21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition

ABSTRACT Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue – 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization

• Publication year

  2018

• Venue

  International Journal of Environmental Health Research

• Publication date

  2018-12-13

• Fields of study

  Political Science, Medicine, Environmental Science

• Identifiers
  DOI 10.1080/09603123.2018.1550193PMID 30545246
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• The Metabolic Ghetto: An Evolutionary Perspective on Nutrition, Power Relations and Chronic Disease

  2019cited by this paper
• Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: a mixed method systematic review

  2017cited by this paper
• Determinants of poor self-rated health among adults in urban Mozambique

  2016cited by this paper
• To What Extent is Drinking Water Tested in Sub-Saharan Africa? A Comparative Analysis of Regulated Water Quality Monitoring

  2016cited by this paper
• Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea

  2016cited by this paper
• Heavy metals contamination and human health risk assessment around Obuasi gold mine in Ghana

  2016cited by this paper
• Anaemia and nutritional status of adolescent girls in Babile District, Eastern Ethiopia

  2016cited by this paper
• Poor Infant Feeding Practices and High Prevalence of Malnutrition in Urban Slum Child Care Centres in Nairobi: A Pilot Study.

  2016cited by this paper
• Environmental transmission of diarrheal pathogens in low and middle income countries.

  2016cited by this paper
• Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya

  2016influential reference
• Physicochemical quality and health implications of bottled water brands sold in Ethiopia.

  2015cited by this paper
• Hand washing promotion for preventing diarrhoea

  2015cited by this paper
• Satellite Based Assessment of Hydroclimatic Conditions Related to Cholera in Zimbabwe

  2015cited by this paper
• Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis.

  2015cited by this paper
• Herpes simplex virus type 2 among mobile pastoralists in northwestern Namibia

  2015cited by this paper
• Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009

  2015cited by this paper
• Water-related factors and childhood diarrhoea in African informal settlements. A cross-sectional study in Ouagadougou (Burkina Faso).

  2015cited by this paper
• How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana.

  2015cited by this paper
• Slum Sanitation and the Social Determinants of Women's Health in Nairobi, Kenya

  2015cited by this paper
• Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums.

  2015cited by this paper
• Seroprevalence, disease awareness, and risk factors for Toxocara canis infection among primary schoolchildren in Makoko, an urban slum community in Nigeria.

  2015cited by this paper
• Bayesian spatial analysis of childhood diseases in Zimbabwe

  2015cited by this paper
• Reducing Sexual Violence by Increasing the Supply of Toilets in Khayelitsha, South Africa: A Mathematical Model

  2015cited by this paper
• Shared toilet users’ collective cleaning and determinant factors in Kampala slums, Uganda

  2014cited by this paper
• Nitrate and drinking water from private wells: will there be an epidemic of cancers of the digestive tract, urinary bladder and thyroid?

  2014cited by this paper
• How adolescents perceive their communities: a qualitative study that explores the relationship between health and the physical environment

  2014cited by this paper
• The etiology, risk factors, and interactions of enteric infections and malnutrition and the consequences for child health and development study (MAL-ED): description of the Tanzanian site.

  2014cited by this paper
• Video Surveillance Captures Student Hand Hygiene Behavior, Reactivity to Observation, and Peer Influence in Kenyan Primary Schools

  2014cited by this paper
• Trends in access to water supply and sanitation in 31 major sub-Saharan African cities: an analysis of DHS data from 2000 to 2012

  2014cited by this paper
• Composting, anaerobic digestion and biochar production in Ghana. Environmental-economic assessment in the context of voluntary carbon markets.

  2014cited by this paper
• Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey

  2014cited by this paper
• The impact of social action funds on child health in a conflict affected country: evidence from Angola.

  2014cited by this paper
• Sanitary Conditions of Food Vending Sites and Food Handling Practices of Street Food Vendors in Benin City, Nigeria: Implication for Food Hygiene and Safety

  2014cited by this paper
• Global assessment of exposure to faecal contamination through drinking water based on a systematic review

  2014cited by this paper
• Determinants of moderate‐to‐severe anaemia among women of reproductive age in Tanzania: analysis of data from the 2010 Tanzania demographic and health survey

  2013influential reference
• Childhood Helminth Exposure Is Protective Against Inflammatory Bowel Disease: A Case Control Study in South Africa

  2013cited by this paper
• Predictors of Dental caries among children 7–14 years old in Northwest Ethiopia: a community based cross-sectional study

  2013cited by this paper
• The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings

  2013cited by this paper
• Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya.

