Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence

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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.

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