Exploring Water, Sanitation, and Hygiene Status and Health Outcomes in Zimbabwe: A Scoping Review of Literature.

This scoping review aimed to explore the water, sanitation, and hygiene status in Zimbabwe and its influence on health outcomes. A systematic search of the literature published in English with an unrestricted search until 31 May 2024 was performed using predefined search strings with Boolean operators, including PubMed, EBSCO, SAGE, SpringerLink, Cochrane Library, ScienceDirect, Scopus, and Web of Science databases. A total of 655 records were identified, of which 20 peer-reviewed articles and 10 other records met the inclusion criteria. The inter-rater agreement for 20% of the dual screening achieved a κ-value of 0.85, indicating almost perfect agreement. Lack of access to adequate clean water, inadequate WASH infrastructure, and unhygienic conditions and practices are among the primary risk factors for diarrhoeal diseases and their associated outbreaks, as identified in several studies. These factors have been reported to play a significant role in recurrent outbreaks of cholera, typhoid, and diarrhoea in Zimbabwe. The lack of adequate WASH facilities in rural schools significantly impacts the management of menstrual hygiene waste. The review concludes that poor Water, Sanitation and Hygiene (WASH) has led to an array of adverse public health outcomes in Zimbabwe over the decades. Despite the existence of a comprehensive WASH policy framework, weak implementation, inadequate funding, poor governance and community participation, and unreliable WASH data monitoring systems largely contribute to the water and sanitation disease burden. Therefore, this review recommends investing in the Rural Water Information Management System (RWIMS) and other digital platforms to improve monitoring and surveillance. Achieving the desired health outcomes requires a fundamental shift in community knowledge, attitudes, and practice. Hence, this review recommends strong community capacity building to support community-led WASH initiatives. The review further recommends strengthening the whole-of-government approach to achieve universal access to WASH in Zimbabwe.