A Water Quality Index (WQI) is a tool that describes the overall water quality by combining complex and technical water quality information into a single meaningful unitless numerical value. WQIs predict water quality since they reflect the impact of multiple Water Quality Parameters (WQPs) and allow for spatial-temporal comparison of water quality status. Most African countries employ adapted WQIs by modifying the original index (or indices) and propose their concepts for evaluating the quality of surface and groundwater, which is normally accompanied by irregularities. The current review examined the process(es) involved in WQI modifications for monitoring water quality in Africa, explored associated limitations, and suggested areas for improvement. A review of 42 research articles from five databases in the last ten years (2012–2022) was conducted. The findings indicated Weighted Arithmetic (WAWQI) and the Canadian Council of Ministers of Environment (CCMEWQI) as the most adapted WQIs. However, several limitations were encountered in WQI developmental steps, mainly in parameter selection and classification schemes used for the final index value. Incorporation of biological parameters, use of less subjective statistical methods in parameter selection, and logical linguistic descriptions in classification schemes were some recommendations for remedying the limitations to register the full potential of adapted WQIs for water quality monitoring in Africa.