A systematic review and meta‐analysis of on farm management and water quality as risk factors triggering pathogen outbreaks in tilapia culture is presented. A total of 121 papers from 28 countries, 37 devoted to management and 84 to water quality associated with the presence of pathogens in tilapia culture were analysed. Most of research has been made on ponds, focusing on bacteria and metazoans. Meta‐analysis reveals the proportion of research showing statistical inferences between management (34%), water quality (38% for bacteria and 16.2% for metazoans) and pathogen outbreaks. The most cited parameters related to pathogens outbreaks were temperature (>30°C), dissolved oxygen (<5.0 mg/L), pH (<8.0) and ammonia (1.0 >mg/L) 65, 38, 32 and 34 papers, respectively. However, statistical inference was <20%. Meta‐analysis reveals tendencies between high temperatures (30–35°C), low dissolved oxygen (<5 mg/L) and high NH3 (1–5 mg/L) with pathogen outbreaks. Despite the knowledge about the relationship between management and water quality as factors for pathogen effects, most information is descriptive and empirical. Future research on tilapia culture outbreaks should be focused on the effects of multiple stressors affecting tilapia pathogen outbreaks, thereby generating strategies to prevent diseases and financial losses.