Background
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties in communication, deficits in social interaction, and repetitive behavioral patterns. Global prevalence estimates range from 1% to 2%, with variations attributed to cultural, social, and methodological factors. In Africa, research remains limited and highly heterogeneous, largely due to scarce diagnostic resources, persistent stigma, and the absence of consistent public policies. 

Methods
A systematic search was conducted across PubMed, Embase, Scopus, and PsycInfo for articles published up to May 2025. Cross-sectional studies conducted in school-based or community populations were included. The analysis followed PRISMA guidelines, and the protocol was registered with PROSPERO (CRD420251138668). A random-effects model using the Freeman-Tukey transformation for variance stabilization was employed for statistical synthesis. 

Results
Seven studies from Egypt, Kenya, Uganda, and Nigeria, comprising 71,341 participants, were included. Across included studies, reported ASD prevalence ranged from 0.54% to 23.8%. When pooled and stratified by methodological criteria, clinically confirmed ASD prevalence was 1% (95% CI, 0.0–1.0%), whereas high-risk screening prevalence was 4% (95% CI, 0.0–16.0%), with very high between-study heterogeneity (I² = 99.8%).

Conclusions
Despite substantial methodological heterogeneity, ASD prevalence estimates in Africa appear comparable to those reported in high-income countries. The marked disparity between high-risk screening prevalence and confirmed diagnoses highlights the urgent need to expand diagnostic confirmation services and strengthen training for primary healthcare professionals to bridge the gap between risk identification and definitive diagnosis across the continent.