Abstract
Our world is rapidly urbanizing. According to the United Nations, between 1990 and 2015, the percent of the world’s population living in urban areas grew from 43% to 54%. Estimates suggest that this trend will continue and that over 68% of the world’s population will call cities home by 2050, with the majority of urbanization occurring in African countries. This urbanization is already having a profound effect on global health and could significantly impact the epidemiology of infectious diseases. A better understanding of infectious disease risk factors specific to urban settings is needed to plan for and mitigate against future urban outbreaks. We conducted a systematic literature review of the Web of Science and PubMed databases to assess the risk factors for infectious diseases in the urban environments of sub-Saharan Africa. A search combining keywords associated with cities, migration, African countries, infectious disease, and risk were used to identify relevant studies. Original research and meta-analyses published between 2004 and 2019 investigating geographical and behavioral risk factors, changing disease distributions, or control programs were included in the study. The search yielded 3610 papers, and 106 met the criteria for inclusion in the analysis. Papers were categorized according to risk factors, geographic area, and study type. The papers covered 31 countries in sub-Saharan Africa with East Africa being the most represented sub-region. Malaria and HIV were the most frequent disease focuses of the studies. The results of this work can inform public health policy as it relates to capacity building and health systems strengthening in rapidly urbanizing areas, as well as highlight knowledge gaps that warrant additional research.
Highlights
Catalyzed by the Industrial Revolution in the 19th century, urbanization continues to be a major driver of demographic change in today’s world
Non-communicable diseases (NCDs) are becoming more prevalent even while infectious diseases remain a substantial source of morbidity and mortality, especially among children; many NCDs, including diabetes, obesity, and heart disease, are strongly associated with urbanization [6,7]
We conducted a systematic search in the PubMed and Web of Science databases on risk factors for infectious diseases in urban environments in sub-Saharan Africa
Summary
Catalyzed by the Industrial Revolution in the 19th century, urbanization continues to be a major driver of demographic change in today’s world. Currently the least urbanized continent, by some measures Africa, and sub-Saharan Africa, is the most rapidly urbanizing region of the world, with estimates suggesting an increase in the proportion of the population living in urban areas from 40% to between 56–62% of the total between 2010 and 2050 [2]; only Asia comes close to matching this projected rate [1,3] This reality is complex, and urbanization in sub-Saharan Africa is distinct from current or historical trends of urbanization in other parts of the world [4]. Urban environments are not homogeneous, so risk factors are likely to vary across the continent, across a country, and even within a city [9,10]
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