Household Drinking-Water Treatment and Safe Storage in Sub-Saharan Africa: Bridging the Gap between Efficacy and Sustained Use in Rural and Peri-Urban Communities

Unsafe drinking water remains a major driver of preventable waterborne disease and child mortality across sub-Saharan Africa. Household water treatment and safe storage (HWTS) interventions—including point-of-use chlorination, filtration, boiling, solar disinfection, and coagulants—offer proven microbial decontamination at the point of consumption. However, a significant gap persists between technical efficacy under ideal conditions and long-term sustained adoption in real-world settings. This narrative review critically examines empirical evidence published between 2020 and 2026 on HWTS efficacy, household recontamination dynamics, behavioral determinants, and implementation models across rural and peri-urban sub-Saharan Africa, with primary emphasis on Nigeria. Synthesised evidence demonstrates that while technologies such as silver-impregnated ceramic vessel filters, biosand filtration, and point-of-use chlorination achieve 2.0 to >4.0 log10 microbial reductions in laboratory trials, real-world effectiveness is heavily compromised by post-treatment recontamination during storage (occurring in 42% to 78% of treated water samples) and rapid adoption decay. Key drivers of low sustained use include organoleptic aversion to chlorine taste, high recurring costs for commercial products, cumbersome daily operation, and lack of institutionalized governance. Cross-sectional and longitudinal data from Nigeria indicate that household water treatment practice remains below 16% nationally, with severe rural-urban and socioeconomic disparities. Sustainable progress requires transitioning from sporadic hardware distribution to multi-sectoral behavioral change strategies, microfinance-backed technology supply chains, community-led monitoring, and institutionalized national WASH policy integration.