The global health threat of African urban slums: the example of urban tuberculosis

Urban slums in developing countries are experiencing the most rapid population growth of any settlement type globally. Such growth of densely settled slums exerts a profound influence on the epidemiology and geography of communicable disease, transmitted through multiple modes. Specifically, high density, poor sanitation, poorly built housing, and lack of both adequate sewage systems and water supply facilitate pathogen spread. Long-range transmission of infection, partly through migration or travel of infected individuals, makes communicable diseases of urban areas in developing countries health problems of the entire world rather than localized areas. Non-endemic areas are threatened with disease spread. Because a significant proportion of slum growth and disease burden is in sub-Saharan Africa, global well-being demands that we understand and control disease spread in African slums as a major international health priority. This paper outlines the potential threats and implications of African urban slum health using the example of tuberculosis (TB), which is highly prevalent in developing countries. Using the case of Nima, a slum in Accra, Ghana, we argue that successful disease control efforts in developed countries depend critically on effective disease surveillance and control efforts in developing countries, including African urban slums.