16 October 2015

Public Health in the post-2015 Development Agenda Series: Integrated Approach Needed to Improve Health Outcomes

This is the third article of the UNAI series “Public Health in the post-2015 development agenda”. Schools and departments of Public Health at UNAI member institutions were asked to submit articles highlighting research and work relating to the proposed SDGs and to showcase the importance of public health in the post-2015 development agenda. Please note that the articles are for discussion, and do not necessarily reflect the views of the United Nations.

The School of Public Health at the University of Nairobi, as a member of United Nations Academic Impact (UNAI), recognizes that lasting impact and improvement of health indicators will only be achieved if public health interventions are integrated with other interventions.  

The University of Nairobi’s School of Public Health has carried out multiple studies related to the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs). In particular, we have taken a lead in promoting a holistic approach to the implementation of MDG 4, reducing child mortality, and MDG 5, improving maternal health, with the knowledge that work related to MDG 6, combatting HIV/AIDs, malaria and other diseases, also affects maternal health and child mortality. For example, by taking an integrated approach to combating malaria at the community level, a study looking at the occurrence of malaria demonstrated its relationship to environmental, nutritional, socio-economic factors as well as existence of co-morbidities.  

Another important area of study undertaken by the School of Public Health at the University of Nairobi has been related to the implementation of MDG 1, eradication of extreme poverty and hunger.  The eradication of extreme poverty and hunger is essential to human development, as good nutrition is crucial to reach the health, education and economic goals contained in the MDGs. Health, cognitive development and productivity cannot be achieved without good nutrition. The eradication of extreme poverty and hunger is also necessary in reducing child mortality. This will require key effective interventions to be scaled up, such as appropriate infant and young child feeding practices. The studies were intended to generate evidence to inform nutrition and public health policy, and as a result nutrition programs have remained a priority in Kenya.  

Dr. Faith Thuita of the University of Nairobi has carried out pioneering work related to MDG 1. Selected studies undertaken by Dr. Thuita as principal investigator focusing on improved maternal, infant and young child feeding practices include:  

  1. The design and implementation of a 4-phased public health evaluation study to increase household support for maternal and young child nutrition by engaging grandmothers and fathers. This was implemented in western Kenya in partnership with the Ministry of Public Health and Sanitation.  
  2. A study to inform nutrition program design in Kenya’s arid and semi-arid areas. The landscape analysis was conducted in 3 counties (Isiolo, Turkana and Marsabit) and was designed to identify potential interventions to improve nutrition in infants and young children (IYC). The study aimed to identify nutrient requirements that are currently not being met in IYC diets and to identify cultural-ecological determinants of IYC feeding that serve as facilitators or barriers for good nutrition. The study was carried out under the auspices of the US government’s Feed the Future Initiative. Two research approaches were used: (1) application of a linear programming software tool (Optifoods) and (2) application of the GAIN-initiated focused ethnographic study (FES) of the determinants of IYC feeding.  
  3. A national study commissioned by the United Nations Children’s Fund (UNICEF) and the Ministry of Health to assess compliance of the country with the international code for marketing of breastmilk substitutes. The study covered urban and rural counties, and identified specific aspects of the International Code of Marketing of Breast-milk Substitutes that are violated and provided a benchmark for on-going monitoring by the Ministry of Health personnel. 

As outlined in the studies by Dr. Faith Thuita and the work of the School of Public Health at the University of Nairobi, it is evident that for complex public health issues to be addressed an integrated and holistic approach must be taken. For this reason, one must recognize that the finalized SDGs must reflect the complexity of the issues they address and be designed to be integrated as one.

Dr. Dismas Ongore is the Director of the School of Public Health at the University of Nairobi, which was launched in February 2011. He is a Public Health physician with research interests in malaria. This public health discussion series was created and curated by UN Academic Impact Intern Zinnia Batliwalla.