Urban Africans Research Articles

Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans

Background. Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.Objectives. To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia. Methods. This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models. Results. Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management. Conclusion. Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.

The Nones of Mombasa: Religious Disbelief and Disaffiliation on the East African Coast

Abstract Religious disbelief (RDb) and religious disaffiliation (RDa), which describe the intellectual, cultural, and social lives of contemporary citizens referred to as “Nones” (i.e., “none of the above” as a respondent’s choice among religious options), are emerging as sociological categories of increasing interest to religious studies scholars. Much of the research done thus far focuses on Western nations and religions. This study and the observations herein apply some of these same interests and methods to the African nonreligious scene. As a field site, the cosmopolitan city of Mombasa (pop. 1.2 million) on the Kenyan coast has for many recent generations been home to a variety of African, Arab, Indian-Asian, and European races, cultures, and religions. African Traditional Religions (ATRs), Islam(s), Indian religions, and Christianities all have a presence in this religiously pluralistic milieu. In this cosmopolitan context, we should expect to find among urban Africans some representation of trends found across the world, one of which is a potentially growing, if silent and low-profile, population called “Nones.”

Low knowledge of national biodiversity symbols among urban South Africans limits their potential value as conservation flagship species

Abstract Most countries have declared one or more animal or plant species to be among their national symbols, termed here national biodiversity symbols. National biodiversity symbols are the species formally or informally recognised by societies and countries as having meaning to one or more of national identity, values and unity. It has been proposed previously that national biodiversity symbols can be used as flagship species to advance habitat conservation in their respective countries. However, this assumes that the symbols are well‐known and revered by the citizens of the country concerned. We examined this assumption via direct interviews with 382 urban residents in four towns in South Africa, which is a mega‐biodiversity country with five national biodiversity symbols (a national tree, flower, animal, bird and fish). We found that less than 3% of the urban respondents could name all five species, ranging from 6% for the national tree to 40% for both the national flower and national animal. Knowledge of other national symbols (flag and anthem) were equally low. The number of national biodiversity symbols known increased with income and education level of respondents. Despite limited knowledge of which species were the national biodiversity symbols, almost two‐thirds of respondents felt that having national biodiversity symbols was important for promoting national identity. These findings show that from a heritage perspective a great deal more awareness needs to be developed in South Africa around the national biodiversity symbols. From a conservation perspective, it indicates that the national biodiversity symbols are unlikely, at this stage at least, to be useful as flagship species for habitat conservation programmes. Read the free Plain Language Summary for this article on the Journal blog.

Out-of-home life spaces valued by urban older adults with limited income.

Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context. To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources.

Values of COVID-19 Self-Testing among Urban and Rural South Africans: A Cross-Sectional Survey

Self-testing for COVID-19 may be a preferable strategy for identifying SARS-CoV-2 infection among populations in low- and middle-income settings. To determine South Africans’ values related to COVID-19 self-testing should it become widely available, a cross-sectional survey was administered in Durban, KwaZulu-Natal Province and the King Sabata Dalindyebo sub-district of the Eastern Cape.A 35-question survey was administered to 531 participants (268 female) in one urban and one rural setting of South Africa. Survey participants were randomly selected by household in the rural setting, while in the urban setting participants were approached in randomly selected public places. The survey assessed participants’ likelihood of using and willingness to pay for a COVID-19 self-test and actions they would take following a COVID-19 self-test. The results were analysed using descriptive statistics and bivariate and multivariate regression.Overall, 93.03% of participants supported COVID-19 self-testing, 61.62% of participants were willing to pay for self-testing, and 90.15% indicated they would communicate their results if they tested positive. Rural participants were more positively associated with each of these outcomes compared with urban-based participants. Should they test positive, most participants said they would: go in-person to a health facility for counselling (76.45%), self-isolate (95.85%), notify close contacts (97.74%), and inform their employer (95.14%).COVID-19 self-testing was a preferable option for most participants, although this varied with setting and demographic characteristics. Self-testing may overcome barriers to care for South Africans, but to achieve this, policies for self-testing and delivery methods must not exacerbate individuals’ underlying economic vulnerabilities.

Green economics: e-waste recycling intentions of urban South Africans

Green economics: e-waste recycling intentions of urban South Africans

Anti-inflammatory diets reduce the risk of excessive gestational weight gain in urban South Africans from the Soweto First 1000-Day Study (S1000).

