Smallholder maize farmers in the agricultural sector are increasingly exposed to climate risks, with effects differing across agroecological zones. This systematic review synthesizes 58 studies from 2015 to 2025 to examine regional variability in climate stress adaptation strategies the role of socio-economic and institutional factors. Dodoma, Singida, Tanga, and Morogoro regions are experiencing climate stress, while under-studied regions such as Rukwa, Kigoma, and Ruvuma are poorly characterized. Farmers have employed a wide range of adaptation measures, such as using drought-tolerant maize varieties, crop diversification, intercropping, soil and water conservation, and small-scale irrigation. However, these measures have not been widely adopted and are not always effective because of limited extension services, high input costs, and limited access to climate information. This review establishes key gaps in region-specific evidence underscores the importance of specific and well-informed policies and practices that incorporate local knowledge, increase institutional support, and improve water and soil management. This study offers targeted policy recommendations for regional and socioeconomic context-considering adaptation performance and scaling up climate-resilient interventions to strengthen food security and farmer livelihoods across Tanzania.