Metabolic dysfunction-associated steatotic liver disease and steatohepatitis are rising across Africa, driven by obesity, diabetes, urbanization, and social determinants, with regional heterogeneity. North Africa shows the highest prevalence, while several sub-Saharan regions have the fastest growth. Coexisting hepatitis B virus, hepatitis C virus, and HIV accelerate fibrosis and complicate hepatocellular carcinoma surveillance. A scalable response is resource stratified triage from non-hepatology settings using FIB-4 with age-adjusted cutoffs, selective elastography, and clear referral thresholds, integrated into noncommunicable disease programs; management prioritizes weight loss, cardiometabolic control, and access to effective therapies.