This paper provides a multi-date review of trends in groundwater pollution from pit latrine sanitation structures using global, regional and South African cases. The paper focuses on three parameters which are microorganisms, nitrate and phosphorus, which are aligned with the challenge of waterborne diseases, and generally linked to poor water quality, and inadequate sanitation and hygiene. Poor sanitation and hygiene open up transmission routes for ingestion of faecal matter, which as at 2018 continue to pose risks of diarrhoea, opportunistic infections, and consequent malnutrition. These challenges currently account for approximately 1.7 million deaths annually, of which more than 90% are in developing countries, which have low sanitation coverage. While pit toilets are the generally preferred form of sanitation technology for developing countries, most provide evidence of the interconnectedness between the structures and groundwater pollution. The mechanism of pollution is generally indicated to be seepage of polluted pit latrine leachate into groundwater. This specific type of microbial and chemical routing from toilets into the environment increases the prevalence of diseases. These diseases usually result in high mortality for developing countries. Therefore, this review has highlighted the need to minimize pollution of groundwater from pit latrines, thereby contributing towards sustainable water quality management.