•  
  •  
 

Abstract

Sub-Saharan Africa’s (SSA) children experience a disproportionate burden of environmental health risks, contributing to over half of global under-five deaths despite representing only 27% of live births 1. This scoping review synthesised evidence from sixty-seven (67) eligible studies (2010–2025) to map out environmental exposures affecting children (0–18 years) in Sub-Saharan Africa, and to identify gaps in global interventions. Included studies focused on children (0-18 years) in SSA, addressed one or more of the four predefined environmental exposure domains (air pollution, WASH, toxic chemicals, climate-related risks), and reported on child health outcomes or interventions. Guided by the PRISMA and Arksey and O’Malley frameworks, peer-reviewed articles and organisational reports were identified from WHO, UNICEF, PubMed, and Google Scholar, and scrutinised for exposure-outcome links, study design, and intervention coverage. Evidence was synthesised across four major domains: air pollution, WASH, toxic chemical exposures, and climate-related risks. The results show that household air pollution, unsafe water and sanitation, lead and e-waste contamination, and climate variability consistently contribute to elevated morbidity and mortality among children, particularly those under five years, where most primary data were reported. Despite progress in WASH and emergency response, major gaps persist in air quality monitoring, toxin surveillance, and climate-health integration. Protecting child health in SSA necessitates strengthened multisectoral action across health, environment, WASH, energy, and social protection sectors to enhance monitoring, mitigation, and adaptive responses, ensuring every child’s right to a safe and clean environment.

Keywords: Sub-Saharan African children, environmental health risks, pollution, WASH, and climate change