  2013cited by this paper
• A retrospective view on the viability of water fluoridation in South Africa to prevent dental caries.

  2012cited by this paper
• ASSOCIATIONS BETWEEN HOUSEHOLD AND NEIGHBOURHOOD SOCIOECONOMIC STATUS AND SYSTOLIC BLOOD PRESSURE AMONG URBAN SOUTH AFRICAN ADOLESCENTS

  2012cited by this paper
• Implementation of an Evidence-Based Hand Hygiene Program in Elementary Schools in Ghana, as Part of a City-to-City Partnership Between Ottawa Public Health and KEEA Health Directorate

  2012cited by this paper
• Excessive iodine intake, water chemicals and endemic goitre in a Sudanese coastal area

  2012cited by this paper
• Spatial and Temporal Patterns of Dengue Transmission along a Red Sea Coastline: A Longitudinal Entomological and Serological Survey in Port Sudan City

  2012cited by this paper
• Randomized intervention study of solar disinfection of drinking water in the prevention of dysentery in Kenyan children aged under 5 years.

  2012cited by this paper
• Groundwater fluoride and dental fluorosis in southwestern Nigeria

  2012cited by this paper
• Integration of routine vaccination and hygiene interventions: a comparison of 2 strategies in Kenya.

  2012cited by this paper
• Population-Based Incidence of Typhoid Fever in an Urban Informal Settlement and a Rural Area in Kenya: Implications for Typhoid Vaccine Use in Africa

  2012cited by this paper
• Comment on randomized intervention study of solar disinfection of drinking water in the prevention of dysentery in Kenyan children aged under 5 years.

  2012cited by this paper
• Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009

  2012cited by this paper
• Common Coinfections of Giardia intestinalis and Helicobacter pylori in Non-Symptomatic Ugandan Children

  2012cited by this paper
• Assessment of water, sanitation, and hygiene practice and associated factors among people living with HIV/AIDS home based care services in Gondar city, Ethiopia

  2012influential reference
• Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008–2009

  2012cited by this paper
• Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study

  2012influential reference
• Water quality decline in coastal aquifers under anthropic pressure: the case of a suburban area of Dakar (Senegal)

  2011cited by this paper
• Drinking water quality, feeding practices, and diarrhea among children under 2 years of HIV-positive mothers in peri-urban Zambia.

  2011cited by this paper
• Occurrence of risk factors for zoonoses in Kisumu City, Kenya: a questionnaire survey.

  2011cited by this paper
• Understanding the inter-relationship between Millennium Development Goal Targets: a spatial analysis of pit latrine density and groundwater source contamination

  2011cited by this paper
• Evaluating the health impact of urban WASH programmes: an affordable approach for enhancing effectiveness

  2011cited by this paper
• Awareness, attitudes and prevention of malaria in the cities of Douala and Yaoundé (Cameroon)

  2011cited by this paper
• Non-communicable diseases in sub-Saharan Africa: what we know now.

  2011cited by this paper
• The effects of informational interventions on household water management, hygiene behaviors, stored drinking water quality, and hand contamination in peri-urban Tanzania.

  2011influential reference
• Predictors of Preterm Births and Low Birthweight in an Inner-City Hospital in Sub-Saharan Africa

  2010cited by this paper
• Seroprevalence of Toxocara canis infection among children in Swaziland, southern Africa

  2010cited by this paper
• Health transition in Africa: practical policy proposals for primary care.

  2010cited by this paper
• Neglected tropical diseases.

  2010cited by this paper
• Knowledge, attitudes and practices about malaria in an urban community in south-western Nigeria.

  2010cited by this paper
• Association of water-borne diseases morbidity pattern and water quality in parts of Ibadan City, Nigeria.

