Health and Wellbeing

Our work here aims to improve and contribute to the evidence base for effective intervention strategies and policies to promote the health and well-being of all people in Africa. The theme has five programs of work (Units): Nutrition and Food Systems; Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health (SRMNCAH); Chronic Diseases Management (CDM); Emerging and Re-emerging Infectious Diseases (ERID) to respond to the COVID-19 and Antimicrobial Resistance (AMR) challenges; and Health Systems Strengthening. 

Nutrition and Food Systems (NFS) Unit – This unit, with three focus areas: maternal, child, and adolescent nutrition;, nutritional epidemiology;, and food systems, aims to generate evidence, build capability, and influence policy and practice to promote positive food systems transformation for optimal nutrition and health in Africa. 

• The maternal, child, and adolescent nutrition program aims to inform policies, strategies, and actions to optimize the health of mothers, children under five, school-going children, and adolescents. Its special focus is nutrition in the first 1000 days, including breastfeeding and complementary feeding. 
• The nutritional epidemiology program aims to improve the understanding of the role of diet in the etiology of health outcomes such as malnutrition, including obesity, in the African context by identifying the determinants that influence diet. This area also evaluates interventions to improve dietary patterns and translates nutritional epidemiology evidence into guidelines, policies, and actions. 
• The food systems program aims to inform policies, strategies, and actions on food systems’ transformation towards healthy, nourishing, inclusive, human-centered, resilient, and sustainable food systems. We focus on sustainable production, access to, and consumption of sustainable healthy foods to promote health and well-being while promoting a healthy environment and mitigating and adapting to climate change challenges. We apply a human rights-based approach to food systems transformation, focusing on food sovereignty, freedom from hunger, and the right to adequate food, especially for the most vulnerable. We build the capability and agency of grassroots organizations, including women and youth groups, as a pathway to effective food systems transformation in communities. 

Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCAH) Unit – SRMNCAH generates rigorous evidence that informs programs and policies to improve sexual, reproductive, maternal, newborn, child and adolescent health in Africa. The unit has five focus areas:

• Maternal, newborn, and child health: We seek to enhance access to safe, high-quality, and affordable maternal, newborn, and child health (MNCH) care within the framework of Universal Health Coverage (UHC). Our work takes a multifaceted approach, including generating evidence, adopting, testing, and adapting interventions to suit specific contexts. We aim to address one of the core challenges in MNCH—ensuring that mothers, newborns, and children have equitable access to essential healthcare services, regardless of their socio-economic status or geographical location.
• Maternal and adolescent mental health: We generate evidence related to the prevalence, underlying contexts, and dynamics of common maternal and adolescent mental health problems. We also seek to develop and test effective interventions to address prevailing mental health challenges among these demographics. Our work on maternal and adolescent mental health acknowledges the critical connection between maternal (perinatal) mental health and MNCH outcomes. Our work also aims to provide valuable insights into the multifaceted landscape of maternal (perinatal) and adolescent mental health, contributing to better policies, practices, and support systems.
• Young people’s sexual and reproductive health and rights (SRHR): We recognize the importance of investing in young people’s SRHR as a critical lever to harness the demographic dividend in Africa. We advance this agenda by researching to understand the drivers of young people’s SRHR with a focus on early adolescents (10-14 years), those from marginalized communities, and those most at risk of being left behind as the world focuses on the achievement of Agenda 2030 on sustainable development, such as pregnant and parenting adolescents. Through strategic partnerships with program implementers working on young people’s SRHR, the Unit also generates evidence about what works to reach youth with safe, respectful, and comprehensive SRHR information and services. Recognizing that education is an essential social determinant of young people’s SRHR, we work with colleagues in the Human Development Theme to understand how to make education systems more inclusive (e.g., promoting school re-entry for pregnant and parenting adolescents).
• Abortion and family planning: We implement studies focused on understanding the contexts and dynamics of unsafe abortion, family planning, contraceptive attitudes and behaviors, and fertility, deepening our understanding of the mortality and morbidity associated with unsafe abortion and unintended pregnancy, strengthening the measurement of unsafe abortion and unintended pregnancy; and assessing the impact of unsafe abortion prevention programs and barriers to quality post-abortion care. 

