**Background**
Urinary incontinence (UI) is a common pelvic floor disorder affecting millions of women worldwide, with global prevalence estimates ranging from 5% to 55%. In Sub-Saharan Africa (SSA), individual hospital- and community-based studies have reported widely varying prevalence figures, but no prior systematic review and meta-analysis had synthesized this evidence. Given that SSA women often have higher parity and face weaker health systems than women in high-income countries, accurate regional estimates are critical for public health planning.
**Methods**
The review was registered in PROSPERO (CRD42021267551) and followed PRISMA guidelines. Medline/PubMed, Google Scholar, and Africa Journal Online were searched for studies published between January 1, 2000, and September 30, 2021. Eligible studies were observational (cross-sectional, cohort, case-control) reporting UI prevalence and/or risk factors in adult SSA women (≥18 years). Two independent authors screened titles/abstracts and full texts; a third reviewer resolved disagreements. Quality was assessed using the Newcastle-Ottawa Quality Assessment instrument adapted for cross-sectional studies. Pooled prevalence was calculated using a weighted inverse variance random-effects model. Heterogeneity was quantified with I² statistics. Subgroup analyses were performed by sub-region (East, West, South Africa), study setting (hospital vs. community), sample size, and UI subtype. Meta-regression examined the influence of publication year and sample size. Publication bias was assessed via funnel plot and Egger’s test.
**Key Results**
Of 1,929 identified articles, 25 studies met inclusion criteria, encompassing 17,863 women from 9 SSA countries (Nigeria n=14, Ethiopia n=3, Ghana n=2, South Africa n=2, and one each from Guinea, Liberia, Rwanda, Sierra Leone, and Tanzania). Fourteen studies were hospital-based, 10 community-based, and 1 university-based. Sample sizes ranged from 100 to 5,001. The systematic review showed UI prevalence ranging from 0.6% in Sierra Leone to 42.1% in Tanzania. The pooled burden of UI across all studies was 21% (95% CI: 16%–26%), with substantial heterogeneity (I² = 91.01%). By subtype, pooled prevalence was 52% for stress UI (95% CI: 42%–62%, I² = 70.78%), 21% for urgency UI (95% CI: 15%–26%, I² = 0.00%), and 27% for mixed UI (95% CI: 20%–35%, I² = 46.37%). Subgroup analysis by sub-region showed pooled estimates of 31% (95% CI: 19%–42%) in East Africa, 16% (95% CI: 11%–21%) in West Africa, and 35% (95% CI: 15%–55%) in South Africa. Community-based studies had a higher pooled burden (23%, 95% CI: 12%–33%) than hospital-based studies (18%, 95% CI: 13%–22%). Meta-regression showed a non-significant decreasing trend by publication year (coefficient = -0.0033, p = 0.533) and a significant decreasing trend with larger sample size (coefficient = -0.0001, p = 0.048). There was no evidence of publication bias (Egger’s test z = 1.74, p = 0.0825). Systematic review of associated factors identified parity, constipation, overweight/obesity, vaginal delivery, chronic cough, gestational age, and aging as the most commonly reported independent risk factors. For example, multiparous women in Ethiopia had approximately 6 times higher odds of UI compared to primigravida women, and women with at least three children in Tanzania had a 2-fold increased risk.
**Clinical Implications**
This study establishes that approximately one in five women in SSA suffers from UI, with stress UI being the predominant subtype. The identified risk factors—particularly parity, constipation, overweight/obesity, and vaginal delivery—are largely modifiable and point to actionable public health strategies. These include promoting healthy body weight through diet and exercise, preventing constipation with high-fiber diets and adequate hydration, educating women on pelvic floor muscle exercises (especially during and after pregnancy), and improving access to family planning to allow women to make informed choices about parity. The lower prevalence compared to high-income countries may reflect under-reporting and low health-seeking behavior rather than a true lower burden, underscoring the need for increased awareness and screening. The substantial heterogeneity and the absence of studies from Central Africa highlight the need for further research in under-represented sub-regions to obtain a complete picture of this treatable condition.