Inflammatory bowel disease (IBD), once thought to be rare in Africa, is now increasingly recognized due to urbanization, dietary changes, and improved diagnostic awareness. However, significant challenges in diagnosis and management persist across the continent. This review explores current trends, risk factors, diagnostic barriers, and treatment gaps related to IBD in the African context, while suggesting strategic solutions. We conducted a narrative review of the published literature, focusing on epidemiology, environmental and genetic drivers, dietary influences, health system constraints, and policy gaps related to IBD in Africa. Rates of IBD are rising in sub-Saharan Africa, particularly among young adults. Ulcerative colitis is reported more frequently than Crohn’s disease, though both are often misdiagnosed as infections. Contributing factors include dietary westernization, reduced microbial exposure, and air pollution. Delayed diagnosis, limited access to advanced treatments, malnutrition, and coexisting infections complicate care. Policy support and investment in research remain limited. IBD is emerging as a significant public health challenge in Africa. Addressing this issue requires coordinated efforts to raise awareness, improve diagnostics and treatment, and strengthen local research. Integrating IBD into broader non-communicable disease strategies and health system planning is essential to mitigate long-term health and economic impacts.