Ocular infections represent a major public health challenge in Africa, where data on their epidemiology and antimicrobial resistance (AMR) remain fragmentary. This study aimed to synthesize available data on the prevalence, microbial aetiology, and antimicrobial resistance profiles of ocular infections in Africa. This systematic review and meta-analysis were conducted via PubMed, Google Scholar, and AJOL (2000-2025). Pooled prevalence was estimated using a random-effects model. Heterogeneity was assessed using the I2 statistic. Fifteen studies (5004 specimens) from five African countries were included. The pooled prevalence of ocular infections was 65% (95% CI: 58% - 71%), with significant heterogeneity (I2 = 97%). Regional prevalence was 61% in East Africa and 74% in West Africa. Gram-positive cocci predominated (69.6%), with Staphylococcus aureus (39.6%) and coagulase-negative staphylococci (CoNS) (18.6%). Multidrug resistance (MDR) rates were high: CoNS (63.5%; 95% CI: 58.7% - 68.1%), Klebsiella pneumoniae (76%; 95% CI: 56.6% - 88.5%), Escherichia coli (60.6%), and S. aureus (54.7%). Temporal analysis revealed a decline in S. aureus and the emergence of CoNS and K. pneumoniae. Ocular infections in Africa exhibited high prevalence and alarming multidrug resistance rates, exceeding global estimates, particularly for CoNS and K. pneumoniae. These findings underscore the urgency of continental surveillance programs and targeted interventions.
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