A healthy and a dignified life experience requires adequate water, sanitation, and hygiene (WaSH) coverage. However, inadequate WaSH resources remain a significant public health challenge in many communities in Southern Africa. A systematic search of peer-reviewed journal articles from 2010 –May 2022 was undertaken on Medline, PubMed, EbscoHost and Google Scholar from 2010 to May 2022 was searched using combinations of predefined search terms with Boolean operators. Eighteen peer-reviewed articles from Southern Africa satisfied the inclusion criteria for this review. The general themes that emerged for both barriers and facilitators included geographical inequalities, climate change, investment in WaSH resources, low levels of knowledge on water borne-diseases and ineffective local community engagement. Key facilitators to improved WaSH practices included improved WaSH infrastructure, effective local community engagement, increased latrine ownership by individual households and the development of social capital. Water and sanitation are critical to ensuring a healthy lifestyle. However, many people and communities in Southern Africa still lack access to safe water and improved sanitation facilities. Rural areas are the most affected by barriers to improved WaSH facilities due to lack of WaSH infrastructure compared to urban settings. Our review has shown that, the current WaSH conditions in Southern Africa do not equate to the improved WaSH standards described in SDG 6 on ensuring access to water and sanitation for all. Key barriers to improved WaSH practices identified include rurality, climate change, low investments in WaSH infrastructure, inadequate knowledge on water-borne illnesses and lack of community engagement.

Masculinity is an important health determinant and has been studied as a risk factor for communicable diseases in the African context. This paper explores how hegemonic and complicit masculinities influence the lifestyle risk factors for noncommunicable diseases among men. A qualitative research method was used, where eight focus group discussions were conducted among adult men in Maseru, Lesotho. The data were analyzed using a thematic analysis approach. Although the participants typically described taking responsibility as a key feature of what it meant to be a man in Lesotho, their reported behaviors and rationales indicated that men commonly abdicated responsibility for their health to women. Participants were aware of the negative effects of smoking on health and acknowledged the difficulty to stop smoking due to the addictive nature of the habit. The initiation of smoking was linked by participants to the need to be seen as a man, and then maintained as a way of distinguishing themselves from the feminine. Regarding harmful alcohol consumption, participants reported that stress, particularly in their relationships with women, were linked to the need to drink, as they reported limited outlets for emotional expression for men in Lesotho. On the subject of poor diet, the study found that most men were aware of the importance of vegetable consumption; the perceived lengthy preparation process meant they typically depended on women for such healthy food preparation. Almost all participants were aware of the increased susceptibility to diverse negative health effects from physical inactivity, but because of the physical nature of the work, those engaged in traditionally masculine occupations did not exercise. In the context of lifestyle risk factors for noncommunicable diseases, masculinity has positive and negative impacts. It is important to design health education programs targeting men to successfully mitigate the negative health impacts of masculinity.

Masculinity is a health determinant for men and a risk factor for non-communicable diseases. This chapter explores how dominant masculinity influences lifestyle risk factors for non-communicable diseases focusing on adult men. The study conducted eight exploratory focus group discussions with adult men from Maseru, Lesotho. The participants were recruited using purposive sampling. Thematic analysis processes were followed to analyse data. The participants’ rationales and behaviours indicated dependence on women for healthy living even though men claimed taking responsibility as one of the key descriptions for a man. Smoking was perceived as one of the practices used to prove masculinity. Participants were informed about the unfavourable impacts of smoking. Stress, leisure time and peer pressure were reported as contributing factors to harmful alcohol consumption among participants. Many participants understood the benefits from healthy diets, however, they depended on females for healthy meals. Nearly all the men were aware of the health benefits of physical activities. Participants were aware of the undesirable effects of physical inactivity. Participants reported various challenges to effective physical activities and classified some activities as suitable for middle-class individuals. Health education focused on men is critical in order to alleviate the negative impacts of masculinity on men’s health.