Water, sanitation, and hygiene (WASH) and other one health determinants of skin neglected tropical diseases: A scoping review

Background Over one billion people are at risk of or affected by skin neglected tropical diseases (skin NTDs), yet evidence linking water, sanitation, and hygiene (WASH) and One Health determinants (environmental exposures, animal interfaces, and climate factors) to these conditions remains poorly synthesised. This scoping review mapped existing evidence on WASH and One Health determinants of the 12 WHO-recognised skin NTDs. Methodology/principal findings MEDLINE/PubMed was searched from inception to November 2025 following PRISMA-ScR guidelines (protocol: https://doi.org/10.17605/OSF.IO/PBEHM ). English-language primary studies assessing at least one skin NTD, one WASH domain and one One Health dimension were included. Data were charted using standardised forms. We found thirty primary studies across 17 countries reporting on 8 of 12 skin NTDs. Buruli ulcer (n = 10), cutaneous leishmaniasis (n = 9), and tungiasis (n = 7) were the most common; with no studies addressing onchocerciasis, yaws, chromoblastomycosis, or sporotrichosis. Improved water access was protective for Buruli ulcer (aOR 0.2) and cutaneous leishmaniasis, while poor housing was consistently associated with tungiasis (aOR 3.35–5.83). In terms of One Health dimensions: possum density showed dose-response associations with Buruli ulcer (aOR 4.52–6.06), animal proximity, including domestic animals and wildlife reservoirs, was associated with cutaneous leishmaniasis (aOR 2.4–3.12), and Mycobacterium ulcerans DNA and viable Mycobacterium leprae mRNA were detected in community water sources, although transmission to humans was not established. Only one interventional study was identified. Conclusions/significance Evidence on WASH and One Health determinants of skin NTDs is limited and concentrated on three diseases, with four skin NTDs entirely unrepresented. Where evidence exists, water access, environmental sanitation, and animal interface management were associated with lower risk. The near-absence of interventional research and limited geographic diversity beyond Africa represent critical gaps for developing the integrated WASH and One Health strategies called for by the WHO 2030 Roadmap.