Introduction

Directive Publications Gift Atumatuchukwu Uzah health issue, with multiple hospital-based studies showing high prevalence among symptomatic and asymptomatic patients. Recent findings have reported seroprevalence ranging between 30% and 85% among various population groups in Nigeria and Africa (Lawson, 2023; Palamides et al., 2020; Ray-Offor & Obiorah, 2018; Smith et al., 2022). Despite this burden, routine testing is not common in many primary care settings due to cost and infrastructure limitations, leaving many cases undiagnosed or misdiagnosed. Within the Rivers State region, there is a growing concern about the underreporting and underdiagnosis of H. pylori infections. A few studies in Port Harcourt have documented high infection rates among patients with dyspeptic symptoms, highlighting the need for localized surveillance and intervention (Lawson, 2023). However, there is a paucity of data on infection rates specifically within tertiary institutions and their healthcare centers, including the IAUE Medical Centre, which caters to a large number of students and staff. Students and staff in university environments like IAUE may face unique risk factors such as shared accommodation, poor dietary habits, and inadequate hygiene practices, which could predispose them to H. pylori infection (Vale & Vítor, 2010; Duan et al. 2023; Ekundayo et al. 2023). Yet, no study to date has systematically evaluated the seroprevalence of H. pylori within this academic medical setting. Establishing accurate prevalence data is critical for informing health promotion strategies, diagnostic protocols, and appropriate therapeutic interventions. Moreover, the emergence of antibiotic-resistant strains of H. pylori further underscores the importance of surveillance. Treatment failure due to increasing antimicrobial resistance, including resistance to clarithromycin and metronidazole, represents a major challenge in H. pylori eradication, posing a challenge to effective eradication (Harrison et al., 2017; Savoldi et al., 2018; Chukwudike et al., 2024). Understanding the seroprevalence or infection rates and potential risk factors in specific populations such as that served by IAUE Medical Centre can contribute to the global understanding of H. pylori epidemiology and improve patient outcomes through tailored public health responses and improving clinical management strategies. METHODOLOGY Study Design A cross-sectional descriptive design was adopted in this study to determine the seroprevalence of Helicobacter pylori infection among patients attending the medical outpatient clinic at Ignatius Ajuru University of Education (IAUE) Medical Centre, Rivers State, Nigeria. The cross-sectional approach is appropriate for estimating the prevalence of a condition at a single point in time and for exploring associations between H. pylori infection and various sociodemographic or clinical variables within the target population. Study Area The study was conducted at the Medical Centre of Ignatius Ajuru University of Education (IAUE), located in Rumuolumeni, Port Harcourt, Rivers State, Nigeria. IAUE is a public university established to provide higher education and promote research across various academic disciplines. The university operates a medical centre that offers primary and secondary healthcare services to its students, staff, and members of the surrounding communities. The IAUE Medical Centre is equipped with basic diagnostic facilities, a pharmacy, consulting rooms, and a laboratory that supports routine clinical investigations. Port Harcourt, the capital of Rivers State, is a major urban center in southern Nigeria with a diverse population and a mix of urban and peri-urban settlements. Rivers State lies in the Niger Delta region, which is characterized by rapid urbanization, oil-based industrial activity, and a tropical climate. The state faces various public health challenges, including limited access to clean water and sanitation, both of which are important risk factors for Helicobacter pylori transmission. These environmental and socioeconomic conditions make the area particularly suitable for investigating the burden of H. pylori infection. The IAUE Medical Centre was selected for this study due to its accessibility to a broad patient population that includes individuals from both academic and non-academic backgrounds. The Centre receives patients with varied medical complaints, including gastrointestinal symptoms, making it an appropriate setting for assessing the seroprevalence of H. pylori. Additionally, the university environment presents an opportunity to evaluate the infection in a relatively defined and structured population, which can contribute valuable insights for targeted health interventions and future research. Study Population The study population consists of consenting adult patients (aged ≥18 years) attending the IAUE Medical Centre for general medical consultation during the study period. Patients presenting with gastrointestinal symptoms suggestive of dyspepsia (e.g., epigastric pain, bloating, nausea) were prioritized, although asymptomatic individuals were also included to capture broader community-level infection rates. Inclusion Criteria • Patients aged ≥18 years. • Willing to provide informed consent. Exclusion Criteria Patients on recent antibiotic or proton pump inhibitor therapy Page - 2Open Access, Volume 18 , 2026