Gender and sexuality-related vulnerabilities: Our research examines the drivers of sexual and gender-based violence (SGBV) and interventions to address SGBV among different populations. Our work also explores the lived experiences of sexual and gender minorities (lesbian, gay, bisexual, trans, intersex, and other gender non-conforming persons), including the interlinkages between their lived experiences and health outcomes.

Chronic Diseases Management (CDM) Unit
Strategic Focus
Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both. Chronic diseases such as cardiovascular diseases (heart diseases), cancer, diabetes, chronic obstructive airway disease, mental disorders, neurological diseases, and arthritis are rapidly growing in sub-Saharan Africa, with related deaths expected to double by 2030. The Chronic Diseases Management (CDM) Unit aims to address this challenge by generating evidence on chronic disease management as a systematic approach to coordinating healthcare interventions across levels (individual, organizational, local, and national). The focus on “management” signals a shift from the dominant notion of treatment and the intended outcome from “cure” to stewardship. Our core mandate is to co-design and evaluate new interventions or new ways of delivering known interventions in various African populations to prevent chronic diseases or care for people with chronic diseases. 

Key Research Questions
The CDM unit addresses three key questions:

1. What is the burden of, and forecast for, chronic diseases in Africa, and what are the context-specific environmental, behavioral, and genomic risk factors for chronic diseases in Africa?
2. What are the best approaches and new tools to deliver known cost-effective interventions for preventing and caring for chronic diseases in Africa?
3. How is the health system responding to manage chronic diseases, and what can be done to strengthen health systems to improve services for chronic diseases?

Focus Areas 

The research in the CDM unit is grouped into five focus areas:

1. The interplay of risk factors for chronic diseases and prevention (CDRISK)
2. Food Environment Policy Action   (FEP-ACT)
3. Cardio-Metabolic Diseases Management (CMD)
4. Mental Health and Neurological diseases (MEN)
5. Cancer Care Pathways (CANCER)

Focus Area I: INTERPLAY OF RISK FACTORS OF CHRONIC DISEASES AND PREVENTION (CDRISK)

Risk factors can cluster and interact, resulting in synergistic action for developing chronic diseases and related mortality. Such interactions are neither simple nor straightforward. Our research identifies the interplay of risk factors, including genomics and behavioral and environmental risks for chronic diseases, in individuals and communities to inform preventive interventions.

Many chronic diseases can be prevented by reducing common risk factors such as tobacco use, harmful alcohol use, physical inactivity, and eating unhealthy diets. In addition, prevention of infections that lead to NCDs can be achieved through vaccinations.  Our research focuses on investigating the distribution of risk factors, identifying those most at risk, and designing interventions to reduce the risk of chronic diseases across all age groups.  There are seven ongoing projects under this focus area (CDRisk1-CDRisk 7)

Focus Area II: FOOD ENVIRONMENT POLICY ACTION (FEP-ACT)

Of the four modifiable risk factors for NCDs, including inadequate physical activity, exposure to tobacco smoke (and air pollutants), and excessive alcohol use, an unhealthy diet generates more disease than all the other risk factors combined. The food environment mainly drives unhealthy food consumption.  The food environment is the physical, economic, political, and sociocultural context in which each consumer engages with the food system.  The food environment influences food choices, food acceptability, and diets through physical and economic access to food (proximity and affordability); food promotion, advertising, and information. Our research focuses on robust measurements of the food environment using validated methods to generate evidence on how this is driving unhealthy food consumption. The evidence generated is then used to drive interventions promoting healthier diets for NCD prevention. There are four ongoing projects (FEN1-FEN4).

FOCUS AREA  III: CARDIO-METABOLIC  DISEASES MANAGEMENT (CMD)

Globally, CMDs are the number-one cause of death, and their prevalence is predicted to increase, especially in Low- and Middle-Income Countries (LMICs), where almost 80% of all adults living with diabetes are found and where 77% of all NCD deaths occur. The current rapid epidemiological transition leading to the rise in CMDs places a high demand on a health workforce that is constrained, is inequitably distributed to serve people in vulnerable positions, and has limited strategies to provide prevention of and care for CMDs.  Our research focuses on identifying those at the highest risk of CMDs and ensuring they receive appropriate treatment to prevent premature deaths. We co-design preventive interventions and health system-strengthening approaches that increase access to services, including digital health technology, task-shifting, self-help, and self-care approaches. There is one ongoing project (CMD1).

