key: cord-0933625-p80ohpb2
authors: Ilesanmi, Olayinka S.; Oderinde, Tinuola M.; Afolabi, Aanuoluwapo A.
title: THE URBAN SLUMS: POTENTIAL SOURCE OF COVID-19 SPIKES IN AFRICA
date: 2020-11-11
journal: Public health in practice
DOI: 10.1016/j.puhip.2020.100052
sha: 3f55a74c5dac44634379de884ef370c8f8b06359
doc_id: 933625
cord_uid: p80ohpb2

nan

Coronaviruses are a large family of viruses that cause illness ranging from the common cold to more severe diseases. The current global outbreak of the novel coronavirus COVID-19 was first officially reported on December 31st, 2019 in the city of Wuhan, Hubei Province, China and spread quickly to other cities throughout China and the world [1] . By late February 2020, Africa (via Egypt) confirmed its first case. As a highly communicable disease, Coronavirus disease-2019 (COVID-19) continues to ravage the state of the world's health and economy. In the wake of the rapid urbanization experienced in low and middle-income countries as well as this pandemic, there is increasing concern over the impact of COVID-19 on urban slums in the developing world [2, 3] . This concern primarily stems from the fact that the populations with high vulnerability to the spread of COVID-19 include migrants, residents of densely populated areas, minorities, older adults, and those with lower socioeconomic status [4] . Three-quarters of Sub-Saharan Africa's urban population currently live under slum conditions making them susceptible to ill health and diseases [5] . This letter therefore sought to highlight the challenges faced by residents of the urban slums in the COVID-19 context in a bid to proffering sustainable solutions to address the challenges.

The word "slum" is often used to describe informal settlements within cities that have inadequate housing and squalid living conditions. According to UN-HABITAT, a slum household is a group of individuals living under the same roof in an urban area who lack one or more of the following -durable housing of a permanent nature that protects against extreme climate conditions; sufficient living space, which means not more than three people sharing the same room; easy access to safe water in sufficient amounts at an affordable price; access to adequate sanitation in the form of a private or public toilet shared by a reasonable number of people and last but not J o u r n a l P r e -p r o o f least security of tenure that prevents forced evictions [5] . Urban slums, account for 43.0% of the population in the developing world as compared to 32.0% of total world's population. 5 According to the World Bank, 55% of the worlds' urban slum population are on the African continent contributes, with the sub-Saharan accounting for a major proportion of this population.

As of 2010, estimates by UN-Habitat revealed that 200 million people in Sub-Saharan Africa were living in slums, an equivalent of 61.7 percent of the region's urban population [5] .

To mitigate the COVID-19 pandemic, emphasis has been placed on hand hygiene by using alcohol-based hand rub or soap and water. Physical distancing, keeping at least 2 feet away from the nearest person while coughing, sneezing and even speaking, has also been adopted as a COVID-19 preventive measure [6] These measures however remain a serious challenge given the inherent nature of slums coupled with inadequate access to safe water and basic sanitation experienced in such settings. The added problem of space constraints, violence, and overcrowding in slums also make physical distancing and self-quarantine impractical, and the rapid spread of the COVID-19 virus is likely [7] . The recommended home stay is just not an option for them, as this often means giving up work and necessities. For example, in some countries, like Kenya and South Africa, people even face government violence for disobeying curfews and other restrictions [8] . Then there is the practical challenge of quarantining where many people share a room and where single toilets cater for many families.

The lockdowns that were enforced across Africa and subsequent limited mobility have impacted the access to basic amenities. Given the nature of COVID-19 transmission, this could result in lethal outbreaks of infectious diseases. The enforced lockdowns were done with an increase in authoritarian behaviors of the police with the poor experiencing brutality and humiliation in J o u r n a l P r e -p r o o f countries such as India, Nigeria, Kenya, and South Africa [9] . The health of people living in slums is a function not only of poverty but of intimately shared physical and social environments [10] . 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.

As the African proverbial saying goes, there are many routes to the marketplace. Hence, the curbing of the spread of COVID-19 in the urban slums is multi-faceted. For starters, immediate provision of potable water in the urban slums will go a long way to reduce the water insecurity of such settlements and in turn reduce the spread of the virus [11] . The use of water trucks would enhance water supply to serve each household, thus reducing the need for queueing at water supply points, and thus aiding social distancing. Mobile chemical toilets and a centralized sewage system will also aid in keeping the slums relatively sanitized [12] . To promote dissemination of the right information on preventing the spread of COVID-19, the use of social media especially among the youths can serve as a useful conduit [4] . The various governments should set up mobile clinics and engage community health workers who will enter the slum settlements to identify, treat and monitor at-risk individuals including elderly and those with comorbidities like diabetes mellitus, hypertension, asthma, tuberculosis and chronic obstructive pulmonary disease [8] . Furthermore, instituting an inter-and intra-slum emergency committee to assist with contact tracing and sustained community engagement will go a long way to contain the spread of COVID-19 among slum population.

The COVID-19 outbreak is rapidly spreading across the globe. 

Perception and practices during the COVID-19 pandemic in an urban community in Nigeria: a cross-sectional study

COVID-19 in Urban Slums of the Developing World

Time to move from vertical to horizontal approach in our COVID-19 response in Nigeria

Health equity and COVID-19: global perspectives

UN Habitat-State of the World's cities. Available from: mirror.unhabitat.org/documents/media_centresowcr2006/SOWCR%205.pdf

In search of the true prevalence of COVID-19 in Africa: Time to involve more Stakeholders

Determinants Of Family Size among Men in Slums of Ibadan

COVID-19 in Africa: socio-economic impact, policy response and opportunities

Has COVID-19 subverted global health?

The health of people who live in slums 2 Improving the health and welfare of people who live in slums

Beyond handwashing: Water insecurity undermines COVID-19 response in developing areas

Analyzing sanitation characteristics in the urban slums of East Africa

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

OIS conceptualized the research. TMO wrote the initial draft. OIS, TMO, and AAA revised and approved the final version of the manuscript.