PurposeTo (i): examine whether maternal dietary inflammation assessed using the dietary inflammatory index (DII) is associated with gestational weight gain (GWG) and delivery outcomes in urban South African women from the Soweto First 1000-Day Study (S1000); and (ii): explore whether serum high-sensitivity c-reactive protein (hs-CRP) levels mediate these associations.MethodsEnergy-adjusted-DII (E-DII™) scores were calculated for 478 pregnant women using a quantitative food frequency questionnaire. GWG (kg/week) was assessed via anthropometry and hs-CRP concentrations were assessed in a sub-sample at < 14 (n = 263) and at 24–28 (n = 270) weeks gestational age. Multivariable linear and logistic regression models were used to examine associations between maternal E-DII scores, GWG, hs-CRP concentrations, and delivery outcomes.ResultsPositive vs. negative E-DII scores were associated with an increased odds of excessive weight gain (OR (95% CI): 2.23 (1.20; 4.14); P = 0.01) during pregnancy. Higher hs-CRP concentrations in the first trimester were associated with lower weight-for-length z-score (β (95% CI): −0.06 (−0.11; −0.01) per 1 mg/l hs-CRP; P = 0.02) and a reduction in odds of a large-for-gestational age delivery (OR (95% CI): 0.66 (0.47; 0.94); P = 0.02). Higher hs-CRP concentrations in the second trimester were associated with an increased odds of delivering preterm (OR (95% CI): 1.16 (1.01; 1.32); P = 0.03).ConclusionsConsumption of an anti-inflammatory diet during pregnancy reduced the risk of excessive GWG in a rapidly urbanising setting (Soweto, South Africa), where obesity prevalence rates are high. Further research is needed to better understand how maternal diet may ameliorate the effects of maternal adiposity on inflammatory milieu and fetal programming.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00394-022-02931-x.

Association between dental and periodontal conditions with chronic kidney disease: A cross-sectional analysis of urban South Africans

Oral diseases are preventable causes of poor health outcomes in people with chronic kidney disease (CKD). Investigate the association between dental and periodontal conditions with kidney function and determine whether inflammation mediate the association between periodontitis and CKD. Cross-sectional analysis of 1551 South African adults of mixed ancestry. CKD was classified as estimated glomerular filtration rate (eGFR) &lt;60mL/min/1.73m2. Oral profile was captured by decayed, missing, filled teeth index (DMFTi), bleeding on probing (BOP), pocket depth (PD), clinical attachment loss (CAL), and periodontitis classified as PD ≥4 mm.Overall, 6% had CKD, with 93% and 66% of participants with and without CKD, respectively having a high DMFTi (p&lt;0.0001). Further, 84% (CKD) and 43% (without CKD) were edentulous (p&lt;0.0001). A great proportion of the dentate sub-sample (n=846) had periodontitis, however, BOP, PD ≥4mm and CAL ≥4mm were similar between the groups. DMFTi was associated with eGFR and prevalent CKD (p&lt;0.023), with this association driven by the Missing component. Periodontitis was not associated with eGFR nor CKD (p&gt;0.282). In routine care of people with CKD, attention should be given to oral health.

The City Makers of Nairobi: An African Urban History

The City Makers of Nairobi: An African Urban History

The association between an energy-adjusted dietary inflammatory index and inflammation in rural and urban Black South Africans.

To quantify the inflammatory potential of the diet of rural and urban Black South Africans using an adapted energy-adjusted dietary inflammatory index (AE-DII) and to investigate its relationship with inflammatory and cardio-metabolic disease risk markers. Dietary inflammatory potential has not been investigated in African populations. Cross-sectional investigation. Rural and urban sites in the North West province of South Africa. 1885 randomly selected, apparently healthy Black South Africans older than 30 years. AE-DII scores ranged from -3·71 to +5·08 with a mean of +0·37. AE-DII scores were significantly higher in men (0·47 ± 1·19) than in women (0·32 ± 1·29), and in rural (0·55 ± 1·29) than urban participants (0·21 ± 1·19). Apart from its dietary constituents, AE-DII scores are primarily associated with age, rural-urban status and education. Contrary to the literature, alcohol consumption was positively associated with AE-DII scores. Of the four tested inflammatory and thirteen cardio-metabolic biomarkers, the AE-DII was only significantly negatively associated with albumin and HDL cholesterol, and positively with waist circumference and fasting glucose, upon full adjustment. Rural men consumed the most pro-inflammatory diet, and urban women the least pro-inflammatory diet. The diet of the participants was not overtly pro- or anti-inflammatory and was not associated with measured inflammatory markers. The inflammatory potential of alcohol at different levels of intake requires further research. Understanding dietary inflammatory potential in the context of food insecurity, unhealthy lifestyle practices and lack of dietary variety remains limited.

