The impact of climate change is already apparent in SSA, as the research reviewed in this study indicates that regions is already being affected by drought (33,47,63,91), extreme heat (9,84,88,90,94,166) and microbial and chemical water quality issues, leading to infectious diseases such as cholera and diarrhea outbreaks as a result of compounding climate extremes on water access and quality (9,16,87,138,143,149,174). Additionally, there have been reports of natural disasters, such as floods (8,68,137,149) and cyclones (16), all contributing to negative health outcomes in addition to economic costs.

The intensified climate events on the continent are leading to several physical, mental and emotional health impacts. Most of the studies in this review focused on WASH issues, food security, physical illnesses such as heat exhaustion, and pathogen infections such as cholera and malnutrition. However, the social, emotional and mental aspects of climate change have been relatively understudied. Loss of livelihood due to the impact of floods, extreme temperature and drought on agricultural, resource-based occupation and outdoor informal economies has been reported in a few studies in the sub-Saharan African context (83,136). Loss of livelihood is often intertwined with disrupted community ties, loss of identity, climate-induced displacement, climate anxiety, depression and gender-based violence (55,57,59,83,166). Therefore, climate change is leading to cascading outcomes affecting all aspects of health and wellness in the region. There is an urgent need for accelerated climate change research in Africa, home to more than 1 billion people and experiencing rapid population growth. Despite the critical need for solutions, only 43 of the publications reviewed in this study discussed specific strategies and knowledge to mitigate the impact of climate change on health. These publications included contributions to new research, evaluations of existing mitigation efforts, and insights into issues unique to the continent, such as lack of access to basic services and nutrition. Several studies have provided specific mitigations, considerations, and recommendations. For example, a study in Ethiopia examined childhood diarrhea, finding a high incidence at the beginning of dry seasons (43). Other studies have addressed climate-specific issues such as extreme temperatures, precipitation, and mortality and proposed mitigation steps to reduce hospital admissions, morbidity, and mortality (81,84,85), including within-hospital settings. The challenges related to water, sanitation, and hygiene (WASH) were also highlighted, with some studies identifying opportunities for integrating climate adaptation into WASH development planning (2). The findings and recommendations from these studies could be implemented in other regions facing similar challenges. Research on water burdens and gender inequalities has emphasized specific strategies for reducing these disparities (42). Overall, these studies offer valuable insights and recommendations that are specific to the region, that can be applied to mitigate the impact of climate change on health across SSA.

This review revealed existing gaps and opportunities in climate research in SSA. First, geographic disparities exist, with some countries being more studied than others. This disparity can lead to an incomplete understanding of what is needed for the continent or country-specific interventions. Even in countries where research has been conducted, authors have acknowledged the need for more primary climate data to promote data-driven decision-making. (14,71,171). Expanding research efforts to include understudied countries can provide a more comprehensive understanding of climate change and health impact across SSA, ensuring that attention is given to those most impacted by climate change and the opportunity to learn from each other.

Some considerations need to be considered when discussing climate change solutions for SSA. For instance, we need to integrate and discuss social determinants of health as we think of climate change and health. Only five studies highlighted or discussed the associations between health, social determinants of health, and climate change (8,45,83,136,142). However, it is well understood that the work a person does, where people live, their educational level, and income level all play a role in determining health (175). More research is needed to account for climate change as a determinant of health, especially since developing countries will be impacted the most. Additionally, there are only a few studies on how climate change leads to gender-based violence. However, relationships between climate change, loss of livelihood, feelings of emasculation and gender-based violence have been reported in sub-Saharan Africa (8,57). Many studies have not adequately considered the vulnerability of different population groups with an intersectional lens. Although a good number of studies mentioned vulnerable groups such as children, pregnant women and elderly people, most of the reviewed papers mentioned only vulnerability in passing, and 38 studies did not consider vulnerability at all in their research. More comprehensive research is needed to focus on community heterogeneity and intersectionality among the most affected groups. Therefore, while the physical impact of climate change has been relatively well studied in certain countries of sub-Saharan Africa, there is a need for more research on the interconnections between climate change and socioeconomic wellness indicators.

Further, while some climate themes have been extensively studied, others have been less studied and require further attention in sub-Saharan Africa. Of the 302 published articles assessed for eligibility, 44 were specific to malaria research. This was one of the largest groups for research, followed by WASH (57). Rightfully, malaria research has been ongoing for a long time and is well-established (176). However, there is a lack of research in other areas of climate change and health, such as extreme heat, natural disasters, and air pollution. For instance, only 10 studies highlighted research related to air pollution (31–37) and two specifically related to climate change and cardiovascular diseases (34,42). This is a significant finding, mainly since the Lancet Global Burden of Disease (2016) reported that 33% of the global burden of stroke is attributed to environmental factors such as air pollution and lead exposure (177). This study also revealed that air pollution has emerged as a significant contributor to the global burden of stroke in low- and middle-income countries (LMIC) (177). Climate change is expected to increase drought and air pollution in some regions of the world, including SSA (21). Despite this significance, research in this area is almost nonexistent and requires urgent attention.

