Background/Aim: Celiac disease (CD) is well characterized in North Africa and in European-descent populations, but its burden across sub-Saharan Africa (SSA) remains poorly defined. Pooled meta-analytic data place seroprevalence in Africa among the lowest of any region, attributed to lower HLA-DQ2 haplotype frequency and wheat consumption in SSA versus northern Africa.¹ Yet Nigeria, Africa's most populous, bread-consuming nation, has only one historically documented case.² This gap raises whether CD is genuinely rare in SSA or systematically underdiagnosed. This review maps the existing SSA literature on CD epidemiology, diagnostic pathways, and clinical presentation and identifies priorities for future screening research.
Methods: The review follows PRISMA-ScR guidance. Two reviewers independently search PubMed, Scopus, African Journals Online, and Google Scholar (1990–2026) using combined MeSH and free-text terms for celiac disease, gluten enteropathy, tissue transglutaminase, and individual SSA country and region names. Study quality is appraised using the Joanna Briggs Institute checklist for prevalence studies. Screening, extraction, appraisal proceed in duplicate, with disagreements resolved by consensus.
Results: The initial search identifies primary studies from four SSA countries meeting inclusion criteria. A Burkina Faso general-population screen of 600 individuals finds no seropositive cases.¹ An HLA-genotyped Ethiopian birth cohort prospectively tracks CD autoimmunity incidence in children.³ A multicenter Nigerian screening of children with type 1 diabetes generates the first systematic West African seroprevalence estimates.² A Durban, South Africa, cohort of 202 adults with type 1 diabetes finds celiac antibody positivity comparable to Western populations, though biopsy confirmation remains limited.⁴ Across studies, authors consistently attribute low case detection to limited clinical suspicion and restricted serology and biopsy access, rather than confirmed biological rarity.
Conclusion: Available evidence indicates CD in SSA is substantially underdiagnosed rather than genuinely rare. This review consolidates a fragmented evidence base and highlights the need for population-based screening and diagnostic capacity-building across the region.