References

  1. Gaffan N, Kpozehouen A, Degbey C, Ahanhanzo YG, Paraïso MN. Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa. Front Public Health. 2023;11.
  2. WHO. Environmental health indicators: Framework and methodologies [Internet]. 1999 [cited 2025 Nov 15]. Available from: https://www.who.int/publications/i/item/WHO-SDE-OEH-99.10
  3. Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice [Internet]. 2005 Feb [cited 2025 Nov 15];8(1):19–32. Available from: https://www.tandfonline.com/doi/pdf/10.1080/1364557032000119616
  4. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. https://doi.org/107326/M18-0850 [Internet]. 2018 Sep 4 [cited 2025 Nov 15];169(7):467–73. Available from: /doi/pdf/10.7326/M18-0850?download=true
  5. WHO & UNICEF. Sanitation Statistics - UNICEF DATA [Internet]. WHO & UNICEF. 2022 [cited 2025 Jul 6]. Available from: https://data.unicef.org/topic/water-and-sanitation/sanitation/
  6. Kazuva E, Zhang J. Analysing municipal solid waste treatment scenarios in rapidly urbanising cities in developing countries: The case of Dar es Salaam, Tanzania. Int J Environ Res Public Health. 2019 Jun 1;16(11).
  7. Angela R. Pashayan. Informal settlements and climate change in the ‘last mile of urbanisation’ | Brookings [Internet]. American University School of International Service. 2024 [cited 2025 Jul 6]. Available from: https://www.brookings.edu/articles/informal-settlements-and-climate-change-in-the-last-mile-of-urbanization/?
  8. Ngueta G, Ndjaboue R. Blood lead concentrations in sub-Saharan African children below 6 years: Systematic review. Tropical Medicine and International Health. 2013 Oct;18(10):1283–91.
  9. Lebbie TS, Moyebi OD, Asante KA, Fobil J, Brune-Drisse MN, Suk WA, et al. E-waste in Africa: A serious threat to the health of children. Vol. 18, International Journal of Environmental Research and Public Health. MDPI; 2021.
  10. UNICEF USA. Turning Climate Hardship into Hope in Eastern and Southern Africa | UNICEF USA [Internet]. UNICEF USA. 2023 [cited 2025 Jul 6]. Available from: https://www.unicefusa.org/stories/turning-climate-hardship-hope-eastern-and-southern-africa
  11. WHO. Pneumonia in children [Internet]. WHO. 2022 [cited 2025 Jul 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/pneumonia/
  12. Medgyesi DN, Mujtaba MN, Yang Q, Abubakari SW, Lee AG, Porter J, et al. Geospatial determinants of maternal and child exposure to fine particulate matter in Kintampo, Ghana: Levels within the household and community, by surrounding building density and near roadways. J Expo Sci Environ Epidemiol [Internet]. 2024 Sep 1 [cited 2025 Jul 7];34(5):802–13. Available from: https://pubmed.ncbi.nlm.nih.gov/3779834/
  13. Lake EA, Karras J, Marks GB, Cowie CT. The effect of air pollution on morbidity and mortality among children aged under five in sub-Saharan Africa: Systematic review and meta-analysis. PLoS One. 2025 Apr 1;20(4 April).
  14. Mberu B, Simiyu S, Gutema FD, Sewell D, Busienei PJ, Tumwebaze IK, et al. Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children. BMJ Open. 2024 Aug 19;14(8).
  15. Ahmed KY, Dadi AF, Kibret GD, Bizuayehu HM, Hassen TA, Amsalu E, et al. Population modifiable risk factors associated with under-5 acute respiratory tract infections and diarrhoea in 25 countries in sub-Saharan Africa (2014–2021): an analysis of data from demographic and health surveys. EClinicalMedicine [Internet]. 2024 Feb 1 [cited 2025 Jul 8];68. Available from: https://scispace.com/papers/population-modifiable-risk-factors-associated-with-under-5-i4atucx9xt
  16. Bickton FM, Ndeketa L, Sibande GT, Nkeramahame J, Payesa C, Milanzi EB. Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys. Environ Health Prev Med. 2020 Dec 1;25(1).
  17. Heft-Neal S, Burney J, Bendavid E, Burke M. Robust relationship between air quality and infant mortality in Africa. Nature. 2018 Jul 12;559(7713):254–8.
  18. deSouza PN, Hammer M, Anthamatten P, Kinney PL, Kim R, Subramanian S V., et al. Impact of air pollution on stunting among children in Africa. Environ Health. 2022 Dec 1;21(1).
  19. Pun VC, Dowling R, Mehta S. Ambient and household air pollution on early-life determinants of stunting: systematic review and meta-analysis. Environmental Science and Pollution Research [Internet]. 2021; Available from: https://doi.org/10.1007/s11356-021-13719-7
  20. Oyenuga VO, Mosler G, Addo-Yobo E, Adeyeye OO, Arhin B, Fortune F, et al. Asthma symptoms, severity, and control with and without a clinical diagnosis of asthma in early adolescence in sub-Saharan Africa: a multi-country, school-based, cross-sectional study. Lancet Child Adolesc Health. 2024 Dec 1;8(12):859–71.
  21. Masekela R, Vanker A. Lung health in children in sub-Saharan Africa: Addressing the need for cleaner air. Vol. 17, International Journal of Environmental Research and Public Health. MDPI AG; 2020. p. 1–13.
  22. Fayehun OA. Household Environmental Health Hazards and Child Survival in Sub-Saharan Africa. USAID [Internet]. 2010; Available from: www.measuredhs.com
  23. Morgan C, Bowling M, Bartram J, Lyn Kayser G. Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Int J Hyg Environ Health. 2017 Aug 1;220(6):950–9.
  24. Nantege R, Kajoba D, Ddamulira C, Ndoboli F, Ndungutse D. Prevalence and factors associated with diarrheal diseases among children below five years in selected slum settlements in Entebbe municipality, Wakiso district, Uganda. BMC Pediatr. 2022 Dec;22.
