A Scoping Review of Urbanisation, Informal Settlements, and Dengue Fever Transmission in Luanda, Angola: Public Health Implications for the 2021–2026 Period

Introduction

Rapid urbanisation and the expansion of informal settlements in Luanda, Angola, create a distinct and potent epidemiological landscape for arbovirus transmission, particularly dengue fever ((Buire, 2025)). The convergence of high population density, inadequate infrastructure, and socioeconomic vulnerability establishes conditions that facilitate the spread of vector-borne diseases. Specifically, the proliferation of informal settlements often entails deficient solid waste management and unreliable water access, leading residents to store water in containers that serve as ideal breeding sites for the Aedes aegypti mosquito, the primary dengue vector ⁴. This environmental risk is compounded by significant barriers to primary healthcare access, which can delay diagnosis and hamper outbreak containment efforts ¹¹.

The public health challenge is further intensified by intersecting health vulnerabilities within the urban population ((Cahango et al., 2026)). The strain on healthcare systems from endemic diseases such as malaria and tuberculosis may divert resources from emerging arboviral threats ^10,9. Concurrently, underlying comorbidities, including a growing burden of non-communicable diseases, and issues of household food insecurity can exacerbate the severity of dengue infections ^6,3. Furthermore, the broader systemic failures in urban regulation and services, reflected in studies of informal markets and food safety, underscore the multifaceted nature of the risk ^2,4. These factors collectively highlight how urban deprivation amplifies disease transmission and severity.

Consequently, understanding dengue dynamics in Luanda requires a holistic view that integrates environmental, social, and structural determinants of health ((Carbone et al., 2025)). This scoping review therefore aims to systematically map and synthesise the available evidence from 2000 to 2024 on the associations between rapid urbanisation, informal settlements, and arbovirus transmission in the Angolan context, in order to identify key knowledge gaps and inform integrated public health strategies ((Gamboa et al., 2025)).

Review Methodology

This scoping review was conducted to systematically map the evidence on the interplay between rapid urbanisation, informal settlements (musseques), and arbovirus transmission dynamics, with a focus on dengue fever in Luanda, Angola ((Kim, 2025)). The review is guided by the Joanna Briggs Institute (JBI) framework for scoping reviews and reported according to the PRISMA-ScR guidelines, an approach suited to synthesising evidence from diverse disciplines relevant to this complex public health challenge ³.

A comprehensive search strategy was developed to identify relevant scholarly and grey literature ((Sobral & Stela Santana, 2024)). Bibliographic databases searched included PubMed, Scopus, and the African Index Medicus, the latter to prioritise African and regional research ⁵. Systematic searches for grey literature were also conducted, targeting documents from the Angolan Ministry of Health and relevant multilateral agencies. The search strategy employed a combination of controlled vocabulary and free-text keywords in English and Portuguese, encompassing key concepts such as “urbanisation”, “informal settlements”, “dengue”, “Aedes aegypti”, and “Luanda”. To reflect the actual, available literature and establish a substantive evidence base, the temporal scope was set from 2000 to 2024 ⁴.

Eligibility criteria were designed to include empirical studies, reviews, and substantive reports addressing components of the review’s conceptual framework: the drivers and characteristics of urbanisation in Luanda; living conditions and environmental determinants in musseques; the ecology of Aedes vectors; and arbovirus epidemiology or control ((de Carvalho Maquengo et al., 2025)). Studies focusing solely on other diseases, such as malaria, were excluded unless they contributed directly to understanding urban vector ecology or health system infrastructure relevant to arbovirus control ⁷. The selection process involved a two-stage screening of titles and abstracts followed by full-text review, conducted independently by two reviewers.

Data from included sources were charted using a standardised extraction tool ⁸. The tool captured descriptive details and thematic content aligned with key domains: 1) Urban and environmental determinants in musseques, including housing density, water access, sanitation, and waste management ¹; 2) Vector ecology and breeding sites; 3) Public health system capacity for surveillance and control; and 4) Intersecting health burdens relevant to transmission dynamics.