A few other studies offer concrete pathways and recommendations on what countries need to focus on and prioritize to reduce the impact of climate change. Technological advancement was one of the most common emerging themes from the included studies, although implementing the suggested technologies might be far-fetched in SSA landscapes. For example, in areas where infectious diseases are a concern, authors recommend focusing on early warning signs, disease forecasting, and climate disaster mitigation (14,71) to strengthen public health systems to cope with and reduce climate change impacts. However, it is difficult in developing countries to focus on early warning systems or disease forecasting when basic solutions for preventing diseases, such as access to safe and clean water or sanitation, are still lacking.

For instance, without the additional burden of intensified climate impacts, current water and sanitation infrastructure or healthcare infrastructure is inadequate to protect public health (2,17,19,127,143). Some countries are already experiencing preventable waterborne diseases that could be addressed by having adequate water and sanitation infrastructure. Some examples include the cholera outbreak in Tanzania in 2023, ongoing in 2024, and another in June 2024 in Nigeria (16,18,178–180), both attributed to climate change. In addition, lack of technologies and inadequate electricity coverage create barriers to implementing other simple solutions to combat extreme heat conditions (166) and a lack of improved agricultural technologies to combat food insecurity(4). For example, irrigation systems are creating vulnerabilities further intensified by climate change. The continent must catch up to address current poor living conditions and, at the same time, accelerate the research needed to move to the 21^st century to address climate change issues.

In tandem with inadequate climate policies, a lack of funding was also identified as limiting climate change research progress in SSA. In the present study, more than half of the studies reviewed were self-funded by researchers. The large amount of self-funded research highlights the financial constraints researchers face, which can limit the scope, scale, and depth of their studies, ultimately hindering the development of comprehensive climate change mitigation and adaptation strategies. Additionally, only seven of the 153 selected studies were funded by local governmental agencies, revealing a much deeper systemic issue about the perceived relevance of climate change impacts in this region. Therefore, there is an urgent need for increased investments in climate research (2,19,20,41,65,67,83). Funding climate research will help inform climate decision-making and policies (71). There is also a lack of climate consideration in government policies (2). To ensure that climate investment and increased funding reap the maximum benefits, there is a need for multiagency collaboration between government agencies to inform policies that achieve economic, environmental, social and health justice (45,173). Local residents and external donor agencies should also be included in climate strategizing to ensure maximum benefits (99). Addressing these limitations through enhanced funding, comprehensive policies, and inclusive collaboration will be pivotal for effectively mitigating the impacts of climate change in SSA.

Even with limited resources, countries can strategize and prioritize actions towards climate change. One thing is evident: the issue is not a lack of understanding of the urgency to address climate change. Studies evaluating climate change perception in various African countries have shown that most of the population is familiar with climate change and have experienced it to some exten(14,59,63,64,67,181). However, there is insufficient data due to technological and resource limitations to provide tailored interventions at the community and national, and lack of national policies. For instance, in Zimbabwe, following the devastation caused by Cyclone Ida, natural disasters exposed another problem—food insecurity. A study of 19 health facilities conducted after Cyclone Ida revealed that 94% of the facilities were not equipped to address malnutrition, either due to lack of proper training, inadequate staffing, or failure to follow proper protocols(66). With climate change, areas with limited resources will be most affected, and there is a need for adequate systems to address climate change and health issues. Therefore, community-focused adaptation plans are necessary, taking into account the strengths and vulnerabilities of individual communities and countries. These details can only be revealed through community-level or national research, which is often obscured by large-resolution, aggregated datasets produced by major development agencies.

There is also a dire need to build capacity for health sector personnel through climate preparedness programs that integrate climate resilience into public health systems. Educational and research institutions can offer expertise in addressing regional or national climate change solutions. These programs should focus on enhancing the ability of healthcare infrastructure to withstand climate-related events and training healthcare professionals to respond effectively to climate-induced health issues (6,21,53,64,130,150,182). Additionally, community-based interventions are essential for educating and empowering local populations on climate-related health risks and adaptive practices. Incorporating climate education in formal and informal places of learning in communities, has shown to increase ability to identify vulnerability and build adaptive capacity (53,60). These climate education programs may include utilizing traditional knowledge to inform strategies to reduce individual- and community-level vulnerabilities, improve infrastructure, create multiple climate-resilient income streams, and address the intersectional vulnerabilities that climate change exposes (60). Due to the large population of young people in Africa, strategies targeting young people are paramount (59). Educational programs may also target improved monitoring and surveillance systems (14,171) to fill the data gap and improve data-driven decision-making. These efforts will ensure that public health systems are resilient, adaptive, and equipped to protect the well-being of all individuals, especially the most vulnerable populations.