Conceptual frameworks regarding waterborne diseases in sub-Saharan Africa and the need of for a new approach to urban exposomes

Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and interventions. The division of urban areas into public, domestic, and individual exposure areas facilitates a more straightforward understanding of the dynamics of waterborne exposomes. Moreover, the inclusion of this division in the driving force–pressure–state–exposure–effect–action framework allows an effective stratified implementation of urban public health policies.