Urban Contexts and Challenges: Nutrition and WASH among Poor Children and Adolescents in Sub-Saharan Africa

May 31, 2018

The HEARD Project conducted a rapid review of the literature to gain a basic understanding of the nutrition and WASH situation among urban poor children (and adolescents) living in Sub-Saharan Africa—with a specific focus on Kenya, Tanzania and Uganda.  This was created as an input to the original consultative meeting in 2017 that kicked off the Implementation Science Collaboration on Urban Health.  The following is an excerpt from the Preliminary Findings Report.

In theory, cities can offer an “urban advantage,” providing citizens the promise of a higher quality of life through greater resources, economic progress, service access, and infrastructure. However, rapid migration and absolute population growth in the 21st century have led to a confluence of urban challenges including the triple threat of non-communicable and communicable disease coupled with violence and injury.[1] According to UNHabitat, 50-80% of people in Sub-Saharan African cities with a million or more inhabitants live in informal settlements, which is substantially higher than the 29% average across the world’s developing regions. Urbanization’s complex challenges are projected to compound globally, as the urban populations of Africa and Asia are slated to double in the next two decades.

Children of the urban poor are among the most vulnerable to urban health inequities. For urban poor children, nutritional issues include inadequate consumption of macro and micro nutrient-dense foods, driven by food scarcity and/or poor quality of food. As of 2015, malnutrition remains a major health challenge for sub-Saharan African children under 5 years old, as one-third of all undernourished children globally live in the sub-region.[2]  Poor diet in childhood can lead to persistent nutritional deficits and a lifetime of physical and cognitive impairment.

Additionally, the poorest urban-dwelling families often face insecure tenure in informal settlements and slums, where there may be limited or no access to clean drinking water, improved sanitation, or widespread hygiene issues (WASH). An estimated 58% of the urban population in sub-Saharan Africa does not have access to improved sanitation.[3] Densely populated areas with inadequate infrastructure for ensuring proper sanitation and hygiene can lead to the spread of infectious diseases, such as parasitic infections and waterborne viruses.

Adolescents face additional vulnerabilities on top of the ones experienced by their younger cohorts, such as increased levels of violence, although there is a need for additional data on the “epidemiology of young people’s health” and the consequences of living in poor urban areas.[4] More innovation and action are required to determine the most effective options for tailoring systems and services to meet the needs of poor adolescents living in urban areas.

The global community’s recognition for action on these issues is reflected in the Sustainable Development Goals 3 (Good Health and Wellbeing), 10 (Reduced Inequalities), 11 (Sustainable Cities and Communities), and 13 (Climate Action), as well as in the UN’s New Urban Agenda, which places health at the center of efforts to create healthier and more livable cities. Reducing food insecurity and addressing malnutrition, as well as increasing access to improved sanitation and hygiene interventions, are crucial priorities for sub-Saharan Africa’s cities, for investing in the region’s health, and for achieving global health priorities.

For more information, please see the Preliminary Findings of a Landscape Analysis here.


[1] WHO. (2018). Urban Health. Retrieved from

[2] United Nations. (2015). The Millennium Development Goals Report. Retrieved from

[3] UNICEF. (2014). Children in Africa: Key Statistics on Child Survival, Protection and Development. Retrieved from

[4] Kabiru, et al. (2013). The health and wellbeing of young people in sub-Saharan Africa: an under-researched area? BMC International Health and Human Rights 2013. Retrieved from