolates reported in the included studies showed marked variation by antibiotic:
The summary indicates major challenges for standard eradication therapies where high resistance to widely used agents is present.
Multidrug-resistant H. pylori isolates accounted for 77.6% of resistant strains across the included studies. This high proportion of multidrug resistance underscores concerns about limited effective antibiotic options and the need for targeted susceptibility testing to guide therapy.
The review identifies several urgent gaps and limitations in the Cameroonian evidence base:
These gaps indicate priorities for expanded, standardized surveillance and prospective studies that include comprehensive susceptibility testing and well-characterized clinical cohorts.
The pooled prevalence of 56.7% confirms a high burden of H. pylori infection in Cameroon, with greater prevalence in specific regions, adult populations, and among patients with gastrointestinal complaints. The association between infection and more severe gastric disease, including the high proportion seen in gastric cancer, supports the clinical importance of detection and appropriate management.
Antimicrobial resistance findings—especially very high pooled resistance to metronidazole and the reported high rate for amoxicillin—have direct implications for choice of empiric regimens and underscore the need for local susceptibility-guided therapy where feasible. The high proportion of multidrug-resistant isolates (77.6%) further reinforces the need for antimicrobial stewardship, routine resistance surveillance, and studies to validate unexpected findings (such as the amoxicillin resistance estimate).
Overall, the review provides a baseline national synthesis intended to inform therapeutic decision-making and resistance stewardship in Cameroon, while highlighting the necessity for confirmatory studies, broader geographic coverage, and inclusion of underrepresented at-risk groups in future research.