Urban Struggles over Water Scarcity in Harare

Abstract This essay counters the growing tendency in current scholarship to attribute nearly all the enduring water scarcity problems to climate change. Focusing on Harare, Zimbabwe's capital city, this essay contends that recurrent water crises can only really be understood within the contentious, long, and complex history of water politics in the capital city from the colonial to the postcolonial period. Although the colonial and postcolonial states in Zimbabwe had very different ideological and racial policies, for various reasons, neither was willing nor able to provide adequate supplies of water to the urban poor even as water was abundant in the city's reservoirs. It posits that while the colonial government racialized access to water by restricting its use by urban Africans, the postcolonial government failed to change the colonial patterns of urban water distribution and did little to increase water supplies to keep pace with a swiftly growing urban population and a geographically expanding city.

Associations of glycated albumin and fructosamine with glycaemic status in urban black South Africans

BackgroundThe associations of glycated albumin (GA) and fructosamine (FA) as alternate tests for diabetes screening in South Africans were examined to overcome shortcomings with oral glucose tolerance tests (OGTTs). MethodsBased on OGTTs, glycaemic status included 1) normal glucose, 2) dysglycaemia (impaired fasting glucose, impaired glucose tolerance, newly diagnosed diabetes), and 3) known diabetes. ResultsAmong 1092 participants, >21 years, mean GA (16.9%) and FA (230.2 μmol/l) increased significantly by age and worsening glycaemic status and were significantly higher in women vs. men and BMI (kg/m2) ≥ 30 vs. <30. For dysglycaemia, correlations of GA and FA with fasting and 2-hour glucose levels were higher in obese (0.576 to 0.688) vs. non-obese (−0.010 to 0.522). Optimal GA threshold to identify dysglycaemia was 15.35% and comparable, but with lower sensitivity (0.54) and specificity (0.55), to Asian studies. For FA, the optimal cut-point of 227.0 μmol/l approximated that described in the literature. Dysglycaemia and known diabetes were associated with GA, while only known diabetes was related to FA, in models adjusted for age, gender and obesity. ConclusionsPotential exists for GA and/or FA as alternative measures of dysglycaemia in clinical practice in Africans, but longitudinal studies are required to clearly elucidate their utility.

Initial engagement and persistence of health risk behaviors through adolescence: longitudinal findings from urban South Africa

BackgroundLittle is known about longitudinal patterns of adolescent health risk behavior initial engagement and persistence in low- and middle-income countries.MethodsBirth to Twenty Plus is a longitudinal birth cohort in Soweto-Johannesburg, South Africa. We used reports from Black African participants on cigarette smoking, alcohol, cannabis, illicit drug, and sexual activity initial engagement and adolescent pregnancy collected over 7 study visits between ages 11 and 18 y. We fit Kaplan-Meier curves to estimate behavior engagement or adolescent pregnancy, examined current behavior at age 18 y by age of first engagement, and performed a clustering analysis to identify patterns of initial engagement and their sociodemographic predictors.ResultsBy age 13 y, cumulative incidence of smoking and alcohol engagement were each > 21%, while the cumulative incidence of other behaviors and adolescent pregnancy were < 5%. By age 18 y (15 y for cannabis), smoking, alcohol, and sexual activity engagement estimates were each > 65%, cannabis and illicit drug engagement were each > 16%; adolescent pregnancy was 31%. Rates of engagement were higher among males. Current risk behavior activity at age 18 y was generally unrelated to age of initial engagement. We identified three clusters reflecting low, moderate, and high-risk patterns of initial risk behavior engagement. One-third of males and 17% of females were assigned to the high-risk cluster. Sociodemographic factors were not associated with cluster membership.ConclusionsAmong urban dwelling Black South Africans, risk behavior engagement across adolescence was common and clustered into distinct patterns of initial engagement which were unrelated to the sociodemographic factors assessed. Patterns of initial risk behavior engagement may inform the timing of primary and secondary public health interventions and support integrated prevention efforts that consider multiple behaviors simultaneously.

