OBJECTIVE We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20 years and available from several databases (MEDLINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications). RESULTS Although hospital-based African studies indicate EP incidence has probably increased in Africa in recent decades, major methodological limitations in the published literature make it impossible to draw formal conclusions concerning the incidence of EP in Africa in recent years. As in industrialized countries, pelvic inflammatory disease (PID) associated with sexually transmitted diseases (STDs) must be considered as the most important risk factor for EP in developing countries. In African developing countries, a majority of hospital-based studies have reported EP case fatality rates of around 1-3%, 10 times higher than that reported in industrialized countries. Late diagnosis, leading in almost all cases to major complications, and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering from EP in Africa. CONCLUSIONS EP should be considered a relevant public health indicator in developing countries, providing an overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergency situations, especially in the field of obstetrics and gynecology.