Fungal Keratitis Among Patients With Microbial Keratitis or Corneal Ulcer in Africa: A Systematic Review and Meta‐Analysis

Background and Aims Fungal keratitis is a sight‐threatening cause of microbial keratitis in tropical, resource‐limited settings, but its burden in Africa has not been synthesized. We estimated the pooled prevalence of fungal keratitis among patients with microbial keratitis or corneal ulcer in Africa and summarized reported etiological patterns and risk factors. Methods Following PRISMA 2020, we searched seven databases, including PubMed/MEDLINE, Scopus, Embase and African Journals Online, to 14 June 2026, and updated the search on 27 September 2026 (PubMed‐indexed and publisher records, citation searching) with a citation‐level screening log. Observational African studies reporting fungal keratitis cases with a defined denominator were included and appraised item by item with the JBI prevalence checklist. Prevalence was pooled with a DerSimonian–Laird random‐effects model after Freeman–Tukey transformation; 95% prediction intervals (PIs), a logit‐model sensitivity analysis, subgroup analyses, meta‐regression and leave‐one‐out analysis were performed. Results The 16 studies from 10 countries (701 fungal keratitis cases among 2150 patients) were included. Study‐level prevalence ranged from 5.6% (16/284) to 61.9% (167/270). The pooled prevalence was 33.6% (95% CI = 23.6%–44.4%), with very high heterogeneity ( I 2 = 96.1%) and a 95% PI of 1.8%–79.6%. The logit model gave 32.3% (95% CI = 23.6%–42.5%). Prevalence did not differ significantly by region (Sub‐Saharan Africa 35.7% vs North Africa 25.5%; p = 0.50), denominator type ( p = 0.77), population definition, sampling, sample size or publication year, so heterogeneity remained unexplained. Filamentous fungi, mainly Fusarium and Aspergillus , predominated; ocular trauma, especially with vegetative matter, and delayed presentation were the most frequently reported risk factors. Conclusion On average, about one in three patients with microbial keratitis or corneal ulcer in the included African studies had fungal keratitis, but prevalence in any individual setting is highly uncertain, as shown by the wide prediction interval. Setting‐specific microbiological surveillance, strengthened corneal microbiology and reliable antifungal supply are needed.