Focus Area IV: Mental Health and Neuro-Degenerative Diseases (MEN)

Several common psychiatric and neurodegenerative diseases share epidemiologic risk, and both conditions are rapidly increasing globally and attracting little attention in most low and middle-income countries. Our work focuses on estimating the burden and addressing major psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia, anxiety disorders, post-traumatic stress disorder, problematic alcohol use, and neurodegenerative diseases, including Parkinson’s disease and Epilepsy. We co-design and evaluate interventions for the prevention and care of these diseases. We have three ongoing projects (MEN1-MEN3)

FOCUS AREA V: CANCER CARE PATHWAYS (CANCER)

Cancer is the second-largest cause of death in low- and middle-income countries (LMIC). However, cancer outcomes remain much worse in LMICs than in high-income counties (HIC), largely due to delayed treatment. The research has been done mostly concerns delays in presentation to formal health services. Yet about half the delay between symptom and treatment initiation arises after the first presentation. Since more people with cancer are surviving better, there is a need to understand their needs and factors that may affect their quality of life and, ultimately, their experience of survivorship and quality of life.

Health Systems Strengthening (HSS) – Our Africa-led agenda to strengthen and build more resilient systems for improved health is addressing knowledge gaps related to chronic disease management, epidemiology and identifying mitigation strategies for the rising burden of injury.

Emerging and Re-emerging Infectious Diseases (ERID) – The Center will produce research on the emerging re-emerging infectious diseases across Africa in terms of epidemiology, understanding coverage of intervention and their impact as well developing and testing and innovations aimed at overcoming identified barriers. The areas of work are summarized below: 

• To contribute to the understanding of the levels, distribution, drivers, and impact of major emerging and re-emerging infectious diseases in sub-Saharan Africa.

Clarifying the epidemiology of emerging and re-emerging infectious diseases is at the center of their prevention and control. We aim to design and conduct epidemiologic studies to improve our understanding of their levels, distribution, risk factors, and impact. COVID-19 has demonstrated, to a new level, the value of countries being able to use data to understand the dynamics of epidemics. Surveillance should be part of enhancing our understanding of the epidemiology of new and old epidemics.

Using existing surveillance systems and data sources, we will aim to deepen our epidemiological understanding of various infectious diseases and thus inform programming. Surveillance to monitor existing epidemics and detection of new ones is limited and the systems, including laboratory capacity, are weak. Detection of the emergence of drug-resistant strains is also a function of active surveillance. We will focus on supporting the implementation of antimicrobial stewardship in priority countries in East and Southern Africa (ESA) and West and Central Africa (WCA).

• To describe and identify gaps in the coverage of interventions against major emerging and re-emerging infectious diseases

The Sustainable Development Goals (SDG) dispensation aims to ensure that no one is left behind. However, continued delivery of health interventions as usual might achieve this. We aim to not only measure coverage of interventions but also identify barriers, and inequities, which often go undetected. We will focus on vaccine-preventable diseases, current epidemics such as COVID-19, and HIV and malaria.

• To assess the impact of large-scale public health interventions against major emerging and re-emerging infectious diseases

Investment in the health sector as a proportion of a country’s GDP, while inadequate, is still substantial. As such, it is important to understand whether interventions in the sector are effective. While vaccines are available for some of the emerging (COVID-19) and re-emerging diseases (tuberculosis), uptake of the respective vaccine in some areas remains low. Over the years, we have built the capacity to conduct large-scale impact evaluations to help inform public health decisions.

• Test health systems innovations to increase access, uptake, and use of interventions with a focus on addressing inequities, reaching traditionally excluded sub-populations, addressing vaccine hesitancy, and proposing evidence-informed solutions to addressing barriers to accessing services

Delivery of interventions often reaches a saturation point to the effect that more of the same does not lead to better health impact. Hard-to-reach sub-populations may remain uncovered/unreached by interventions and as such serve as the source of outbreaks and possibly development of resistance due to irrational use of antimicrobials. We aim to promote innovation to advance and improve access to critical public health interventions to ensure reduced inequality and inequity in disease burden. We will focus on harnessing community resources, the use of digital technology, and tweaking the healthcare system to serve hard-to-reach populations better.