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The global demand for plastics has increased majorly because of their versatility, light weight, strength and cost–effectiveness. Africa is ranked top in mismanagement of plastic waste, resulting in the plastic problem in the environment. Nevertheless, plastics produce microplastics through degradation and fragmentation of plastic debris largely from anthropogenic sources. Microplastics have become ubiquitous in the natural environment, and the terrestrial environment is the major source. The propensity of microplastics to adsorb and concentrate persistent organic pollutants (POPs) provides potential health effects in the different trophic levels of organisms in both aquatic and territorial environments. Thus, the fate of microplastics is increasingly becoming a global concern. Despite the numerous global studies on the impact of microplastics in the environment, there are insufficient data available on the occurrence and distribution of microplastics and associated health effects in aquatic ecosystems in Africa. The reviewed research articles from 2000 to 2021 provide a summary of the current knowledge on the occurrence and distribution of microplastics, analytical approaches used to detect and quantify microplastics, associated health effects and mitigation measures through government policy to ban plastic use in Africa. The findings presented provide a platform for future research to focus on the associated effects of adsorbed and concentrated POPs on microplastics in aquatic environments in Africa. With the evidence presented, policymakers will make more informed decisions on the future of plastics in Africa. The authors recommend improving information and expanding knowledge through research on the fate and potential ecological impact of microplastics in aquatic environments in Africa.