Sub-Saharan Africa (SSA) is the region most vulnerable to climate change and related hydro-meteorological risks. These risks are exacerbated in rapidly expanding urban areas due to the loss and degradation of green and blue spaces with their regulating ecosystem services. The potential of nature-based solutions (NBSs) to mitigate hydro-meteorological risks such as floods is increasingly recognised in Europe. However, its application in urban areas of SSA still needs to be systematically explored to inform and promote its uptake in this region. We conducted a multidisciplinary systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol to establish the general patterns in the literature on NBSs and hydro-meteorological risk mitigation in SSA. We searched scientific journal databases, websites of 12 key institutions and 11 NBS databases and identified 45 papers for analysis. We found at least 1 reported NBS in 71 % of urban areas of SSA across 83 locations. Of the papers, 62 % were clustered in South Africa, Kenya, Tanzania and Nigeria only, while the most studied cities were Dar es Salaam and Kampala. Moreover, 66 NBS practices were identified, most of which (n=44) were for flood mitigation. With only Mozambique (n=2) among the most at-risk countries reporting NBSs, we found that NBSs are implemented where risks occur but not where they are most severe. Mangrove restoration (n=10) and wetland restoration (n=7), reforestation (n=10) and urban forests (n=8), and agroforestry (n=3) and conservation agriculture (n=2) were the most common NBS practices identified for floods, extreme-heat and drought mitigation, respectively. Traditional practices that fit the definition of NBSs, such as grass strips and stone bunds, and practices that are more popular in the Global North, such as green roofs and green façades, were also identified. These NBSs also provided ecosystem services, including 15 regulatory, 5 provisioning and 4 cultural ecosystem services, while 4 out of every 5 NBSs created livelihood opportunities. We conclude that the reported uptake of NBSs for hydro-meteorological risks in SSA is low. However, there could be more NBSs, especially at the local level, that are unreported. NBSs can help SSA address major development challenges such as water and food insecurity and unemployment and help the sub-region progress towards climate-resilient development. Therefore, we recommend that NBSs be mainstreamed into urban planning and knowledge exchange opportunities between SSA and Europe and that other regions be explored to promote uptake.