Longitudinal Associations of Pubertal Timing and Tempo With Adolescent Mental Health and Risk Behavior Initiation in Urban South Africa

PurposeIn high-income countries, early and rapid pubertal development is consistently associated with poor adjustment and increased risk behavior in adolescence. This study contributes to the meager knowledge of these associations in lower income countries. MethodsWe used longitudinal data from 1,784 urban black South Africans in the Birth to Twenty Plus cohort. We used regression analyses to assess associations between age at menarche and latent classes of pubertal timing and tempo and adolescent internalizing and externalizing emotional and behavioral problems, eating attitudes, and patterns of health risk behavior initiation. ResultsRelatively earlier and faster pubertal timing and tempo were associated with increased health risk behavior initiation (e.g., adjusted odds ratio [95% confidence interval] high- vs. low-risk pattern = 5.7 [1.7, 19.06] for male genital development; adjusted odds ratio = 3.45 [1.13, 10.49] for female breast development). Among males, earlier and faster pubertal timing and tempo were associated with increased externalizing problems in early adolescence and increased oppositional defiant problems in midadolescence, whereas later and slower pubertal timing and tempo were associated with decreases. Among females, earlier and faster pubertal timing and tempo were associated with increased internalizing and externalizing problems in midadolescence and increased dieting behaviors in early and late adolescence (β [95% confidence interval] = 2.51 [.87, 4.15] for pubic hair development), whereas later and slower pubertal timing and tempo were associated with decreases. ConclusionsIn this urban South African cohort, relatively earlier and faster pubertal development was detrimental to mental health and risk behavior activity, whereas later and slower maturation was somewhat protective.

The association between fetal growth and neonatal adiposity in urban South African infants.

To examine associations between maternal body mass index (BMI), gestational weight gain (GWG) and fetal growth and neonatal adiposity in urban South Africans. Maternal BMI was assessed at recruitment and GWG (kg/week) was calculated. Longitudinal fetal growth was measured via ultrasound and modelled using Superimposition by Translation and Rotation (SITAR). Neonatal adiposity was assessed using air displacement plethysmography or dual-energy X-ray absorptiometry. Multiple linear regression models were used to examine associations between maternal BMI, GWG and SITAR fetal growth parameters and neonatal fat mass index (FMI; kg/m3 ) in 304 mother-neonate pairs. In pooled analyses, longitudinally modelled abdominal circumference size (β = 0.64 kg/m3 , P < .001) and velocity (β = 8.39 kg/m3 , P < .001) and biparietal diameter velocity (β = 4.55 kg/m3 , P = .020) were positively associated with neonatal FMI. GWG was positively associated with neonatal FMI in preliminary models (β = 1.07 kg/m3 per 1 kg/week; P = .040), with pooled models indicating mediation via fetal growth. In utero abdominal growth is predictive of neonatal adiposity. Additionally, greater fetal growth - particularly of the abdominal circumference - mediates the effect of GWG on neonatal adiposity. In settings such as South Africa, strategies to ensure healthy pregnancy weight gain can contribute to prevention of intergenerational obesity risk.

Racing on the Rand: Black Competitive Cycling around Johannesburg, 1930–1960

The history of bicycle racing amongst urban black South Africans exists largely outside of published academic literature. Individuals and communities created vibrant social spaces around this sport during decades of intensifying segregation and apartheid. Racing was not ‘hidden’ from the hundreds of participants and the many thousands of spectators who cheered them. But the early township scene remains virtually unknown today and with only a few exceptions African racers simply do not feature in the historical narrative of bicycle racing in South Africa. Yet certain municipalities sponsored racing events for black residents and in some instances, the popularity of track racing even led authorities to construct a velodrome. By the 1940s, corporate mining operations included bicycle racing among their sponsored leisure activities and several funded constructions of tracks that exceeded municipal offerings. However, an earlier history of racing, one organized or supported by entirely African participants, and one that existed largely outside the purview of both the white cycling community and the broader white sporting public, also undergirded the increasing numbers of black South Africans in cycling. Both racing clubs and regional governing bodies existed, sometimes for decades, prior to the expansion of municipal and corporate efforts to include bicycle racing within their formal recreational programs.

Gut Microbiome Profiles Are Associated With Type 2 Diabetes in Urban Africans.

