Prevalence and patterns of peptic ulcer disease in Africa: a systematic review and meta-analysis

Peptic ulcer disease (PUD) remains a significant yet poorly understood public health issue in Africa, despite its declining prevalence in Western countries. Studies from Africa report a highly variable burden, with the highest prevalence observed in West Africa and the lowest in Southern Africa. However, the overall burden of PUD in Africa, its patterns (duodenal ulcers, gastric ulcers, and coexisting ulcers), and its association with H. pylori infection remain unclear.

This review aims to systematically analyze the pooled prevalence and patterns of PUD in Africa through a systematic review and meta-analysis.

A systematic review and meta-analysis was conducted following the PRISMA checklist. We searched PubMed, Hinari, and Google Scholar, supplemented by Google and Yahoo search engines. Observational studies reporting the prevalence and patterns of PUD among the African population were included. Two independent reviewers extracted data and assessed study quality. Pooled prevalence estimates were calculated using a random-effects model, with heterogeneity assessed via the Cochrane Q test and I² statistic.

A comprehensive analysis of 58 studies revealed a pooled prevalence of PUD in Africa at 15.2%. The most common ulcer pattern was DU at 10.2%, followed by GU at 5.8%, while 0.6% of cases had both types. Regional variations were observed, with West Africa having the highest prevalence (19%), followed by East Africa (15%), North Africa (12%), and Southern Africa (8%). Among individual countries, Ghana reported the highest prevalence (27%), followed by Ethiopia (19%) and Tanzania (16%). Furthermore, the pooled prevalence of PUD was 14% before 2010 and 15% in 2011 and later. Additionally, 57.1% of patients tested positive for Helicobacter pylori infection, with its prevalence reaching 76.4% among those diagnosed with PUD. Substantial heterogeneity was observed across most analyses, with I² values exceeding 95% and p-values < 0.001.

The analysis revealed a significant burden of PUD in Africa, with DU being more common than GU. Regional disparities were observed, with the highest prevalence in West and East Africa. Over the past two decades, the burden has remained relatively stable, reflecting a concerning trend. H. pylori infection was also frequently diagnosed in individuals undergoing endoscopic examination. However, substantial heterogeneity was noted across studies, highlighting variability in reported prevalence.