Background <p>Malaria and schistosomiasis are major public health challenges in sub-Saharan Africa (SSA), with overlapping geographical distributions leading to high rates of coinfection among children. <i>Plasmodium falciparum</i> (<i>P. falciparum</i>) causes most severe malaria cases, while <i>Schistosoma haematobium</i> (<i>S. haematobium</i>) and <i>Schistosoma mansoni</i> (<i>S. mansoni</i>) are the predominant schistosome species. Coinfections result from shared environmental factors, but interactions between these parasites remain unclear due to inconsistent study findings. This systematic review and meta-analysis aim to provide pooled prevalence estimates of <i>P. falciparum–Schistosoma</i> coinfection in children aged 0–17&#xa0;years in SSA.</p> Method <p>This systematic review and meta-analysis followed the PRISMA guidelines. We searched PubMed, the Cochrane Library, Web of Science, EBSCOhost, Google Scholar, ProQuest, and publisher platforms (Wiley Online Library, SpringerLink) and screened the reference lists for observational studies reporting coinfection with <i>P. falciparum</i> and <i>S. haematobium</i> and/or <i>S. mansoni</i> among children in SSA. Data from 21 eligible studies were extracted using Microsoft Excel and analysed using Stata version 17. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Proportions were stabilized using the Freeman–Tukey double arcsine transformation, and pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I², and publication bias was evaluated using funnel plots, Egger’s test, and Begg’s test.</p> Result <p>Twenty-one studies were included in this analysis. The aggregated prevalence of <i>P. falciparum–S. haematobium</i> coinfection was 10.0% (95% CI 6.0–14.0%), with substantial heterogeneity (I² = 98.0%, <i>p</i> &lt; 0.001). The highest prevalence was recorded in West Africa (13.0%, 95% CI 6.0–22.0%), followed by Central Africa (9.0%, 95% CI 7.0–10.0%) and East Africa (3.0%, 95% CI 0.0–11.0%); however, the regional differences were not significant (<i>p</i> = 0.150). No significant temporal variation was detected (<i>p</i> = 0.185), with prevalence estimates of 22.0% (2011–2015), 5.0% (2016–2020), and 7.0% (2021–2025). The diagnostic methods yielded significantly different estimates (<i>p</i> &lt; 0.001), ranging from 13.0% (PCR + microscopy) and 11.0% (microscopy) to 3.0% (RDT + microscopy) and 1.0% (PCR + PCR). The pooled prevalence of <i>P. falciparum–S. mansoni</i> coinfection was 13.0% (95% CI 6.0–24.0%), with very high heterogeneity (I² = 99.28%, <i>p</i> &lt; 0.001). Significant regional variation was identified (<i>p</i> &lt; 0.001), with East Africa exhibiting the highest prevalence (25.0%, 95% CI 13.0–39.0%) compared to Central Africa (3.0%, 95% CI 2.0–5.0%) and West Africa (2.0%, 95% CI 1.0–3.0%). Temporal patterns did not show significant differences (<i>p</i> = 0.683), with prevalence estimates of 13.0% (2010–2014), 18.0% (2015–2019), and 14.0% (2020–2025). Diagnostic approaches also varied significantly (<i>p</i> &lt; 0.001), with prevalence ranging from 12.0% (microscopy + microscopy) to 6.0% (PCR + PCR) and 2.0% (PCR + microscopy).</p> Conclusion <p>Coinfections of <i>P. falciparum</i> and <i>Schistosoma</i> species remain a major health challenge in SSA, particularly affecting children owing to systemic healthcare gaps, poverty, and inadequate water and sanitation. Geographic and temporal patterns reflect persistent transmission hotspots, with diagnostic limitations underestimating the true prevalence. Effective control requires integrated public health strategies prioritizing children, combining medical treatment, improved sanitation, and affordable, sensitive diagnostics to stop transmission.</p>