  25. Ganyaglo SY, Gibrilla A, Teye EM, Owusu-Ansah EDGJ, Tettey S, Diabene PY, et al. Groundwater fluoride contamination and probabilistic health risk assessment in fluoride endemic areas of the Upper East Region, Ghana. Chemosphere. 2019 Oct;233:862–72.
  26. Neyole EM. Household Drinking water contamination by Escherichia Coli and prevalence of diarrhoea in children under five years in Baringo County, Kenya. International Journal of Sciences: Basic and Applied Research. https://repository.nrf.go.ke/entities/publication/80bfdd03-41f4-4059-b1c0-5354294efe42/full? 2020.
  27. Soboksa NE, Gari SR, Hailu AB, Alemu BM. Child defecation, faeces disposal practices and associated factors in community-led total sanitation adopted districts in Jimma Zone, Ethiopia. Environmental Challenges [Internet]. 2021 Apr 1 [cited 2025 Sep 9];3:100059. Available from: https://www.sciencedirect.com/science/article/pii/S266701002100038X
  28. Geere JAL, Hunter PR, Jagals P. Domestic water carrying and its implications for health: A review and mixed methods pilot study in Limpopo Province, South Africa. Environ Health [Internet]. 2010 Aug 26 [cited 2025 Sep 9];9(1):1–13. Available from: https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-9-52
  29. Cumming O, Cairncross S. Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Vol. 12, Maternal and Child Nutrition. Blackwell Publishing Ltd; 2016. p. 91–105.
  30. Tirima S, Bartrem C, Von Lindern I, Von Braun M, Lind D, Anka SM, et al. Environmental remediation to address childhood lead poisoning epidemic due to artisanal gold mining in Zamfara, Nigeria. Environ Health Perspect [Internet]. 2016 Sep 1 [cited 2025 Sep 9];124(9):1471–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26745642/
  31. Pure Earth & UNICEF. The Toxic Truth Report - Pure Earth and UNICEF [Internet]. Pure Earth & UNICEF. 2020 [cited 2025 Jul 6]. Available from: https://www.pureearth.org/global-lead-program/the-toxic-truth-report/
  32. Desye B, Tesfaye AH, Berihun G, Ademas A, Sewunet B. A systematic review of the health effects of lead exposure from electronic waste in children. Vol. 11, Frontiers in Public Health. Frontiers Media S.A.; 2023.
  33. Ondayo MA, Simiyu GM, Raburu PO, Were FH. Child Exposure to Lead in the Vicinities of Informally Used Lead-Acid Battery Recycling Operations in Nairobi Slums, Kenya. J Health Pollut [Internet]. 2016 Dec [cited 2025 Jul 6];6(12):15–25. Available from: https://pubmed.ncbi.nlm.nih.gov/30524801/
  34. Davies B, Hlela MBKM, Rother HA. Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010–2019: a retrospective case review. BMC Public Health [Internet]. 2023 Dec 1 [cited 2025 Sep 9];23(1):1–11. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15652-5
  35. Osunkentan AO, Evans D. Chronic adverse effects of long-term exposure of children to dichlorodiphenyltrichloroethane (DDT) through indoor residual spraying: A systematic review. Rural Remote Health. 2015;15(2).
  36. Chilaka CA, Mally A. Mycotoxin Occurrence, Exposure and Health Implications in Infants and Young Children in Sub-Saharan Africa: A Review. Foods. 2020 Nov 1;9(11).
  37. Thiede BC, Strube J. Climate variability and child nutrition: Findings from sub-Saharan Africa. Global Environmental Change. 2020 Nov 1;65.
  38. Aborode AT, Otorkpa OJ, Abdullateef AO, Oluwaseun OS, Adegoye GA, Aondongu NJ, et al. Impact of Climate Change-Induced Flooding Water Related Diseases and Malnutrition in Borno State, Nigeria: A Public Health Crisis. Vol. 19, Environmental Health Insights. SAGE Publications Inc.; 2025.
  39. Asirvatham R, Demi SM, Ezezika O. Are sub-Saharan African national food and agriculture policies nutrition-sensitive? A case study of Ethiopia, Ghana, Malawi, Nigeria, and South Africa. Vol. 11, Agriculture and Food Security. BioMed Central Ltd; 2022.
  40. Kofi Amega A. Improving child survival in sub-Saharan Africa: Key environmental and nutritional interventions. Ann Glob Health. 2020;86(1):1–6.
  41. Malings C, Westervelt DM, Hauryliuk A, Presto AA, Grieshop A, Bittner A, et al. Application of low-cost fine particulate mass monitors to convert satellite aerosol optical depth to surface concentrations in North America and Africa. Atmos Meas Tech. 2020 Jul 17;13(7):3873–92.
  42. Woolley KE, Bartington SE, Pope FD, Greenfield SM, Tusting LS, Price MJ, et al. Cooking outdoors or with cleaner fuels does not increase malarial risk in children under 5 years: a cross-sectional study of 17 sub-Saharan African countries. Malar J. 2022 Dec 1;21(1).
  43. Tietjen B, Jacobsen K, Hollander J. Climate Change and Urban Migration in Sub-Saharan African Cities: Impacts and Governance Challenges. 2023; Available from: https://doi.org/10.1162/crcj_a
  44. Jafta N, Shezi B, Buthelezi M, Muteti-Fana S, Naidoo RN. Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens. Curr Opin Pulm Med [Internet]. 2024 Mar 1 [cited 2025 Jul 5];31(2):89. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11789611/
  45. UNICEF. Silent suffocation in Africa: Air pollution is a growing menace | UNICEF [Internet]. UNICEF. 2019 [cited 2025 Jul 5]. Available from: https://www.unicef.org/reports/silent-suffocation-in-africa-air-pollution-2019
  46. Cai YS, Gibson H, Ramakrishnan R, Mamouei M, Rahimi K. Ambient air pollution and respiratory health in sub-Saharan African children: A cross-sectional analysis. Int J Environ Res Public Health. 2021 Sep 1;18(18).
