Coccidiosis is one of the leading morbidity causes in chickens, causing a reduction of body weight and egg production. Backyard chickens are at risk of developing clinical and subclinical coccidiosis due to outdoor housing and scavenging behaviour, jeopardizing food security in households. The objectives of this study were to estimate clinical prevalence of coccidiosis at country and regional levels in the Horn of Africa in extensive backyard chickens. A binomial random effects model was developed to impute prevalence of coccidiosis. Previously gathered prevalence data (n = 40) in backyard chickens was used to define the model. Precipitation (OR: 1.09 (95% CI: 1.05–1.13) and the presence of seasonal rainfall (OR: 1.85, 95% CI: 1.27–2.70) significantly increase prevalence. Results showed an overall prevalence of coccidiosis in the Horn of Africa of 0.21 (95% CI: 0.15–0.29). Ethiopia, the Republic of South Sudan and Kenya showed the highest prevalence and Djibouti the lowest. Significant differences between Djibouti and the countries with highest prevalence were found. However, no evidence of a significant difference between the rest of the countries. Kenya and Ethiopia showed larger prevalence differences between regions. Results could assist with the targeting of testing for coccidiosis, the observation for clinical disease of chickens living in specific regions and as a baseline for the evaluation of future control measures.