Prevalence and associated factors of irritable bowel syndrome in selected Sub-Saharan African countries: A systematic review and meta-analysis

Abstract

Irritable bowel syndrome (IBS) is a global health challenge, yet data concerning its impact in Sub-Saharan Africa (SSA) remains fragmented and underrepresented in global syntheses. This systematic review and meta-analysis aimed to estimate the pooled prevalence of IBS and identify the associated factors in SSA. A systematic search of PubMed, Scopus, African Index Medicus, African Journals Online, and Google Scholar was conducted up to February 2026. Observational studies reporting IBS prevalence or associated factors in SSA, using Manning or Rome (I-IV) criteria, were included. Data were synthesized using a random-effects model. Heterogeneity was assessed using the I 2 statistic, and publication bias was evaluated using Egger’s test. Twenty cross-sectional studies involving 14,447 participants across eight countries were included. The pooled prevalence of IBS in SSA was 16% (0.16; 95% CI: 0.13–0.19; I² = 97.6%), with significant heterogeneity (I 2 =97.60%), indicating substantial variability across studies, which limits the interpretability of a single summary estimate. Prevalence varied significantly by diagnostic criteria: Rome II (30%), Rome III (17%), Manning (14%), and Rome IV (11%). Hospital-based settings reported the highest prevalence (28%). Mixed IBS (IBS-M) had the highest pooled prevalence among subtypes, estimated at 8%. Key associated factors included female sex (Pooled OR: 1.44; 95% CI: 1.16–1.79), anxiety (Pooled OR: 1.89; 95% CI: 1.37–2.60), stress (Pooled OR: 3.51; 95% CI: 1.49–8.27), and smoking (Pooled OR: 2.46; 95% CI: 1.51–4.01). IBS appears to be commonly reported in SSA. The close correlations with psychological distress and lifestyle factors indicate the need for combined biopsychosocial management strategies. However, most studies originate from West Africa; therefore, these findings should be interpreted cautiously and may not represent the entire region. Future research should utilize standardized Rome IV criteria in community-based longitudinal cohorts to better capture the evolving epidemiology of the region, while also addressing sources of heterogeneity beyond diagnostic criteria, as substantial variability persists even within Rome IV-defined studies. • IBS prevalence in Sub-Saharan Africa is estimated at 16% (95% CI: 13–19%), but extreme heterogeneity (I² ≈ 97.6%) limits its reliability as a single summary estimate. • Prevalence varies substantially by diagnostic criteria, decreasing from 30% (Rome II) to 11% (Rome IV), although high heterogeneity persists even within Rome IV studies. • Hospital-based studies report higher prevalence (28%) than community-based estimates, suggesting potential overestimation in clinical populations. • Female sex, anxiety, stress, and smoking are associated with IBS, although evidence for some factors (e.g., stress) is limited. • Evidence is geographically skewed toward West Africa, limiting generalizability across Sub-Saharan Africa and highlighting the need for more representative data.