Gift Atumatuchukwu Uzah Directive Publications Page - 3Open Access, Volume 18 , 2026 (within the past 2 weeks), previous H. pylori treatment, or chronic comorbidities that could confound test results (e.g., malignancies or immunosuppressive conditions) were excluded from the study. Sample Size Determination A total of 98 samples were collected from consenting patients attending IAUE Medical Centre. The sample size determination was based on standard prevalence estimation formulas, using an assumed H. pylori prevalence of 55% (based on prior regional studies), a 95% confidence interval, and a 5% margin of error. Using the formula: n=(Z 2 pq)/d 2 Where: • Z = 1.96 (95% confidence) • p = assumed prevalence (55%) • q = 1 - p • d = margin of error (0.05) Sampling Technique Systematic random sampling of patients who meet the inclusion criteria were considered. Blood samples were collected under sterile conditions, and serum were tested using a commercially validated enzyme-linked immunosorbent assay (ELISA) to detect H. pylori-specific IgG antibodies. This serological method is cost-effective and suitable for epidemiological surveys, although it detects both current and past infections. Data Collection and Analysis Data on sociodemographic characteristics, clinical symptoms, hygiene practices, and dietary habits were collected via structured questionnaires and analyzed using descriptive and inferential statistics (e.g., chi-square tests and logistic regression). A p-value <0.05 were considered statistically significant. The outcomes of the serological testing and sociodemographic data were corroborated to other research work and which help to inform local disease burden and guide public health interventions targeting H. pylori control. Ethical Considerations Ethical approval was obtained from the IAUE Research Ethics Committee. Informed consent was secured from each participant, and confidentiality was maintained. RESULTS A.Sociodemographic characteristic of respondents Table 1.1. Age Distribution of Respondents. Age Group Frequency (n) Percentage (%) 10 – 20 56 57.1 21 – 30 31 31.6 31 – 40 11 11.2 Total 98 100 Source: An Extract From SPSS Version 25.0

Directive Publications Gift Atumatuchukwu Uzah Figure 1.1. Bar Chart Showing Age Distribution of Respondents. Table 1.1 and figure 1.1 shows the age distribution of the 98 respondents. The largest proportion (57.1%) falls within the 10–20 years age group, followed by 21–30 years with 31.6%. Only 11.2% of the respondents are between 31–40 years. This indicates that most participants were young individuals, likely reflecting the IAUE demographic dominated by students and young adults. Table 1.2. Sex Distribution of Respondents. Sex Frequency (n) Percentage (%) Male 82 83.7 Female 16 16.3 Total 98 100 Source: An Extract From SPSS Version 25.0. Figure 1.2. Bar Chart Showing Sex Distribution of Respondents. Table 1.2 and figure 1.2 shows the sex distribution of the 98 respondents. The majority of the respondents were male, accounting for 83.7% (n = 82), while females constituted only 16.3% (n = 16). This indicates that the study population was predominantly male, which may reflect the demographic characteristics of the IAUE Medical Centre attendees. Table 1.3. Marital Status of Respondents. Marital Status Frequency (n) Percentage (%) Single 93 94.9 Married 5 5.1 Divorced 0 0.0 Widowed 0 0.0 Total 98 100 Source: An Extract From SPSS Version 25.0 Page - 4Open Access, Volume 18 , 2026

Gift Atumatuchukwu Uzah Directive Publications Page - 5Open Access, Volume 18 , 2026 Figure 1.3. Bar Chart Showing Marital Status Distribution of Respondents. Table 1.3 and figure 1.3 shows the marital status distribution of the 98 respondents. The majority were single, accounting for 94.9% (n = 93), while only 5.1% (n = 5) were married. None of the respondents were divorced or widowed. This shows that most participants were young adults, which aligns with the IAUE Medical Centre population that mainly consists of students. Table 1.4. Educational Level of Respondents. Educational Level Frequency (n) Percentage (%) No Formal Education 0 0.0 Primary 0 0.0 Secondary 20 20.4 Tertiary 78 79.6 Total 98 100 Source: An Extract From SPSS Version 25.0

