<p>Bovine theileriosis is a major tick-borne disease constraining cattle productivity in India. A systematic review and meta-analysis were conducted to estimate the pooled prevalence and explore sources of heterogeneity in reported infections across the country. Following PRISMA guidelines, 624 articles were screened, of which 100 studies comprising 130 study-reports published between 2010 and 2024 met the inclusion criteria. A total of 78,668 cattle were examined, with 29,325 testing positive for <i>Theileria</i> spp. Random-effects meta-analysis was performed, along with subgroup analyses, assessment of publication bias, and mixed-effects meta-regression. The pooled national prevalence of bovine theileriosis was 29.8% (95% CI: 26.2–33.8%), with extreme heterogeneity (I² = 99.1%) and a wide prediction interval (1–69%). Prevalence varied strongly by diagnostic method, being highest with serology (82.99%), followed by PCR (37.29%) and blood smear examination (27.40%). Smaller studies (&lt; 100 animals) consistently reported higher prevalence than larger surveys, indicating small-study effects. Marked regional variation was observed, with the highest burden in Uttarakhand and Haryana, and comparatively lower prevalence in parts of eastern and southern India. Meta-regression confirmed that diagnostic method and geographical region were the dominant drivers of variability, whereas study year and sample size showed no independent effect. This study provides a comprehensive estimate of the national burden of bovine theileriosis and underscores the importance of standardized diagnostics and region-specific surveillance. The findings can support improved disease control strategies and guide future epidemiological research in endemic areas.</p>