Introduction: Low-middle income countries have high H. pylori prevalence, with acquisition mostly in early childhood. Recent studies from Africa show especially high rates of resistance to first-line antibiotics used to treat H. pylori. We sought to assess the knowledge and practices of primary care physicians (PCPs) in the diagnosis and management of H. pylori infection in Cameroon.
Methods: A hospital-based cross-sectional study was conducted in 4 randomly selected regions of Cameroon, from November 2021 to June 2022. PCPs were recruited by non-probability convenience sampling and interviewed by pre-structured questionnaire on knowledge and approach to H. pylori diagnosis and management. Chi-square, Fisher exact, and Student’s t-tests were performed for descriptive analyses. Multivariable logistic regression was used to examine associations between knowledge and practice, with the model adjusted by PCP age, geographic region, number of patients, and years in practice. Analysis was performed in SAS version 9.4.
Results: A total of 382 PCPs were included. Most (60%) were males, between the ages of 26 – 30 years (60%). The majority had been 2 – 6 years in practice (57%), saw < 10 patients per day (54%), and had not attended postgraduate training on H. pylori (87%). About 80% of PCPs considered H. pylori the cause of GERD symptoms, and about 42% thought H. pylori the main cause of dyspepsia. The dominant diagnostic tests used were serology (53%) and stool antigen (31%). The most prescribed antibiotics for H. pylori eradication were Amoxicillin (AMX, 83%), Clarithromycin (CLA, 74%), and Metronidazole (MNZ, 65%). The most frequently used first-line therapies were AMX/CLA/MNZ & PPI concomitant (40%), AMX/CLA/PPI triple (22%), and AMX/MNZ/PPI triple (15%). 48% of PCPs stated they treated H. pylori infection without a confirmed diagnosis. 38% reported not treating asymptomatic cases with a positive H. pylori test or referring such cases to a gastroenterologist. 52% request laboratory confirmation of H. pylori eradication, with the majority (58%) using serology. If first-line therapy fails, 54% of PCPs then refer to gastroenterologists. Large gaps exist between PCP perception of guidelines versus actual practice for H. pylori diagnostic tests: serology (75%), stool antigen (83%), or urea breath (87%).
Discussion: The majority of PCPS lack the knowledge for adequate diagnosis and management of H. pylori. Strategies targeting PCP education are needed to improve the management of H. pylori infection in Cameroon.