Directive Publications Gift Atumatuchukwu Uzah Figure 1.4. Bar Chart Showing educational level Distribution of Respondents Table 1.4 and Figure 1.4 present the educational level of the 98 respondents. A majority (79.6%) had tertiary education, while 20.4% had secondary education. None of the respondents reported having primary or no formal education. This indicates that the study participants were predominantly well‑educated, consistent with the IAUE Medical Centre population, which largely comprises students and staff of an academic institution. Table 1.5. Occupation of Respondents. Occupation Frequency (n) Percentage (%) Student 90 91.8 Others 8 8.2 Total 98 100 Source: An Extract From SPSS Version 25.0 Figure 1.5. Pie Chart Showing Occupation of Distribution of Respondents. Table 1.5 and figure 1.5 show that the vast majority of respondents (91.8%) were students, while only 8.2% fell into the ‘Others’ category. This indicates that most participants were members of the IAUE academic environment, which aligns with the study setting at the IAUE Medical Centre. The dominance of students in the sample implies that the findings primarily reflect the health profile of a young, school‑based population. Table 1.6. Place of Residence of Respondents. Residence Frequency (n) Percentage (%) Urban 54 55.1 Semi-urban 30 30.6 Rural 14 14.3 Total 98 100 Source: An Extract From SPSS Version 25.0 Page - 6Open Access, Volume 18 , 2026

Gift Atumatuchukwu Uzah Directive Publications Page - 7Open Access, Volume 18 , 2026 Figure 1.6. Pie Chart Showing Place of Residence Distribution of Respondents Table 1.6 and Figure 1.6 present the place of residence of the 98 respondents. A majority (55.1%) resided in urban areas, followed by 30.6% living in semi-urban locations. Only 14.3% were from rural areas. This distribution indicates that most participants were urban dwellers, which aligns with the IAUE Medical Centre’s location within an urban environment. The predominance of urban residents suggests easier access to healthcare services, which may influence the study’s findings. Table 1.7. Monthly Household Income of Respondents Monthly Income ₦ Frequency (n) Percentage (%) < 50,000 48 49.0 50,000 – 100,000 21 21.4 100,001 – 200,000 14 14.3 > 200,000 15 15.3 Total 98 100 Source: An Extract From SPSS Version 25.0 Figure 1.7. Pie Chart Showing Place of Residence Distribution of Respondents

Directive Publications Gift Atumatuchukwu Uzah Table 1.7 and Figure 1.7 present the monthly household income of the 98 respondents. Nearly half (49.0%) reported earning less than ₦50,000 monthly, while 21.4% earned between ₦50,000 and ₦100,000. Additionally, 14.3% earned between ₦100,001 and ₦200,000, and 15.3% reported earnings above ₦200,000. This distribution shows that most respondents fall within the lower-income category, which may reflect the socioeconomic characteristics of the IAUE Medical Centre population, comprising mainly students and lower‑income earners. B.Seroprevalence of H. pylori Infection Table 2.1. H. pylori Seropositivity among Patients. H. pylori Status Frequency Percentage (%) Positive 56 57.1 Negative 42 42.9 Total 98 100.0 Seroprevalence = 57.1% Table 2.1 shows that out of the 98 patients tested for Helicobacter pylori infection, 56 (57.1%) were seropositive, while 42 (42.9%) tested negative. This indicates that more than half of the sampled population had been exposed to or infected with H. pylori. The seroprevalence rate of 57.1% suggests that H. pylori infection is relatively common among patients attending the IAUE Medical Centre and may represent a significant public health concern requiring further attention in terms of prevention, diagnosis, and treatment strategies. Table 2.2. Age vs H. pylori Seropositivity. Age Group Positive Negative Total 18–25 15 16 31 26–35 22 15 37 36–45 10 7 17 46–55 5 3 8 >55 4 1 5 Total 56 42 98 χ² = 6.03, p = 0.048 (significant) Table 2.2 presents the relationship between age and H. pylori seropositivity among the 98 respondents. The highest number of positive cases occurred in the 26–35 age group (22 out of 37), followed by the 18–25 group (15 out of 31). The lowest frequency of positive cases was found among respondents above 55 years (4 out of 5). The chi-square test result (χ² = 6.03, p = 0.048) indicates that there is a statistically significant association between age and H. pylori infection at the 0.05 level. This suggests that H. pylori seropositivity varies significantly across age categories, with younger adults especially those aged 26–35 appearing more affected than older participants. Table 2.3. Sex vs H. pylori Seropositivity. Sex Positive Negative Total Male 25 20 45 Female 31 22 53 Total 56 42 98 χ² = 0.12, p = 0.73 (not significant) Table 2.3 shows the relationship between sex and H. pylori seropositivity. Among the 45 males, 25 tested positives, while 31 out of 53 females were positive for H. pylori. Although more females were infected than males in absolute numbers, the chi-square test result (χ² = 0.12, p = 0.73) indicates no statistically significant association between sex and H. pylori infection. This means that infection rates did not differ meaningfully by sex, suggesting that both males and females have a comparable likelihood of acquiring H. pylori within the study population. Page - 8Open Access, Volume 18 , 2026

