Africa is a big, complicated place. Planning a trip to a city is different from trekking the savanna. Some trips would have plenty of access to toilets and clean water, and other styles of travel would be...rougher. We are at no greater risk of GI diseases than folks with colons. We do have to be more careful to stay hydrated, but I’d expect bottled water to be plentiful. People need toilets of some sort everywhere people live, though there are a wide variety of approaches to public toilets. Just do a little research.