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Background: The role of fungi in the pathogenesis of respiratory illness has received scant attention in the medical literature. The parallel increases in allergic diseases and informal settlements have necessitated an evaluation of a possible link between the two factors, as mould growth is facilitated by the conditions present in these areas. Objective: This review evaluated the association of airborne mould prevalence in an informal settlement and its relation to childhood respiratory health. Method: A prospective study of an informal settlement, Malakazi near Durban, South Africa was conducted. Factors enhancing mould growth, such as temperature and humidity, were evaluated. Homes were categorised as either study homes or controls, based on building structure, ventilation and occupant behaviours. Mould levels and species were studied both indoors and outdoors. Respiratory health was determined using standardised questionnaires, lung function tests and allergen sensitisation. Result: High fungal loads were seen throughout the informal settlement. Higher indoor to outdoor mould spore count ratios were seen in the study homes as compared to controls. Aspergillus (27%), Penicillium (26%) and Wallemia (23%) were the moulds commonly identified. Respiratory illness as determined by a questionnaire, lung function tests and bronchial reversibility was associated with increased mould growth in study homes. Temperature and humidity changes amplified indoor mould growth in study homes. Mould sensitisation was common in both groups studied. Conclusion: Informal settlements provide conditions to support mould growth. Increased mould growth impacts negatively on childhood respiratory health. Minimum standards for building construction and mould counts to identify 27 Urban Health and Development Bulletin Urban Health and Development Bulletin pathogenic levels are needed to improve health. Further studies are essential to answer these questions.