Spatial Inequalities in Built Environment Features for Physical Activity: A Cross-sectional Environmental Audit in Soweto, South Africa.

We used the Microscale Audit of Pedestrian Streetscapes Global version (MAPS-Global) auditing tool to investigate the spatial distribution of built environmental features relevant to physical activity in Soweto, an urban African township, from August to October 2022. We explored possible spatial inequalities in these features between areas of higher and lower deprivation within Soweto. We audited 25% of the street network across four small areas in Soweto (two higher and two lower deprivation). MAPS-Global assesses a range of characteristics related to pedestrian friendliness, in three sections-routes, segments and crossings. Differences by deprivation were evaluated using linear regression for routes, linear mixed-effects models for segments and crossings, or generalized estimating equations for highly zero-inflated features. In total, we audited 241 routes, 754 segments and 512 crossings. We observed more negative environmental features in higher deprivation areas compared to lower deprivation areas. We observed a high proportion of zeros (> 85%) for features such as private recreational facilities, cycling infrastructure, public transit stops and crosswalk amenities. Overall, we found that environments tended to be unsupportive for physical activity across all areas, and that higher deprivation areas exhibited more unsupportive elements compared to lower deprivation areas. We noted the widespread absence of many activity-promoting features in Soweto. These inequalities may contribute to reduced opportunities for safe and appropriate physical activity and underscore the need for equitable urban planning to promote healthier and more active lifestyles in urban African settings.