Gift Atumatuchukwu Uzah Directive Publications Page - 9Open Access, Volume 18 , 2026 Table 2.4. Hygiene Practices vs H. pylori Infection Handwashing Before Meals Positive Negative Total Yes 32 28 60 No 24 14 38 Total 56 42 98 χ² = 2.18, p = 0.09 (not significant) Table 2.4 examines the relationship between handwashing practices before meals and H. pylori infection. Among respondents who regularly washed their hands before meals, 32 out of 60 tested positives, while 24 out of 38 who did not wash hands tested positive. Although a higher proportion of non-handwashers were infected, the chi-square result (χ² = 2.18, p = 0.09) shows no statistically significant association between handwashing habits and H. pylori seropositivity at the 0.05 level. This suggests that while poor hygiene may contribute to infection risk, it was not a strong predictor of H. pylori infection in this study population. Table 2.5. Sharing Eating Utensils vs H. pylori Infection. Sharing Eating Utensils Positive Negative Total Yes 37 17 54 No 19 25 44 Total 56 42 98 χ² = 4.95, p = 0.026 (significant) Table 2.5 shows the relationship between sharing eating utensils and H. pylori infection. Among respondents who shared utensils, 37 out of 54 tested positive, compared to 19 out of 44 who did not share utensils. The chi-square test (χ² = 4.95, p = 0.026) indicates a statistically significant association between sharing eating utensils and H. pylori seropositivity. This suggests that individuals who share eating utensils are more likely to be infected with H. pylori, highlighting shared utensils as a potential transmission route within the study population. DISCUSSION The study revealed a relatively high seroprevalence of Helicobacter pylori among patients attending IAUE Medical Centre, with 57.1% (56/98) testing positive for H. pylori antibodies. This finding indicates that more than half of the study population had previous exposure to or infection with the organism. The observed prevalence may be associated with environmental conditions, sanitation challenges, and socioeconomic factors that influence H. pylori transmission. Studies have shown that infection remains highly prevalent in developing regions, particularly in Africa, where childhood exposure, household transmission, and poor living conditions contribute to sustained infection rates with prevalence rates exceeding 70% (Hooi et al., 2017; Smith et al., 2022). Similarly, Nigerian studies have reported substantial levels of H. pylori infection among different populations, highlighting the continued public health importance of the organism in the country (Harrison et al., 2017; Palamides et al., 2020). The present finding suggests that H. pylori remains an important health concern in Rivers State. However, this result is in contrast with the submission of Adim et al (2024) who reported a prevalence of 31% among pregnant women in Mbodo-Aluu community, indicating that H. pylori prevalence may vary with population characteristics. This finding is supported by epidemiological reviews have emphasized that sanitation, household crowding, water contamination, and socioeconomic conditions contribute significantly to differences in H. pylori prevalence worldwide (Mežmale et al., 2020; Zamani et al., 2018). Furthermore, the study revealed a significant relationship between age and H. pylori infection (p = 0.048). Respondents aged 26–35 years accounted for the highest number of positive cases, followed by those aged 18–25 years. This suggests increased exposure among young adults, which may be related to lifestyle patterns, social interaction possibly due to higher movement, shared accommodation, poor dietary habits, and work-related stress. Previous studies indicate that H. pylori acquisition commonly occurs early in life and infection patterns may reflect cumulative exposure to risk factors throughout life (Eusebi et al., 2014; Zamani et al., 2018). However, the present finding differs from reports suggesting increasing prevalence with advancing age, supported by the life-course epidemiology perspective, which implies that exposures in early adulthood increase the likelihood of infection before immunity declines where older individuals demonstrate higher infection rates due to longer duration of exposure (Hooi et al., 2017; Eusebi et al., 2014). However, the study revealed no significant relationship between sex and H. pylori seropositivity (p = 0.73). Although females (31) had slightly higher infection rates than males (25), the difference was not statistically significant. This suggests that sex does not play a meaningful role in determining H.

