<p>The research studies focusing on the analysis and occurrence of pharmaceuticals in African water resources have intensified in the last five years. Therefore, this paper reviewed studies that investigated the occurrence of pharmaceutical contaminants in African waters between 2020 and 2024. It was discovered that the number of studies focusing on non-target (suspecting screening) monitoring where pharmaceuticals are at the focal point in African waters is increasing. This demonstrates a shift in the availability of research infrastructure in Africa, such as the liquid chromatography-mass spectrometry-based instruments, which are capable of performing the suspect screening studies. As such, some metabolites of pharmaceuticals have also been detected in the African waters. The environmental monitoring studies have focused on the analysis of pharmaceuticals in wastewater and surface water, with the inclusion of less-studied matrices in Africa, such as seawater and biota. Over 600 papers have been published in this study area in Africa. South Africa and Nigeria are seen as the key African countries in researching pharmaceutical occurrence, with Kenya, Uganda, and Ethiopia following behind. The most common strategy utilized is the targeted study of multi-class occurrence of pharmaceuticals allowing for a broad understanding of the occurrence, treatment efficiency and propagation of pharmaceuticals. Non-steroidal anti-inflammatory drugs, steroid hormones, and antiretroviral drugs are among the most prevalent drugs in the African environment. This review article further provides a critical assessment of the available information, identification of research gaps, and potential future surveys.</p> Graphical Abstract <p></p>