Urbanization and health: The effects of the built environment on chronic disease risk factors among women in Tanzania.

Sub-Saharan Africa is experiencing rapid urban growth. Cities enable greater access to health services and improved water and sanitation infrastructure, leading to some improvements in health. However, urban settings may also be associated with more sedentary, stressful lifestyles and consumption of less nutritious food. C-reactive protein (CRP) is a measure of chronic inflammation predictive of cardiovascular disease, and high body mass index (BMI), a ratio of weight to height, indicates overweight or obesity and is associated with an increased risk of many chronic diseases. To explore the association between urbanicity and these two markers, we overlaid data from the 2010 Tanzania Demographic and Health Survey (DHS) with a satellite-derived measure of built environment. Linear regression models were constructed for the outcomes of BMI and CRP, by 1) administratively defined urban/rural categorization from the DHS, 2) satellite derived built environment, and 3) built environment stratified by urban/rural. A total of 2,212 women were included; 23% had elevated CRP, 21% were overweight or obese. A third (33%) lived in a highly built up area and 29% lived in an area classified as urban. A strong positive association between both CRP and BMI and built environment was detected; log CRP increased 0.43 in the highest built up areas compared to not built up (p