Fossil fuel use, urban air pollution and health in rapidly growing African cities: Implications for sustainable and low-emission urban development.

Rapid urbanization and persistent reliance on fossil fuels in African cities have intensified ambient air pollution, posing significant public health and environmental challenges. This critical systematic review with policy synthesis, conducted in accordance with PRISMA 2020 reporting principles, synthesizes evidence on fossil fuel sources, urban air quality trends, health impacts, structural drivers, and policy responses while identifying evidence gaps and opportunities for integrated interventions. Diesel-powered road transport, backup generators, and household energy use emerge as dominant sources of particulate matter, nitrogen oxides, black carbon, and volatile organic compounds, disproportionately affecting children, the elderly, and low-income populations. Observed pollution levels often exceed World Health Organization guidelines, yet monitoring networks are sparse and unevenly distributed, limiting exposure assessment. Structural and institutional factors including urban sprawl, energy insecurity, weak fuel standards, and fragmented governance amplify emissions and health burdens. Policy synthesis indicates opportunities for co-benefits through transport electrification, clean cooking transitions, renewable mini-grids, and integrated urban planning, with interventions capable of simultaneously improving air quality, population health, and climate mitigation outcomes. Evidence-policy gaps highlight the need for cross-sectoral coordination, enhanced monitoring infrastructure, and health-informed energy and transport strategies. This review is intended to provide an evidence-informed policy synthesis for national and city governments, urban planners, environmental regulators, public health agencies, and development partners. By integrating evidence across energy, transport, health, and urban planning, it identifies practical pathways for reducing fossil-fuel dependence while improving air quality, population health, climate resilience, and sustainable urban development in rapidly growing African cities.