Prevalence of ocular allergy among children in Africa: a systematic review and meta-analysis

Ocular allergy ranges from seasonal and perennial allergic conjunctivitis to chronic, potentially sight-threatening vernal keratoconjunctivitis (VKC). African prevalence studies use heterogeneous terminology and case-ascertainment methods, and their estimates have not previously been synthesized. To synthesise published prevalence estimates of ocular allergy among African children, quantify uncertainty around summary estimates, and describe between-study variation. PubMed/MEDLINE, Google Scholar, African Journals Online and African Index Medicus were searched for observational studies published from 1 January 2010 to 31 December 2025. Disease-specific terms were supplemented with broader ocular-morbidity terminology, reference-list screening and citation verification to identify studies reporting ocular allergy as a secondary outcome. Eligible studies enrolled African children and provided an extractable numerator and denominator. Logit-transformed proportions were pooled using a random-effects restricted maximum-likelihood (REML) model in Stata 17. Heterogeneity, 95% prediction intervals, diagnostic and setting subgroups, and sensitivity analyses were reported. Fourteen studies from five countries included 18,681 children, of whom 1,911 had ocular allergy, allergic conjunctivitis or VKC/vernal disease. The pooled prevalence was 9.4% (95% confidence interval [CI] 5.4%–15.6%), with extreme heterogeneity (τ2 = 1.23; I2 = 99.19%; Q(13) = 1844.38, p < 0.001) and a 95% prediction interval of 0.8%–55.9%. The pooled estimate was 14.5% (95% CI 5.5%–33.0%; k = 6) for allergic conjunctivitis and 6.6% (95% CI 3.8%–11.2%; k = 8) for VKC/vernal disease; the subgroup difference was not statistically significant (Q β (1) = 1.99, p = 0.158). School/community studies yielded 8.9% (95% CI 5.0%–15.4%; k = 13), whereas the single clinic study reported 17.6% (95% CI 15.8%–19.6%). Substituting a narrower VKC case definition gave 8.4% (95% CI 4.9%–14.2%), and leave-one-out estimates ranged from 8.0% to 10.2%. Published studies consistently report ocular allergy among African children, although the available evidence is too heterogeneous to support a reliable continental prevalence estimate. Variation in case definition and ascertainment is a plausible and likely substantial contributor, but could not be quantified formally. The findings support consideration of ocular allergy within school eye-health and primary eye-care programmes while underscoring the need for standardised diagnostic and reporting methods.