{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:11:12Z","timestamp":1790655072955,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Africa\u2019s rapid urbanization often exceeds the capacity of governments to provide essential services and infrastructure, exacerbating structural inequalities and exposing vulnerable populations to serious health risks. This paper examines the case of Douala, Cameroon, to demonstrate that health inequities in African cities are not simply the result of urban growth but are shaped by spatial inequities, historical legacies, and systemic exclusion. Disadvantaged neighborhoods are particularly impacted, becoming epicenters of health crises. Using a mixed-methods approach combining spatial analysis, household surveys and interviews, the study identifies three key findings: (1) Healthcare services in Douala are unevenly distributed and dominated by private providers, which limits access for low-income residents. (2) Inadequate infrastructure and environmental risks in informal settlements lead to a higher disease burden and an overflow of demand into better-equipped districts, which overwhelms public health centers across the city. (3) This structural mismatch fuels widespread reliance on informal and unregulated care practices. This study positions Douala as a microcosm of broader public health challenges in rapidly urbanizing African cities. It highlights the need for integrated urban planning and health system reforms that address spatial inequalities, strengthen public health infrastructure, and prioritize equity\u2014key principles for achieving the third Sustainable Development Goal (ensuring good health and well-being for all residents) in sub-Saharan Africa.<\/jats:p>","DOI":"10.3390\/ijerph22081172","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T14:11:44Z","timestamp":1753366304000},"page":"1172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Urbanization and Health Inequity in Sub-Saharan Africa: Examining Public Health and Environmental Crises in Douala, Cameroon"],"prefix":"10.3390","volume":"22","author":[{"given":"Babette Linda","family":"Safougne Djomekui","sequence":"first","affiliation":[{"name":"African Centre for Cities, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0188-4738","authenticated-orcid":false,"given":"Chr\u00e9tien","family":"Ngouanet","sequence":"additional","affiliation":[{"name":"National Institute for Cartography, Yaound\u00e9 P.O. Box 157, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Smit","sequence":"additional","affiliation":[{"name":"African Centre for Cities, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"ref_1","unstructured":"UN-Habitat (2022). Chapter 3\u2014Poverty and Inequality: Enduring Features of an Urban Future. World Cities Report 2022, United Nations Human Settlements Programme."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1080\/07352166.2023.2171616","article-title":"City in Africa I: Urbanism and informality","volume":"45","author":"Cobbinah","year":"2023","journal-title":"J. Urban Aff."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1007\/s11524-016-0050-0","article-title":"Urban health research in Africa: Themes and priority research questions","volume":"93","author":"Oni","year":"2016","journal-title":"J. Urban Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Moeti, T., Mokhele, T., Weir-Smith, G., Dlamini, S., and Tesfamichael, S. (2023). Factors affecting access to public healthcare facilities in the City of Tshwane, South Africa. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043651"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Cai, Y.S., and Mustapha, A. (2023). Editorial: Environmental health in informal settlements\u2014Current progress, challenges and perspectives. