Clinical and environmental factors associated with Helicobacter pylori infection among patients presenting with Karuho syndrome in Bunia, Democratic Republic of the Congo

Introduction Karuho syndrome is a culturally recognised condition in eastern Democratic Republic of the Congo (DRC), commonly perceived as a form of poisoning and frequently managed in tradimodern healthcare settings. Its clinical characteristics and underlying aetiology remain poorly understood. Purpose To investigate the association between Karuho syndrome and Helicobacter pylori infection by describing the sociodemographic profile of affected patients, identifying associated clinical manifestations, and examining environmental, behavioural, and comorbidity-related factors. Methods A cross-sectional analytical study was conducted between 5 May 2024 and 2 January 2025 among 345 consecutive patients presenting with Karuho syndrome at four tradimodern treatment centres in Bunia, Ituri Province, Democratic Republic of the Congo. Participants underwent stool antigen testing for H. pylori. Sociodemographic, clinical, environmental, behavioural, and biological variables were analysed using bivariate logistic regression. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and statistical significance was set at p < .05. Results Of the 345 participants, 267 (77.4%) tested positive for H. pylori infection. The most affected age group was 20–29 years (OR = 10.7, p = .004), while secondary education was the strongest sociodemographic correlate (OR = 12.8, p = .004). Consumption of food prepared outside the home (OR = 20.78, p < .001) and self-medication (OR = 17.81, p = .012) were the strongest environmental and behavioural factors associated with infection. Clinically, chest pain (OR = 15.16), cough (OR = 11.70), epigastric pain (OR = 10.93), and vomiting (OR = 10.21) showed the strongest associations with H. pylori positivity. Diabetes mellitus (OR = 8.94), malaria (OR = 5.42), and typhoid fever (OR = 6.22) were significantly associated with infection. Conclusion Karuho syndrome demonstrated substantial overlap with the clinical manifestations associated with H. pylori infection. The findings suggest that many symptoms attributed to Karuho may be associated with H. pylori infection and related environmental exposures. However, the cross-sectional design does not permit causal inference. Further microbiological, endoscopic, and longitudinal studies are required to clarify the relationship between Karuho syndrome and H. pylori infection.