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This book is based on the evidence collected during the "Technical e-Learning Course on Wastewater Treatment", an international training project developed in 2020 in Italy by the Hydroaid Association, in collaboration with Turin Polytechnic. This work intended to address the sustainability of urban sanitation in various African countries, which the world of international cooperation has been looking at in recent years with growing interest. Data and information reported by the project participants were elaborated and verified. Four African countries-Benin, Egypt, Ethiopia, and Malawi-were considered and two relevant case studies among those proposed by the participants were presented. Starting from this analysis, significant elements about the status and coverage of wastewater management were extracted and reported. The analysis of existing wastewater treatment plants (WWTPs) allowed evaluating their design features and the current status of the operation. Considerations about the environmental, economic, social, and technical sustainability of wastewater treatment and management were finally reported.