Directive Publications Gift Atumatuchukwu Uzah pylori susceptibility among patients attending IAUE Medical Centre. This finding is consistent with Hooi et al. (2017) who reported that H. pylori infection shows no sex predilection. Similarly, Smith et al. (2018), which investigated clinical and sociodemographic risk factors for H. pylori infection in Nigeria and found no significant association between sex and infection status. The study reported similar infection proportions between males and females. The present result reflects the biological theory that exposure rather than biological sex is the major determinant of infection. Similarly, no significant relationship was observed between handwashing before meals and H. pylori infection (p = 0.09) in the study. Although individuals with poor handwashing practices showed a higher proportion of infection, the association was not statistically significant. This finding supports the understanding that H. pylori transmission is complex and involves multiple pathways, including oral–oral, fecal–oral, and environmental routes (Duan et al., 2023; Vale & Vítor, 2010). Previous studies have indicated that hygiene practices may influence transmission; however, handwashing alone may not completely prevent infection because exposure may occur through contaminated food, water, and close household contact (Salih, 2009; Ekundayo et al., 2023). The finding is supported by public health theory which proposes that disease transmission is multifactorial and cannot be attributed to a single behavioral factor. Finally, the study revealed a significant relationship between sharing of eating utensils and H. pylori infection (p = 0.026). Participants who shared utensils recorded more positive cases than those who did not, suggesting that close interpersonal contact may contribute to transmission. This finding agrees with evidence that intrafamilial spread and oral–oral transmission pathways contribute to H. pylori dissemination (Vale & Vítor, 2010; Duan et al., 2023). The finding also supports previous observations that household behaviors and communal practices may influence infection risk. However, transmission is multifactorial, and environmental factors such as sanitation and water quality may also contribute substantially to infection patterns (Ekundayo et al., 2023; Mežmale et al., 2020). The present finding is supported by the infectious disease transmission model, which identifies direct contact as a significant route of transmission. CONCLUSIONS The study established that H. pylori infection is highly prevalent among patients attending IAUE Medical Centre. The significant association between age and infection suggests that young adults may be at greater risk due to lifestyle characteristics such as communal living and poor hygiene practices. Although infection rates were slightly higher among females, sex showed no significant association with infection. Importantly, sharing eating utensils was significantly associated with H. pylori seropositivity, indicating that oral–oral transmission remains a critical pathway within the study population. The lack of significant association with handwashing reinforces the multifactorial nature of H. pylori transmission, which may involve close contact, poor sanitation, and dietary habits. Overall, the findings emphasize the need for improved awareness, early diagnosis, and behavioural modifications to reduce the burden of H. pylori infection in the IAUE community. Disclaimer (Artificial Intelligence) Author(s) hereby declare that NO generative AI technologies such as Large Language Models (ChatGPT, COPILOT, etc.) and text-to-image generators have been used during the writing or editing of this manuscript. REFERENCES 1. Abdulrasheed, A., Lawal, O. O., Abioye-Kuteyi, E. 