Epidemiology of Vernal Keratoconjuctivitis in African Children: A Systematic Review and Meta- Analysis

Background: VKC is a chronic, allergic ocular surface disease that mostly affects children and adolescents in tropical regions. It can significantly impact vision and quality of life if not treated or if severe. VKC information on African populations is limited and region-specific, with some indications of very high prevalence in certain areas. Objective: T o estimate the pooled prevalence of VKC in Africa and to investigate the heterogeneity between different regions of Africa . This meta-analysis and systematic review presents the first pooled estimate of the prevalence of vernal keratoconjunctivitis (VKC) in African children. Methods: A systematic review and meta-analysis were undertaken according to the PRISMA 2020 guidelines. A comprehensive search on PubMed, Google Scholar, African Journals Online, and institutional repositories (2000-2025) was carried out to identify observational studies reporting the prevalence of VKC in African populations. Two reviewers independently screened and selected the studies, extracted data related to sample size, VKC cases, study setting, and diagnostic criteria, and evaluated the studies' quality using the JBI checklist for prevalence studies. A random-effects meta-analysis using logit transformation of proportions was performed to pool prevalence estimates. Heterogeneity assessment was performed using the Q-statistic, I², and τ², and meta-regression analysis by country was used to explore differences among studies. Potential publication bias was tested using funnel plot analysis and Egger’s test. Results: Fourteen studies (N ≈ 20,000 individuals) from 7 African countries met the inclusion criteria. The overall prevalence of VKC was estimated as 8.1% (with a 95% confidence interval of about 6% to 12%). Prevalence was very variable across different settings, from about 3% among certain North African communities to as much as 37% within certain zones of West Africa. The level of heterogeneity was high (Q = 272.741, p < 0.001; τ² = 0.443), reflecting high variability across the studies in question. Country-specific meta-regression analysis was not statistically significant overall (p = 0.109); however, one particular country (Mali) had significantly higher prevalence than others (p = 0.010). There was also no significant asymmetry of the funnel plot (p > 0.4), suggesting that there was no significant publication bias. Conclusion: VKC affects a considerable proportion of the population in Africa, especially children, with marked regional variation. This high burden calls for increased awareness, early diagnosis, and region-appropriate preventive and management strategies to mitigate vision-threatening complications of VKC.