  2010cited by this paper
• Social and cultural features of cholera and shigellosis in peri-urban and rural communities of Zanzibar

  2010cited by this paper
• Estimating the Burden of Disease Attributable to Four Selected Environmental Risk Factors in South Africa

  2010cited by this paper
• Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa

  2010cited by this paper
• Quantitative Microbial Risk Analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana.

  2010cited by this paper
• Application of the WHO five keys of food safety to improve food handling practices of food vendors in a poor resource community in Ghana.

  2010cited by this paper
• Health professionals as stigmatisers of tuberculosis: Insights from community members and patients with TB in an urban district in Ghana

  2009influential reference
• Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso

  2009cited by this paper
• Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea

  2009cited by this paper
• Distance threshold for the effect of urban agriculture on elevated self-reported malaria prevalence in Accra, Ghana.

  2009cited by this paper
• Impact of drainage networks on cholera outbreaks in Lusaka, Zambia.

  2009cited by this paper
• Knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State.

  2009cited by this paper
• The knowledge, attitude and practices of food handlers in food sanitation in a metropolis in south eastern Nigeria.

  2009cited by this paper
• Seroprevalence of Toxoplasma gondii infection among children in Swaziland, southern Africa

  2009cited by this paper
• What explains the rural-urban gap in infant mortality: Household or community characteristics?

  2009cited by this paper
• [Ischemic cardiomyopathy in Lome: epidemiologic aspects and risk factors (study of 461 cases)].

  2008cited by this paper
• Developing and evaluating complex interventions: the new Medical Research Council guidance

  2008cited by this paper
• Water disinfection and hygiene behaviour in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs

  2008cited by this paper
• Spatial dependency of V. cholera prevalence on open space refuse dumps in Kumasi, Ghana: a spatial statistical modelling

  2008cited by this paper
• Effectiveness of common and improved sanitary washing methods in selected cities of West Africa for the reduction of coliform bacteria and helminth eggs on vegetables

  2007cited by this paper
• Point-of-use water treatment and use among mothers in Malawi.

  2007cited by this paper
• Incidence of cryptosporidiosis species in paediatric patients in Malawi

  2007cited by this paper
• New Highly Divergent rRNA Sequence among Biodiverse Genotypes of Enterocytozoon bieneusi Strains Isolated from Humans in Gabon and Cameroon

  2007cited by this paper
• [Arterial hypertension in sub-Saharan Africa. Update and perspectives].

  2007cited by this paper
• Urban farming and malaria risk factors in a medium-sized town in Cote d'Ivoire.

  2006cited by this paper
• Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors

  2006cited by this paper
• Community mercury levels in the vicinity of peri-urban waste disposal sites and fossil fuel burning operations.

  2006cited by this paper
• [Hypertension: epidemiology and metabolic abnormalities in Foutah-Djallon in Guinea].

  2006cited by this paper
• HYPERTENSION ARTERIELLE : EPIDEMIOLOGIE ET ANOMALIES METABOLIQUES AU FOUTAH- DJALLON EN GUINEE. HYPERTENSION: EPIDEMIOLOGY AND METABOLIC ABNORMALITIES IN FOUTAH-DJALLON IN GUINEA.

  2006cited by this paper
• Recall of intestinal helminthiasis by HIV-infected South Africans and avoidance of possible misinterpretation of egg excretion in worm/HIV co-infection analyses

  2006influential reference
• BMC Public Health BioMed Central Research article Unfavourable birth outcomes of the Roma women in the Czech Republic and the potential explanations: a population-based study

  2005cited by this paper
• Etiology of childhood diarrhea in Zliten, Libya.