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Directive Publications Gift Atumatuchukwu Uzah 24. Palamides, P., Jolaiya, T., Idowu, A., et al. (2020). Helicobacter pylori patient isolates from South Africa and Nigeria differ in virulence factor pathogenicity profile and associated gastric disease outcome. Scientific Reports, 10, 11409. https://doi.org/10.1038/ s41598-020-66128-0 25. Panarelli, N. C., & Yantiss, R. K. (2018). Inflammatory and infectious manifestations of immunodeficiency in the gastrointestinal tract. Modern Pathology, 31(6), 844– 861. https://doi.org/10.1038/s41379-018-0015-9 26. Plummer, M., Franceschi, S., Vignat, J., Forman, D., & de Martel, C. (2015). Global burden of gastric cancer attributable to Helicobacter pylori. International Journal of Cancer, 136(2), 487–490. https://doi.org/10.1002/ ijc.28999 27. Ray-Offor, E., & Obiorah, C. C. (2018). Helicobacter pylori and precancerous lesions of the stomach in a Nigerian metropolis: A cohort study. Nigerian Journal of Clinical Practice, 21(3), 375–379. https://doi.org/10.4103/njcp. njcp_302_17 28. Sabbagh, P., Mohammadnia-Afrouzi, M., Javanian, M., Babazadeh, A., Koppolu, V., Vasigala, V. K. R., Ebrahimpour, S., & Nouri, H. R. (2019). Diagnostic methods for Helicobacter pylori infection: Ideals, options, and limitations. European Journal of Clinical Microbiology & Infectious Diseases, 38, 55–66. https:// doi.org/10.1007/s10096-018-3414-4 29. Salih, B. A. (2009). Helicobacter pylori infection in developing countries: The burden for how long? Saudi Journal of Gastroenterology, 15(3), 201–207. https://doi. org/10.4103/1319-3767.54743 30. Savoldi, A., Carrara, E., Graham, D. Y., Conti, M., & Tacconelli, E. (2018). Prevalence of antibiotic resistance in Helicobacter pylori: A systematic review and meta-analysis in World Health Organization regions. Gastroenterology, 155(5), 1372–1382.e17. https://doi. org/10.1053/j.gastro.2018.07.007 31. Sharma, M. P., & Bhatia, V. (2004). Abdominal tuberculosis. Indian Journal of Medical Research, 120(4), 305–315. 32. Smith, S. I., Ajayi, A., Jolaiya, T., Onyekwere, C., Setshedi, M., Schulz, C., Otegbayo, J. A., Ndip, R; Dieye, Y., & Arigbabu, A. (2022). Helicobacter pylori infection in Africa: Update of the current situation and challenges. Digestive Diseases, 40(5), 535–544. https://doi. org/10.1159/000518959 33. Smith, S., Jolaiya, T., Fowora, M., Palamides, P., Ngoka, F., Bamidele, M., Lesi, O., Onyekwere, C., Ugiagbe, R., Agbo, I., Ndububa, D., Adekanle, O., Adedeji, A., Adeleye, I., & Harrison, U. (2018). Clinical and socio-demographic risk factors for acquisition of Helicobacter pylori infection in Nigeria. Asian Pacific Journal of Cancer Prevention, 19(7), 1851–1857. https://doi.org/10.22034/ APJCP.2018.19.7.1851 34. Vale, F. F., & Vítor, J. M. B. (2010). Transmission pathway of Helicobacter pylori: Does food play a role in rural and urban areas? International Journal of Food Microbiology, 138(1–2), 1–12. https://doi.org/10.1016/j. ijfoodmicro.2010.01.016 35. World Health Organization. (2017). Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug-resistant bacterial infections, including tuberculosis. World Health Organization. https://iris.who.int/handle/10665/311820 36. World Health Organization. (2021). Helicobacter pylori and cancer. World Health Organization. https://www. who.int/news-room/fact-sheets/detail/helicobacter- pylori-and-cancer 37. Zamani, M., Ebrahimtabar, F., Zamani, V., Miller, W. H., Alizadeh-Navaei, R., Shokri-Shirvani, J., & Derakhshan, M. H. (2018). Systematic review with meta-analysis: The worldwide prevalence of Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics, 47(7), 868– 876. https://doi.org/10.1111/apt.14561 Page - 12Open Access, Volume 18 , 2026