  47. Schwela. Review of Urban Air Quality in Sub-Saharan Africa Region: Air Quality Profile of SSA Countries [Internet]. World Bank. World Bank, Washington, DC; 2012 [cited 2025 Jul 5]. Available from: https://hdl.handle.net/10986/26864
  48. Mudau LS, Thumbathi AMD, Nkosi DV, Mudau LS, Thumbathi AMD, Nkosi DV. Poor Disposal of Soiled Diapers in Sub-Saharan Africa: A Gap in Environmental Health Literacy in Rural Communities. Environmental Health Literacy Update - New Evidence, Methodologies and Perspectives [Internet]. 2023 Nov 6 [cited 2025 Jul 6]; Available from: https://www.intechopen.com/chapters/1146721
  49. Morakinyo OM, Mokgobu MI. Indoor Household Exposures and Associated Morbidity and Mortality Outcomes in Children and Adults in South Africa. Int J Environ Res Public Health [Internet]. 2022 Aug 1 [cited 2025 Sep 9];19(15):9471. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9367742/
  50. Njoku A, Agbalenyo M, Laude J, Ajibola TF, Attah MA, Sarko SB. Environmental Injustice and Electronic Waste in Ghana: Challenges and Recommendations. Int J Environ Res Public Health. 2024 Jan 1;21(1).
  51. WHO/UNICEF. Open defecation | JMP [Internet]. JMP. 2022 [cited 2025 Jul 8]. Available from: https://washdata.org/monitoring/sanitation/open-defecation
  52. Asgedom YS, Melaku T, Gebrekidan AY, Meskele M, Asnake G, Alemu A, et al. Prevalence of active trachoma among 1–9 years of age children in Ethiopia: a systematic review and meta-analysis. BMJ Open [Internet]. 2024 Jul 1 [cited 2025 Sep 9];14(7):e079623. Available from: https://bmjopen.bmj.com/content/14/7/e079623
  53. Nti AAA, Arko-Mensah J, Botwe PK, Dwomoh D, Kwarteng L, Takyi SA, et al. Effect of particulate matter exposure on respiratory health of e-waste workers at agbogbloshie, Accra, Ghana. Int J Environ Res Public Health. 2020 May 1;17(9).
  54. Ibor OR, Nnadozie P, Ogarekpe DM, Idogho O, Anyanti J, Aizobu D, et al. Public health implications of endocrine disrupting chemicals in drinking water and aquatic food resources in Nigeria: A state-of-the-science review. Science of The Total Environment [Internet]. 2023 Feb 1 [cited 2025 Sep 9];858:159835. Available from: https://www.sciencedirect.com/science/article/pii/S0048969722069352
  55. Veale et al. Toxicovigilance I: a survey of acute poisonings in South Africa based on Tygerberg Poison Information Centre data. - Free Online Library [Internet]. South African Medical Journal. 2013 [cited 2025 Jul 6].
  56. Clarke K, Rivas AC, Milletich S, Sabo-Attwood T, Coker ES. Prenatal Exposure to Ambient PM2.5 and Early Childhood Growth Impairment Risk in East Africa. Toxics. 2022 Nov 1;10(11).
  57. Ryckman T, Beal T, Nordhagen S, Chimanya K, Matji J. Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa. Nutr Rev [Internet]. 2021 Mar 9 [cited 2025 Sep 9];79(Supplement_1):35–51. Available from: https://dx.doi.org/10.1093/nutrit/nuaa137
  58. White JM, Bégin F, Kumapley R, Murray C, Krasevec J. Complementary feeding practices: Current global and regional estimates. Matern Child Nutr. 2017 Oct 1;13.
  59. Ngo NS, Gatari M, Yan B, Chillrud SN, Bouhamam K, Kinney PL. Occupational exposure to roadway emissions and inside informal settlements in sub-Saharan Africa: A pilot study in Nairobi, Kenya. Atmos Environ. 2015 Jun 1;111:179–84.
  60. Bwire G, Munier A, Ouedraogo I, Heyerdahl L, Komakech H, Kagirita A, et al. Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015. PLoS Negl Trop Dis [Internet]. 2017 Mar 13 [cited 2025 Sep 9];11(3):e0005407. Available from: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005407
  61. Gedamu G, Mitiku KW, Belay MA, Simegn MB, Chanie SD, Tilahun WM, et al. Barriers to the sustainability of rural water schemes in Sub-Saharan African countries: a systematic review. Vol. 15, Journal of Water, Sanitation and Hygiene for Development. IWA Publishing; 2025. p. 427–42.
  62. Visser ME, Schoonees A, Ezekiel CN, Randall NP, Naude CE. Agricultural and nutritional education interventions for reducing aflatoxin exposure to improve infant and child growth in low- and middle-income countries. Cochrane Database of Systematic Reviews [Internet]. 2020 Apr 9 [cited 2025 Sep 9];2020(4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013376.pub2/full
  63. Cirolia LR. Fractured fiscal authority and fragmented infrastructures: Financing sustainable urban development in Sub-Saharan Africa. Habitat Int. 2020 Oct 1;104.
  64. Wuehler SE, Hess SY, Brown KH. Accelerating improvements in nutritional and health status of young children in the Sahel region of Sub-Saharan Africa: Review of international guidelines on infant and young child feeding and nutrition. Matern Child Nutr [Internet]. 2011 Apr [cited 2025 Sep 9];7(SUPPL. 1):6–34. Available from: https://pubmed.ncbi.nlm.nih.gov/21410888/
  65. Caldwell KL, Cheng PY, Jarrett JM, Makhmudov A, Vance K, Ward CD, et al. Measurement challenges at low blood lead levels. Paediatrics [Internet]. 2017 Aug 1 [cited 2025 Jul 7];140(2). Available from: /pediatrics/article/140/2/e20170272/38644/Measurement-Challenges-at-Low-Blood-Lead-Levels
  66. Tasic H, Akseer N, Gebreyesus SH, Ataullahjan A, Brar S, Confreda E, et al. Drivers of stunting reduction in Ethiopia: a country case study. Am J Clin Nutr [Internet]. 2020 Sep 1 [cited 2025 Sep 9];112:875S-893S. Available from: https://www.sciencedirect.com/science/article/pii/S0002916522009613?via%3Dihub
  67. Ibrahim AS, Kuuire V, Kepe T. On mapping urban community resilience: Land use vulnerability, coping and adaptive strategies in Ghana. J Environ Manage. 2024 Nov 1;370.

