Background <p>The prevalence of childhood asthma is increasing in developing countries, accompanied by numerous risk factors. This leads to substantial asthma related morbidity, mortality and economic consequences. The systematic review and meta-analysis aimed to determine prevalence and risk factors associated with asthma in East Africa, thereby elucidating the asthma burden among children and adolescents in the region.</p> Methods <p>Relevant articles were identified through searches of five databases ( PubMed, Embase (Ovid), CINAHL (EBSCO), Scopus, and Web of Science), with the PRISMA guideline used for data extraction. Random effects meta-analyses were performed to calculate pooled estimates and associated 95% confidence intervals [CIs]. Heterogeneity between the studies was assessed using Cochrane Q-test and the I² statistic.</p> Results <p>This meta-analysis encompassed 11 studies involving 20,258 children with asthma across six East African countries. The pooled prevalence of asthma was 15.2% (95% CI: 11.9%,18.5%), with notable variation across countries, ranging from 5.2% (95% CI: 3.3%, 7.1%) in Tanzania to 20.8% (95% CI: 17.6%, 24.0%) in Uganda. Risk factors for asthma included family history of asthma (pooled odds ratio [POR] = 3.1, 95% CI: 1.7, 4.5), environmental exposure(POR = 10.1, 95% CI: 1.3, 19.8), allergy exposure (POR = 3.1, 95% CI: 2.3, 4.0), and exposure to smoking (POR = 2.9, 95% CI: 1.4, 4.3).</p> Conclusion <p>The prevalence of asthma among children in East Africa was high, and multiple risk factors were associated with it.It appears that strategies and targeted interventions to address specific modifiable factors (e.g., environmental exposure, allergy exposure, and exposure to smoking) should be emphasized. </p> Clinical trail number <p>CRD42024545007.</p>