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Cities in the poorest countries of the world are rapidly urbanizing. In fact, some of the fastest growing cities on the planet are found in sub-Saharan Africa. Many people benefit from economic, educational, and health opportunities that exist in cities and, as a result, city-dwellers often face less risk of poverty and disease in the context of climate change than their rural-dwelling counterparts. However, rapid urbanization, resulting from a large and constant influx of migrants from rural areas, can put pressure on existing social, economic, and health systems. For poor cities, they face a challenge to support existing residents while also expanding to support the needs of migrants, many of whom are deeply impoverished. Additionally, in a climate change, linked to heat waves, floods, droughts, and other related events, can add stress to complex urban food, health, hygiene, and housing systems. In this project we investigate urban expansion, climate change, and health in four major African cities – Ouagadougou, Addis Ababa, Nairobi, and Kigali. We consider different scenarios of urban expansion using historic and contemporary maps of urban extent, combined with climate (temperature, rainfall, and vegetation) and land cover combined with spatially referenced health information from the Demographic and Health Surveys (DHS) to investigate the relationships between urban dwelling, climate change and health. Temperature and rainfall scenarios are developed under different urban land use futures (expanding agricultural areas versus reducing agricultural areas) to examine the ways that individual health outcomes related to malnutrition vary under different potential future conditions. Preliminary results of the research highlight the importance of temperature for health, in particular, and suggest that while urban conditions related to urban infrastructure (e.g., educational attainment, electricity access, and improved hygiene) cannot reduce health risks to counter the impacts of high temperatures and reduced agricultural land. As cities in poor countries urbanize, city-dwellers face unique risks when droughts, heat waves, and other extreme weather events occur. In this project we explore urban land use conditions, climate conditions and health using future scenarios. Specifically we evaluate health outcomes in the future while considering different land use practices, urban expansion, temperature, and rainfall conditions to identify individual-level risk and protective factors. We compare results across four major cities in sub Saharan Africa.