Abstract

Diarrheal disease remains a leading cause of morbidity and mortality among children under five across Africa, driven 
by gaps in water, sanitation, and hygiene (WASH), limited access to timely treatment, and uneven vaccine coverage. 
In the last decade, control strategies have combined long-established clinical interventions (oral rehydration, zinc, 
breastfeeding, rotavirus vaccination) with innovations in diagnostics, surveillance, digital health, and sanitation 
engineering. This review synthesizes recent progress and emerging technologies relevant to African settings: 
expansion of rotavirus vaccine introductions and supply mechanisms; efforts to scale up co-packaged oral 
rehydration solution (ORS) and zinc; development and deployment of point-of-care and multiplex molecular 
diagnostics; wastewater-based epidemiology and environmental surveillance; and novel water- and sanitation
focused technologies (point-of-use treatment, container-based sanitation, improved fecal sludge management). We 
highlight implementation barriers (supply chains, health system capacity, behavior change, financing) and identify 
research and policy priorities needed to accelerate impact, including cost-effective diagnostic algorithms, integrated 
surveillance platforms, sustainable financing for WASH, and locally adapted delivery strategies.