Background: Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by gluten. Historically considered rare in Africa, CD is increasingly recognized in pediatric populations. However, diagnosis and management remain challenging due to clinical overlap with endemic malnutrition and limited access to culturally appropriate gluten-free diets (GFD). This narrative review examines the burden, diagnostic barriers, and dietary management dilemmas of pediatric CD in Africa.
Methods: A narrative review was conducted using literature from _Scopus, PubMed, and Google Scholar_ searched between July and August 2026. Search terms included “celiac disease” OR “coeliac disease” AND “child_” OR “pediatric_” AND “Africa” AND “prevalence” OR “diagnosis” OR “malnutrition” OR “gluten-free diet” OR “diagnostic barriers.” Inclusion criteria: studies of children <18 years in African countries reporting epidemiology, clinical features, diagnosis, or dietary management of CD, published in English 2001-2026. Data were extracted and synthesized thematically due to study heterogeneity.
Results: CD prevalence in at-risk African pediatric groups exceeds prior estimates. CD autoimmunity was found in 5.8% of Nigerian children with type 1 diabetes and 6.4% seropositivity among Egyptian children with type 1 diabetes. Clinically diagnosed cohorts from Djibouti and Saharawi refugees confirm substantial disease burden and diagnostic delay. Clinical features of CD including malnutrition, stunted growth, and chronic diarrhea overlap with protein-calorie malnutrition and infectious diseases, leading to diagnostic overshadowing and misattribution across African settings. GFD implementation is complicated by inaccessibility of Western products. Imposing an Italian-style GFD on Saharawi children altered salivary microbiota and metabolome and induced metabolic dysfunction, despite locally available gluten-free staples.
Conclusion: African children with CD face compounded risks of underdiagnosis and suboptimal post-diagnosis care. There is need for targeted screening of at-risk groups, clinician education to reduce diagnostic overshadowing, and development of GFD guidance based on indigenous gluten-free staples rather than imported Western models to address this dual burden.