Bahasa Abstract

Anak-anak di Afrika Sub-Sahara (SSA) mengalami beban risiko kesehatan lingkungan yang tidak proporsional, berkontribusi terhadap lebih dari setengah kematian balita di dunia meskipun hanya mewakili 27% dari kelahiran hidup¹. Tinjauan cakupan ini mensintesis bukti dari enam puluh tujuh (67) studi yang memenuhi syarat (2010–2025) untuk memetakan paparan lingkungan yang memengaruhi anak-anak (0–18 tahun) di Afrika Sub-Sahara, dan untuk mengidentifikasi kesenjangan dalam intervensi global. Studi yang disertakan berfokus pada anak-anak (0-18 tahun) di SSA, membahas satu atau lebih dari empat domain paparan lingkungan yang telah ditentukan sebelumnya (polusi udara, WASH, bahan kimia beracun, risiko terkait iklim), dan melaporkan hasil atau intervensi kesehatan anak. Dipandu oleh kerangka kerja PRISMA dan Arksey dan O’Malley, artikel yang ditinjau sejawat dan laporan organisasi diidentifikasi dari WHO, UNICEF, PubMed, dan Google Scholar, dan diteliti untuk hubungan paparan-hasil, desain studi, dan cakupan intervensi. Bukti disintesis di empat domain utama: polusi udara, WASH (Air, Sanitasi, dan Kebersihan), paparan bahan kimia beracun, dan risiko terkait iklim. Hasil menunjukkan bahwa polusi udara rumah tangga, air dan sanitasi yang tidak aman, kontaminasi timbal dan limbah elektronik, serta variabilitas iklim secara konsisten berkontribusi pada peningkatan morbiditas dan mortalitas di kalangan anak-anak, khususnya anak-anak di bawah lima tahun, di mana sebagian besar data primer dilaporkan. Terlepas dari kemajuan dalam WASH dan respons darurat, kesenjangan besar masih ada dalam pemantauan kualitas udara, pengawasan racun, dan integrasi iklim-kesehatan. Melindungi kesehatan anak di Afrika Sub-Sahara memerlukan penguatan aksi multisektoral di sektor kesehatan, lingkungan, WASH, energi, dan perlindungan sosial untuk meningkatkan pemantauan, mitigasi, dan respons adaptif, memastikan hak setiap anak atas lingkungan yang aman dan bersih.

Kata Kunci: Anak-anak Afrika Sub-Sahara, risiko kesehatan lingkungan, polusi, WASH, dan perubahan iklim

Additional Files
Suplementary Content.docx (35 kB)
Extended Data Extraction Table with characteristics of all studies included
Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.