  2005cited by this paper
• Allergic disease in urban and rural populations: increasing prevalence with increasing urbanization

  2005cited by this paper

• Déterminants de la pratique « WASH » par les ménages dans la commune de Djougou au Bénin en 2024

  2025cites this paper
• Strategies to promote uptake and sustainability of Water, Sanitation and Hygiene (WASH) interventions in basic education institutions in conflict settings: a scoping review of the Horn of Africa

  2025cites this paper
• Post-COVID-19 WASH Insecurity and Monkeypox Transmission in Nigeria

  2025cites this paper
• Soil-transmitted Helminth (STH) Infections in Northern Nigeria between 2000-2022: A Review

  2025cites this paper
• Voices from Iraq: Emerging Clinical Evidence and Implications for Global Health Equity

  2025cites this paper
• Unraveling diarrheal disease knowledge, understanding, and management practices among climate change vulnerable coastal communities in Ghana

  2024cites this paper
• Knowledge, attitudes, and practices related to soil-transmitted helminth infections among residents of Bata district, Equatorial Guinea; a cross-sectional study

  2024cites this paper
• “If I was in charge”: A qualitative investigation of water security, gender-based violence and wellbeing in Kenya.

  2024cites this paper
• Determinants of WASH programmes adoption in flood-prone Tsholotsho District, Zimbabwe

  2024cites this paper
• Community engagement enhances undergraduate civil engineering capstone design projects

  2024cites this paper
• Water Insecurity and Rights Erosion: A Comprehensive Analysis of Rohingya Refugee Camps in New Delhi

  2024cites this paper
• Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps

  2023cites this paper
• Co-creation and self-evaluation: An accountability mechanism process in water, sanitation and hygiene services delivery in childcare centres in Nairobi's informal settlements

  2023cites this paper
• An Analysis of Factors Influencing Household Water, Sanitation, and Hygiene (WASH) Experiences during Flood Hazards in Tsholotsho District Using a Seemingly Unrelated Regression (SUR) Model

  2023cites this paper
• Using household survey data to explore the effects of the domiciliary environment on weight at birth: a multilevel mixed-effects analysis of the 2016 Ethiopian Demographic Health Survey

  2023cites this paper
• Mapping water, sanitation, and hygiene achievements to prosperity, stability, and resilience outcomes

  2023cites this paper
• Prevalence, intensity and associated risk factors of soil-transmitted helminth infections among individuals living in Bata district, Equatorial Guinea

  2023cites this paper
• Multiscalar Evaluation of the Water Distribution System and Diarrheal Disease Risk in Addis Ababa, Ethiopia

  2023cites this paper
• Water and Health Nexus—Land Use Dynamics, Flooding, and Water-Borne Diseases in the Odaw River Basin, Ghana

  2022cites this paper
• Building resilience to hazards in the water, sanitation, and hygiene (WASH) systems: a global review

  2022influential citation
• Barriers and facilitators to Water, Sanitation and Hygiene (WaSH) practices in Southern Africa: A scoping review

  2022cites this paper
• Public procurement law, political economy of the lowest responsive bidding, and the development of the water, sanitation and hygiene sector in Nigeria

  2022cites this paper
• Water, Sanitation and Hygiene Practice among Students in Secondary School, Ijebu Ode, Nigeria

  2022cites this paper
• “If It's Yellow, Let It Mellow, If It's Brown, Let It Drown”: Examining the Health Effects of Drought-Induced Water Rationing for Sanitary Needs

  2022cites this paper
• Water Scarcity & Health in Urban Africa

  2021cites this paper
• PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low‐ and middle‐income countries? A mixed‐method systematic review protocol

  2021cites this paper
• Drinking water salinity is associated with hypertension and hyperdilute urine among Daasanach pastoralists in Northern Kenya.

  2021cites this paper
• Influences of Land-Use Dynamics and Surface Water Systems Interactions on Water-Related Infectious Diseases—A Systematic Review

  2020cites this paper
• Prediction ability of vector species, environmental characteristics and socio-economic factors for malaria risk in Sub-Saharan African Countries

  2020cites this paper
• Rapid evidence assessment of the impacts of sewerage, drainage, and piped water chlorination in urban settings of low- and middle-income countries

  2020cites this paper
• A SEM Approach to the Direct and Indirect Links between WaSH Services and Access to Food in Countries in Protracted Crises: The Case of Western Bahr-el-Ghazal State, South Sudan

  2020cites this paper
• Spatial Analysis of Risk Factors of Potable Water and The Efficiency of HIV/AIDS in Ekiti State, Nigeria

  2019cites this paper
• Effects of single and combined water, sanitation and hygiene (WASH) interventions on nutritional status of children: a systematic review and meta-analysis

  2019cites this paper