Introduction: Antenatal depression is a serious problem worldwide that has devastating consequences to the mother, child and family. The pooled evidence regarding the prevalence and associated factors of antenatal depression is rare in Africa. Therefore, the aim of this review was to determine the pooled prevalence and associated factors of antenatal depression in Africa

Methods: We searched CINHAL, MEDLINE, PsycINFO, Psychiatry-online, PubMed, SCOPES, and Emcare databases for English written observational studies conducted in Africa from 2007 to 2018.Quality of studies was assessed using the Newcastle Ottawa Scale (NOS) and studies with good quality were included in the final review. Heterogeneity across studies was assessed using I²and Higgins test. Publication bias was checked using Funnel plot and Egger’s regression test and adjustment was made by using Duval and Tweedie’s Trim and Fill analysis. A random effect Meta-analysis was employed to determine the pooled estimates with 95% confidence interval (CI). Stata 14 was used for analysis. The review protocol has been registered in PROSPERO number CRD42018106717.

Result: Of the 175 studies identified, 28 studies with an overall sample size of 17,938 were included. According to the random effect model following trim and fill analysis, the pooled prevalence of antenatal depression in Africa was 26.3% (95%CI: 22.2, 30.4). Economic difficulties [POR=1.87;95%CI:1.25,2.78,I²=88.1%], unfavorable marital condition[POR=4.17;95% CI:1.75, 9.94, I²=81.2%], poor support from relatives [POR=1.36;95% CI:1.18, 1.56, I²=78.0%], bad obstetric history[POR=2.30;95% CI:1.81, 2.92), I²=81.7%], and history of mental health problem [POR=2.97; 95% CI:1.74, 5.06, I²=92.0%] were the factors associated with antenatal depression.

Conclusion: The prevalence of antenatal depression is high in Africa. Economic difficulties, bad obstetric history, poor support from relatives, previous mental health problems, and unfavorable marital conditions increased the risk of antenatal depression.  Therefore, these factors should be considered while designing mental health care services for pregnant mothers.

Key words: Antenatal-depression, systematic-review, Meta-analysis, Africa