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1200422"},{"key":"ref_6","first-page":"135","article-title":"Population resilience to flooding in the urbanised mangrove of Douala, Cameroon","volume":"14","author":"Yemmafouo","year":"2022","journal-title":"Int. J. Disaster Resil. Built Environ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.glohj.2020.04.003","article-title":"Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa","volume":"4","author":"Zerbo","year":"2020","journal-title":"Glob. Health J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Oskam, M.J., Pavlova, M., Hongoro, C., and Groot, W. (2021). Socio-economic inequalities in access to drinking water among inhabitants of informal settlements in South Africa. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910528"},{"key":"ref_9","first-page":"11","article-title":"The problem of drinking water supply in the \u201cmangroville\u201d of Douala, Cameroon","volume":"16","author":"Yemmafouo","year":"2020","journal-title":"Eur. Sci. J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Boyce, M.R., Katz, R., and Standley, C.J. (2019). Risk factors for infectious diseases in urban environments of sub-Saharan Africa: A systematic review and critical appraisal of evidence. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4040123"},{"key":"ref_11","first-page":"819563","article-title":"Factors contributing to urban malaria transmission in Sub-Saharan Africa: A systematic review","volume":"2012","author":"Marshall","year":"2012","journal-title":"J. Trop. Med."},{"key":"ref_12","unstructured":"De Padou Nsegbe, A. (2021). Marginalit\u00e9 et vuln\u00e9rabilit\u00e9 aux risques sanitaires en milieu urbain \u00e0 forte croissance: L\u2019exemple de la commune de Douala IVe (Cameroun). Afr. Cities J., (In French)."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"van Ham, M., Tammaru, T., Ubareviciene, R., and Janssen, H. (2021). Social inequality and spatial segregation in Cape Town. Urban Socio-Economic Segregation and Income Inequality: A Global Perspective, Springer.","DOI":"10.1007\/978-3-030-64569-4"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1177\/20438206231217572","article-title":"Coloniality and racialization of informality","volume":"15","author":"Olajide","year":"2023","journal-title":"Dialogues Hum. Geogr."},{"key":"ref_15","unstructured":"Lefebvre, H. (1991). The Production of Space, Blackwell Publishers. Available online: https:\/\/iberian-connections.yale.edu\/wp-content\/uploads\/2020\/04\/The-production-of-space-by-Henri-Lefebvre-translated-by-Donald-Nicholson-Smith.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/j.1467-8306.1980.tb01308.x","article-title":"The socio-spatial dialectic","volume":"70","author":"Soja","year":"1980","journal-title":"Ann. Assoc. Am. Geogr."},{"key":"ref_17","unstructured":"(2024, October 10). National Institute of Statistics. Monographie de la ville de Douala. Available online: https:\/\/fr.scribd.com\/document\/597208604\/Rapport-Monographie-Douala-Vf."},{"key":"ref_18","unstructured":"Ministry of Public Health (2023). Programmatic Healthcare Map."},{"key":"ref_19","unstructured":"Mbaha, J.P., Olinga, J.M., and Tchiadeu, G. (2025, April 15). Cinquante ans de conqu\u00eate spatiale \u00e0 Douala. D\u2019h\u00e9ritage colonial en construction socio-spatiale vuln\u00e9rable aux risques naturels. Universit\u00e9 de Douala, Cameroun. Available online: https:\/\/d1wqtxts1xzle7.cloudfront.net\/41694366\/Cinquante_ans_de_conquete_spatiale_Mbaha_Olinga_Tchiadeu_Actes_du_Colloque_des_cinquantenaire_a_Douala_2013-libre.pdf?1454002440=&response-content-disposition=inline%3B+filename%3DCinquante_ans_de_conquete_spatiale_a_Dou.pdf&Expires=1752909728&Signature=VF1JCkrampq6P9c0U-tUMhzDOSd4dzoK72bvnDs4IK1xo0gdZ4XOHkd95HRjrhblNhkiwUu9fOBTPtfMHLITMXhHlYjuXIjeQ4THL~63h~U~NIxt9ztmh6F~tJJEgLG6bO5LC0H8K42NF2MG-4z7vF5MK4OUgf6n7HSml0JRjNFm52T0v003ZVf1LOF8L-j3aDEIhQsL5Ya4mwWaNyCK5lYNvrV3oyXWHmrXCxGocKhGRHrgVBr6uKSiFtd9MPGjtVcFvFLg6tii89W17021tT2UNcOiCF0W6Q7~wS~9Uwi8gf~0nhRz09GONM8tlDJzesufzhvVaYyIW0OupZHccw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA."},{"key":"ref_20","first-page":"281","article-title":"Soixante ans de politique urbaine \u00e0 Douala. La revanche de l\u2019informel face \u00e0 la volont\u00e9 planificatrice","volume":"271\u2013272","author":"Jacquemot","year":"2020","journal-title":"Afr. Contemp."