Gut dysbiosis has been associated with several disease outcomes including diabetes in human populations. Currently, there are no studies of the gut microbiome composition in relation to type 2 diabetes (T2D) in Africans. Here, we describe the profile of the gut microbiome in non-diabetic adults (controls) and investigate the association between gut microbiota and T2D in urban West Africans. Gut microbiota composition was determined in 291 Nigerians (98 cases, 193 controls) using fecal 16S V4 rRNA gene sequencing done on the Illumina MiSeq platform. Data analysis of operational taxonomic units (OTU) was conducted to describe microbiome composition and identify differences between T2D and controls. The most abundant phyla were Firmicutes, Actinobacteria, and Bacteroidetes. Clostridiaceae, and Peptostreptococcaceaea were significantly lower in cases than controls (p < 0.001). Feature selection analysis identified a panel of 18 OTUs enriched in cases that included Desulfovibrio piger, Prevotella, Peptostreptococcus, and Eubacterium. A panel of 17 OTUs that was enriched in the controls included Collinsella, Ruminococcus lactaris, Anaerostipes, and Clostridium. OTUs with strain-level annotation showing the largest fold-change included Cellulosilyticum ruminicola (log2FC = −3.1; p = 4.2 × 10−5), Clostridium paraputrificum (log2FC = −2.5; p = 0.005), and Clostridium butyricum (log2FC = −1.76; p = 0.01), all lower in cases. These findings are notable because supplementation with Clostridium butyricum and Desulfovibrio piger has been shown to improve hyperglycemia and reduce insulin resistance in murine models. This first investigation of gut microbiome and diabetes in urban Africans shows that T2D is associated with compositional changes in gut microbiota highlighting the possibility of developing strategies to improve glucose control by modifying bacterial composition in the gut.

Gendered livelihoods and land tenure: The case of artisanal gold miners in Mali, West Africa

Artisanal small-scale mining (ASM) is an important source of income for millions of sub-Saharan Africans. Scholars from various disciplines have demonstrated that urban and rural Africans take up mining as a response to unemployment, lack of credit and poor income prospects in the agricultural sector, and as a way for young people to achieve a degree of personal autonomy. Although several studies have investigated the role of women in artisanal mining, little attention has been given to the gendered land tenure rights that govern mineral resource access and that shape the prospects for mining as a viable livelihood strategy. This article presents evidence that women exploit artisanal mining opportunities in ways that differ from those of men based on gender differences in land tenure relations. Customary and freehold tenure regimes—through their flexibility and place-based functionality—create unique income-generating and investment opportunities for women at artisanal gold mining sites in western Mali. Specifically, the unique labor demands and commercial aspects of artisanal gold extraction interact with the host-stranger dynamics of customary tenure regimes to create labor market opportunities that women are able to exploit. Mining income invested in freehold land property enables women to achieve or at least strive for a degree of financial autonomy that is difficult or impossible within the unequal gender relations that characterize other rural economic activities, especially agriculture. Customary and formal land tenure institutions play a complex role that both constrains and enables these livelihood strategies, which are based on geographic mobility and power-laden social relations within rural economies that are increasingly monetized.

Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation.

A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption. We conducted six focus group discussions using a semi-structured guide. The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented. Adults aged 18 years or above living in Soweto (n 57). Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons. While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.

Mapping changes in housing in sub-Saharan Africa from 2000 to 2015

Access to adequate housing is a fundamental human right, essential to human security, nutrition and health, and a core objective of the United Nations Sustainable Development Goals1,2. Globally, the housing need is most acute in Africa, where the population will more than double by 2050. However, existing data on housing quality across Africa are limited primarily to urban areas and are mostly recorded at the national level. Here we quantify changes in housing in sub-Saharan Africa from 2000 to 2015 by combining national survey data within a geostatistical framework. We show a marked transformation of housing in urban and rural sub-Saharan Africa between 2000 and 2015, with the prevalence of improved housing (with improved water and sanitation, sufficient living area and durable construction) doubling from 11% (95% confidence interval, 10–12%) to 23% (21–25%). However, 53 (50–57) million urban Africans (47% (44–50%) of the urban population analysed) were living in unimproved housing in 2015. We provide high-resolution, standardized estimates of housing conditions across sub-Saharan Africa. Our maps provide a baseline for measuring change and a mechanism to guide interventions during the era of the Sustainable Development Goals.