Colorectal Inflammatory Bowel Disease in Sub-Saharan Africa: Diagnostic Challenges and Systemic Care Constraints

BackgroundColorectal inflammatory bowel disease (cIBD) encompasses the colitides-ulcerative colitis (UC) and Crohn's colitis (CC)-and is defined by chronic, relapsing inflammation of the colon and rectum. Indeterminate colitis (IC) is diagnosed when available clinical and diagnostic features do not allow clear classification as UC or CC. cIBD is increasingly recognized as a global disease; however, in Sub-Saharan Africa (SSA), it is often misdiagnosed within an infectious-disease-dominant clinical environment, under conditions of constrained diagnostic infrastructure and unmet management needs. In this overview, we summarize the current state of the cIBD landscape in SSA, detailing limitations related to diagnostic misclassification, systemic-level constraints, and management challenges.MethodsA comprehensive literature review was conducted from 1997 to 2026 using a multipronged search strategy guided by a prespecified protocol consistent with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Electronic searches were conducted in MEDLINE (via PubMed), Current Nursing, Excerpta Medica Database (EMBASE), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, the Cochrane Library, and the Google® search engine.ResultsAcross Africa, a total of 268 studies have been identified, with SSA contributing only a minority. Among publications from 2024 to 2026, 175 were case reports. Overall, 1953 documented cases of cIBD were reported across 34 publications spanning 1997 to 2026, with the majority originating from South Africa. Ulcerative colitis (UC) accounted for most reported cases, while the remaining literature primarily consisted of isolated case reports or small case series. Ghana and Nigeria have shown a marked increase in reported cases of cIBD over time. A retrospective analysis covering 1997 to 2026 identified 45 cases, reflecting approximately a 65% rise in case detection at Korle-Bu Teaching Hospital in Accra, Ghana. The largest data set was from Nigeria, comprising 459 suspected cases and 208 histologically confirmed cIBD patients collected from 18 centers. The scarcity and limited transparency of data regarding the current state of cIBD reflect persistent challenges, such as low disease awareness, diagnostic limitations, underdiagnosis, underreporting, the lack of dedicated cIBD registries, and a shortage of specialized health care professionals. Significant gaps persist in diagnostic infrastructure, including inadequately equipped laboratories and limited clinical capacity for managing cIBD. Notably, cIBD in sub-Saharan Africa appears to affect a younger demographic, and high rates of misdiagnosis persist due to the similarity of symptoms with infectious and parasitic diseases.ConclusionEmerging evidence indicates that the incidence and prevalence of cIBD in SSA are increasing. Significant challenges persist, including diagnostic misclassification and misdiagnosis within a parasitic and infectious-colitides-dominant clinical environment, under conditions of constrained diagnostic infrastructure. These challenges are further exacerbated by inadequate endoscopic, pathological, and laboratory capacities within health care systems. Shortages in personnel, equipment, infrastructure, and funding constitute significant barriers. Addressing these deficiencies necessitates the development of context-specific diagnostic algorithms, the expansion of laboratory and endoscopic facilities, targeted clinician training, and the implementation of integrated care pathways that facilitate the simultaneous assessment of infectious and inflammatory etiologies of colitis. Currently, the literature on cIBD from SSA remains scarce.