Background: Coeliac disease (CD) is a common immune-mediated disorder with a global distribution, yet its burden in sub-Saharan Africa remains poorly defined. The apparent scarcity of CD in the region contrasts with evidence of compatible genetic susceptibility, gluten exposure and documented disease. Whether this reflects genuinely low prevalence or limitations in recognition and diagnosis remains an important unanswered public health question.
Objective: To examine the available evidence on CD in sub-Saharan Africa, with emphasis on epidemiological patterns, diagnostic recognition and health-system factors that may contribute to an apparently low disease burden.
Methods: Published evidence addressing CD epidemiology, diagnosis and clinical recognition in sub-Saharan African populations was reviewed. Evidence was examined thematically to identify reported prevalence, diagnostic approaches, population gaps and barriers to timely recognition.
Results: Available evidence demonstrates substantial heterogeneity and important geographical gaps. African epidemiological estimates have been disproportionately informed by North African populations, while population-based evidence from much of sub-Saharan Africa remains limited. Studies and reviews indicate that CD can occur in African populations, challenging assumptions that the disease is uncommon solely because of geographical or ethnic differences. Limited diagnostic capacity, variable clinical suspicion and restricted access to appropriate testing may contribute to under-recognition and incomplete estimation of disease burden. These gaps are particularly relevant where gastrointestinal and nutritional manifestations may overlap with more commonly recognised conditions.
Conclusion: The apparent low burden of CD in sub-Saharan Africa should be interpreted cautiously. Rather than assuming rarity, strengthening epidemiological surveillance, healthcare-worker awareness and access to appropriate diagnostic pathways could help determine the true burden of disease. Closing the evidence gap should be considered an important component of improving equitable recognition and management of CD globally.