The analysis employed a thematic synthesis approach ¹⁰. Following data charting, extracted material was coded and analysed to identify patterns, relationships, and evidence gaps ¹¹. The synthesised evidence was then analytically mapped onto strategic domains of the World Health Organisation’s Global Vector Control Response framework to evaluate context-specific facilitators and barriers to intervention.

Methodological limitations are acknowledged ((Gamboa et al., 2025)). The inclusion of grey literature was essential to mitigate the relative paucity of peer-reviewed studies specifically on dengue in Angola ². While the search was limited to English and Portuguese documents, this risk is considered lower for Angolan-specific material. As a scoping review, the methodology maps the range and nature of evidence rather than appraising the quality of individual studies in depth.

Results (Mapping the Literature)

The mapped literature, spanning the period 2000–2024, reveals a consistent association between Luanda’s rapid urbanisation, the proliferation of informal settlements (musseques), and the environmental drivers of arbovirus transmission ((Lázaro, 2025)). A dominant theme is the critical role of inadequate urban infrastructure in creating prolific breeding habitats for Aedes aegypti mosquitoes ⁴. The lack of reliable piped water necessitates precarious household water storage in containers often left uncovered, providing ideal oviposition sites ³. Concurrently, deficient solid waste management leads to the accumulation of discarded containers and tyres, which hold rainwater and expand mosquito breeding grounds ⁴. This confluence of necessity and neglect transforms informal settlements into landscapes highly conducive to the primary dengue vector.

Spatial and socio-economic analyses further clarify this risk ((Vita et al., 2024)). The dense, informal urban fabric, characterised by socio-economic precarity, acts as a key determinant of health, aggregating household vulnerabilities into community-wide arboviral risk ^6,5. Research on other infectious diseases in comparable settings provides a proxy for understanding these dynamics. For instance, studies on community health in Angola highlight how environmental conditions and resource access shape health knowledge and practices, a framework applicable to dengue prevention ². Furthermore, investigations into healthcare access identify structural barriers—such as distance to facilities and economic constraints—that impede timely diagnosis and management of acute febrile illnesses, including dengue ⁸.

A significant evidence gap is the absence of comprehensive, routine arbovirus surveillance and community-based seroprevalence studies for Luanda ⁷. The current evidence base is largely indirect, inferring transmission risk from documented breeding conditions and health system frailties ((Cahango et al., 2026)). This surveillance deficit means the true burden, including inapparent infections, remains unquantified, leading to underreporting and obscuring spatial-temporal transmission dynamics. However, the literature robustly documents the systemic weaknesses, such as fragmented primary healthcare access, that would undermine any surveillance or response effort ⁸.

The mapped socio-economic vulnerabilities are profound and multifaceted ((Carbone et al., 2025)). Studies link household food insecurity and paediatric malnutrition in Luanda’s settings to compromised immune responses, which may potentially affect arbovirus disease severity ^10,9. Furthermore, the co-circulation of other microbial hazards illustrates a broader environment of biological risk where dengue transmission intersects with other public health threats ¹¹. The urban political ecology provides essential context, framing informal settlements as an integral part of the city’s fabric, shaped by historical processes and land politics ¹. This scholarship underscores a context where top-down public health interventions may be met with distrust, highlighting community engagement as both a necessity and a challenge. Ultimately, the evidence constructs a narrative in which arbovirus transmission is a biosocial phenomenon, driven by the material conditions of informal settlements and conditioned by socio-economic precarity, healthcare access barriers, and urban political dynamics.

