Prevalence and Associated Factors of Retinopathy of Prematurity in Sub‑saharan Africa: A Systematic Review and Meta‑analysis

Background: Retinopathy of prematurity (ROP) is gaining prominence in childhood blindness with increasing neonatal survival in resource-constrained areas. There is an impending "new ROP epidemic" in sub-Saharan Africa (SSA), yet regional data remain limited and controversial. Estimation of the burden, and identification of modifiable risk determinants, is critical in guiding screening and prevention policies. Methods: Systematic review and meta-analysis followed PRISMA 2020 guidelines. PubMed, Google Scholar, African Journals Online, and institutional repositories were searched (January 2000–July 2025) for observational studies on SSA ROP prevalence in preterm or low-birth-weight neonates. Two reviewers screened studies independently, extracted data, and appraised quality with the Joanna Briggs Institute checklist. Logit transformed proportions, random-effects meta-analytic approach estimated pooled prevalence, and heterogeneity and publication bias assessed by Cochran's Q, I², and Egger's tests. Results: Twelve studies from nine countries involving 11.212 infants me the inclusion criteria and eleven were included in the meta-analysis the pooled prevalence of any ROP was 22.0%(95%CI: 16.6-28.4%), with moderate heterogeneity (I² = 67%) Nation-specific rates ranged from 5.7% in Uganda to 47.2% in Nigeria (I² = 67%). There was no apparent publication bias (Egger's p = 0.24). Consistent risk associations across studies included low gestational age and low birth weight, prolonged or unregulated treatment with oxygen, neonatal infection, blood transfusion, and mechanical intervention. Exclusive breast feeding was linked with protection in selected groups. Conclusion: Approximately one in five at-risk preterm infants in SSA develops ROP, a burden comparable to that seen in middle-income regions. As neonatal care advances, survival gains are creating new blindness risks unless screening and prevention systems are rapidly implemented. The findings imply that, when practical, improving neonatal care procedures such as enhancing oxygen monitoring, preventing infections, and encouraging breastfeeding may reduce the burden of ROP. However, implementation needs to be tailored to the capacity of the health system and local resources.