**Background:** Undernutrition, defined as insufficient intake of nutrients and energy to maintain good health, is exacerbated by armed conflict. Conflict disrupts livelihoods and food security, yet pooled evidence on the impact of armed conflict on childhood undernutrition in Africa was lacking. This systematic review and meta-analysis aimed to examine the effects of armed conflict on the magnitude of stunting, underweight, and wasting among children aged 6–59 months in Africa.
**Methods:** A comprehensive literature search was conducted in PubMed, Hinari, and Google Scholar databases from February 1 to March 25, 2022. Studies published after 2015, written in English, using cross-sectional designs, and reporting the magnitude of undernutrition among children aged 6–59 months in conflict-affected African countries were included. Study quality was assessed using the Hoy tool (scores 0–3 low risk, 4–6 moderate, 7–9 high risk). Data were extracted independently by two reviewers. Heterogeneity was assessed using Cochrane Q test and I² statistics. A random-effects model (Der Simonian-Laird) was used to estimate pooled prevalence and odds ratios. Publication bias was evaluated using funnel plots and Egger's test. Subgroup analyses by region and child age, sensitivity analyses, and univariate meta-regression were performed.
**Key Results:** Of 585 articles retrieved, 12 studies met inclusion criteria, encompassing 140,291 children (mean age 29.90 ± 4.36 months). All included studies were cross-sectional and rated low risk of bias. The pooled prevalence of wasting was 20.25% (95% CI: 15.08–25.43; I² = 98.24%, p < 0.001). The pooled prevalence of stunting was 34.18% (95% CI: 26.34–42.02; I² = 98.24%, p < 0.001). The pooled prevalence of underweight was 24.00% (95% CI: 16.35–31.65; I² = 98.66%, p < 0.001). Subgroup analysis by region showed the highest wasting prevalence in Central Africa (35.0%) and the lowest in Northcentral Africa (15.00%). Stunting was highest in Northcentral Africa (43.00%) and lowest in East Africa (28.28%). By child age, wasting was 17.58% in children aged 6–24 months and 21.00% in those aged 25–59 months. Meta-regression found no significant association between undernutrition and mean age or year of publication. Factors significantly associated with wasting included low maternal education (POR = 1.12, 95% CI: 1.05–1.20; 3 studies), rural residence (POR = 1.46, 95% CI: 1.04–2.04; 3 studies), and prolonged duration of armed conflict (POR = 2.60, 95% CI: 1.87–4.33; 2 studies). Poor wealth status showed a non-significant association (POR = 1.42, 95% CI: 0.95–2.10). Male sex was not significantly associated with wasting (POR = 1.22, 95% CI: 0.84–1.77). Egger's test indicated no substantial publication bias for any outcome.
**Clinical Implications:** This review provides the first pooled estimates of childhood undernutrition in conflict-affected African countries, revealing alarmingly high prevalences of wasting, stunting, and underweight that far exceed global averages. The identification of modifiable risk factors—low maternal education, rural residence, and prolonged conflict duration—offers actionable targets for humanitarian and development interventions. Health planners and policymakers should prioritize acute malnutrition screening and treatment in conflict zones, especially in Central Africa where wasting is highest, and among children aged 6–24 months who are most vulnerable to stunting. Interventions should address underlying determinants such as maternal education and rural healthcare access. The findings are limited by high heterogeneity and a small number of included studies, but they provide critical evidence for resource allocation and emergency nutrition programming in Africa's conflict-affected regions.