Discussion

The discussion synthesises evidence that rapid urbanisation and the expansion of informal settlements in Luanda create a syndemic environment conducive to arbovirus transmission, primarily through the exacerbation of social and environmental determinants of health ((Costa et al., 2025)). The dense, unplanned nature of these areas, characterised by inadequate water storage, poor drainage, and limited waste management, provides prolific breeding sites for Aedes aegypti mosquitoes ((Buire, 2025)). This environmental risk is compounded by significant strains on public health infrastructure. Research confirms that access to primary healthcare in Luanda is hindered by geographical, financial, and organisational barriers, which are most acute in informal settlements ((de Carvalho Maquengo et al., 2025)). This limited access impedes timely dengue diagnosis, case management, and vector control activities, thereby increasing the potential for severe outbreaks and community transmission ((Vita et al., 2024)).

Furthermore, the urban landscape fosters intersecting health vulnerabilities that may amplify the burden of arboviral diseases ((Costa-Manuel et al., 2025)). Studies document a high prevalence of conditions such as paediatric malnutrition and hypertension within Luanda’s population ((Carbone et al., 2025); ⁶). Such comorbidities can potentially worsen clinical outcomes for dengue patients, placing additional demand on an overburdened health system. The persistence of informal markets and specific food preparation practices, while studied for microbiological risks, also highlights environmental conditions—such as standing water and inadequate refuse disposal—that are directly relevant to vector proliferation ((Costa et al., 2025)). This underscores that the drivers of arbovirus transmission are deeply embedded in the broader urban ecology and socio-economic context.

Therefore, the evidence indicates that effective dengue prevention in Luanda requires integrated interventions that extend beyond siloed vector control ((Gamboa et al., 2025)). Public health strategies must concurrently address the underlying urban planning deficits, strengthen primary healthcare access, and improve sanitation and housing conditions in informal settlements ((Buire, 2025); ¹¹). Community engagement, informed by local knowledge and practices regarding health and mosquito prevention, is also critical for sustainable intervention ((Sobral & Stela Santana, 2024)).

Conclusion

This conclusion synthesises evidence on the critical nexus between rapid urbanisation, informal settlements, and arbovirus transmission risk in Luanda, Angola, within a feasible chronological scope (2000–2024). The findings affirm that the city’s ongoing “fabrique urbaine” or urban fabric-making ¹ actively shapes an ideal ecological niche for Aedes aegypti mosquitoes. This is driven by high-density, unplanned habitation, chronic water insecurity, and inadequate solid waste management ^2,4. Consequently, arbovirus risk is disproportionately borne by informal settlements marginalised from formal planning and infrastructure ³.

Effective mitigation must therefore be reconceptualised as an integral component of urban equity and primary healthcare strengthening, rather than a purely vertical intervention ((Cahango et al., 2026)). The populations most exposed to arboviruses often face intersecting health burdens, including barriers to accessing primary healthcare ⁶ and a growing prevalence of non-communicable diseases ⁵. Systemic challenges in managing other endemic diseases, such as varied community practices regarding malaria prevention ⁹ and high rates of loss to follow-up in tuberculosis treatment ¹⁰, mirror the obstacles to sustained vector control and underscore a syndemic reality.

Targeted interventions must address specific environmental pathways ((Costa et al., 2025)). The reliance on informal water storage due to insecure supply is a key driver of mosquito breeding ². Furthermore, the socio-political dynamics of the city, reflected in citizen mobilisations and engagement with urban space ⁸, highlight the potential for community-led, participatory vector control programmes that align with local agency. However, significant knowledge gaps impede preparedness. There is a pressing need for contemporary, localised entomological surveillance and robust seroprevalence studies to define the true arbovirus burden ⁷. Research must also explore potential epidemiological interplays, such as the influence of conditions like sickle cell trait on arbovirus severity, as suggested by analogous malaria research ¹¹.

Ultimately, the trajectory of arbovirus risk in Luanda will be shaped by urban development choices. Mitigation requires proactive, integrated planning that embeds vector control within municipal water, sanitation, and waste services, strengthens diagnostic capacity, and leverages community structures. Fostering resilient, well-serviced, and inclusive cities is the most foundational public health imperative for preventing arbovirus transmission in Angola’s future.

References

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