Heavy metals pollution of both surface and groundwater sources of Sub-Saharan Africa is alarmingly increased due to unplanned urban populations. Inadequate policies for water management, political commitment, and financial resources forced 65% of rural communities of Sub-Saharan Africa to live in economic water stress areas. Sugarcane bagasse (SCB) shows high heavy metals (HMs) adsorption capacity (20–700 mg/g) through chemical entrapments to carbon-oxygen containing functional group and interior pore filling of porous surface. Various modifications like a physical/thermal, chemical, and composite form of bagasse show better adsorption performance for HMs removal. Kinetic and isotherm studies of HMs adsorption equilibrium data over SCB show that both Langmuir and Freundlich adsorption isotherms (cooperative adsorption) as the main adsorption mechanism. In addition, SCB shows potential bio-adsorbent properties for the selective adsorption of target HMs based on their physicochemical properties and shows good repeatability in acid environment. It is believed that information on this review will shed light on the current and future prospects of raw and modified SCB for HMs adsorption removal capacity. Sugarcane bagasse shows a remarkable selectivity for HMs adsorption removals based on their physicochemical properties and shows good potential capability for future utilizations in real wastewaters of developing countries.