Impact of infrastructure and housing conditions on health outcomes in Zambia: A scoping review and thematic analysis

Abstract

Infrastructure and housing conditions are increasingly recognised as key determinants of public health, yet evidence from Zambia remains limited and fragmented. This scoping review maps research on how WASH infrastructure, service provision, and housing quality influence health outcomes. Following the Arksey and O’Malley framework, strengthened by Joanna Briggs Institute (JBI) guidance and reported in line with the PRISMA-ScR checklist, searches across Scopus, Web of Science, PubMed, Google Scholar, and organisational sources identified studies published between 2012 and October 2025. From 4,525 records and 141 full texts, 32 studies met inclusion criteria and were synthesised thematically. Four themes emerged: water and sanitation services, where inadequate or poorly maintained systems drive contamination and disease; WASH access, highlighting persistent inequalities linked to socio-economic status, settlement type, and rapid urbanisation; WASH and health outcomes, showing consistent associations between poor sanitation, limited drainage, water scarcity, and communicable diseases such as cholera and diarrhoea; and housing and malaria, demonstrating how structural features like wall and roof materials, ventilation, and openings affect vector exposure. Across studies, weak sanitation, inadequate drainage, overcrowding, and poor housing quality heightened vulnerability to cholera, diarrhoeal diseases, respiratory conditions, and malaria. Evidence gaps include measuring housing quality, integrating infrastructure factors into health research, and representing peri-urban areas. Findings underscore the need for improved, context-appropriate WASH systems, housing interventions, and standardised assessment approaches, while embedding public health considerations into housing and urban development policies to reduce preventable disease burdens in Zambia.