},{"key":"ref_21","unstructured":"UN-Habitat (2024, October 05). Urban Planning & Infrastructure in Migration Contexts, Douala-Cameroon\u2014Volume 1\u2014Spatial Profile, Available online: https:\/\/unhabitat.org\/sites\/default\/files\/2022\/10\/221006_douala_spatial_profile_vf_compressed_0.pdf."},{"key":"ref_22","unstructured":"Tchaw\u00e9 Hatcheu, E. (2013). Survivre dans les mangrovilles de Douala. L\u2019\u00c9talement Urbain en Afrique. D\u00e9fis et Paradoxes, L\u2019Harmattan."},{"key":"ref_23","unstructured":"Ministry of Public Health (2024, October 09). Profil de l\u2019offre de Soins et Caract\u00e9ristiques de la Demande de Quelques Soins et Services, Available online: http:\/\/cdnss.minsante.cm\/sites\/default\/files\/RAPPORT%20THEMATIQUE%20CIS%202019.pdf."},{"key":"ref_24","unstructured":"National Institute of Statistics (NIS), and ICF (2024, October 09). Cameroon Demographic and Health Survey 2018, Available online: https:\/\/dhsprogram.com\/pubs\/pdf\/SR266\/SR266.pdf."},{"key":"ref_25","unstructured":"Ministry of Public Health (2024, October 09). Strategie Sectorielle de la Sante 2020\u20132030, Available online: https:\/\/minepat.gov.cm\/wp-content\/uploads\/2022\/01\/Strategie-Sectorielle-de-la-Sante_Francais.pdf."},{"key":"ref_26","unstructured":"Ministry of Public Health (2024, October 10). Plan Strat\u00e9gique National de Lutte Contre le Paludisme au Cameroun 2019\u20132023, Available online: https:\/\/lnsp-cam.org\/wp-content\/uploads\/2021\/10\/PSNLP-2019-2023-CONSOLIDE-TRANSMIS.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/jeg\/lbaa026","article-title":"Colonial legacies: Shaping African cities","volume":"21","author":"Baruah","year":"2021","journal-title":"J. Econ. Geogr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Magidimisha-Chipungu, H.H., and Chipungu, L. (2021). Southern African Cities at a Glance\u2014An Introduction. Urban Inclusivity in Southern Africa, Springer.","DOI":"10.1007\/978-3-030-81511-0"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"115290","DOI":"10.1016\/j.socscimed.2022.115290","article-title":"Social vulnerability, exposure to environmental risk factors, and accessibility of healthcare services: Evidence from 2,000+ informal settlements in Argentina","volume":"309","author":"Palacios","year":"2022","journal-title":"Soc. Sci. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100242","DOI":"10.1016\/j.wss.2025.100242","article-title":"Exploring the impact of demographic, architectural, and well-being factors on health outcomes in informal settlements: The role of daylight, window depth, and building orientation","volume":"8","author":"Hussainzad","year":"2025","journal-title":"Wellbeing Space Soc."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Weimann, A., and Oni, T. (2019). A systematised review of the health impact of urban informal settlements and implications for upgrading interventions in South Africa, a rapidly urbanising middle-income country. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16193608"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e4375","DOI":"10.1111\/hsc.13836","article-title":"When the healthcare system neglects some people: Rural\u2013urban migration, socio-cultural conditions, and health coping strategies in informal settlement, Madina, Ghana: An exploratory design","volume":"30","author":"Afeadie","year":"2022","journal-title":"Health Soc. Care Community"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"177","DOI":"10.36941\/ajis-2020-0096","article-title":"Sanitation dilemmas and Africa\u2019s urban futures: Foregrounding environmental public health in contemporary urban planning","volume":"9","author":"Manteaw","year":"2020","journal-title":"Acad. J. Interdiscip. Stud."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s12939-025-02428-z","article-title":"Health seeking by people living with non-communicable diseases in a pluralistic health system: The role of informal healthcare providers","volume":"24","author":"Conteh","year":"2025","journal-title":"Int. J. 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