Addressing Antibiotic Use in Nairobi City County: A Practical Policy Framework for the Role of Public Health

Purpose: This policy paper provides a practical framework for the role of public health in addressing antibiotic use in Nairobi City County. Methodology: This study adopts a descriptive, analytical, and comparative policy research design, combining secondary data analysis with a public health systems perspective. The approach is intentionally policy-oriented, focusing on synthesizing existing evidence to inform practical and preventive interventions rather than generating new clinical or laboratory data. Findings: Findings from research demonstrates that cleaner cities experience lower infection rates and reduced dependence on antibiotics. In contrast, poor urban hygiene and environmental health conditions create settings in which infections recur frequently, normalizing repeated antibiotic use among households. In Nairobi City County, respiratory diseases are among the leading causes of outpatient visits and mortality, reflecting the combined effects of population density, air pollution, and uneven access to basic services. This persistent burden places sustained pressure on health facilities and households, often resulting in frequent antibiotic use as a routine response to illness rather than a targeted clinical intervention. Furthermore, comparative analysis shows that clean developed cities exhibit substantially lower burdens of both communicable and non-communicable respiratory, gastrointestinal, and skin infections, reflecting strong sanitation systems, clean urban environments, effective air quality control, and robust preventive public health infrastructure. Nairobi City County registers the highest burden, reflecting dense population, air pollution, informal settlements, sanitation gaps, and waste management challenges typical of large urban centres. Unique Contribution to Theory, Practice and Policy: The policy paper recommends regular and well-managed water-based street and public-space cleaning to remove dust, organic waste, faecal matter, food residue, and other contaminants from streets, markets, transport hubs, and pedestrian areas. This reduces the environmental load of pathogens and airborne particulates lowering the incidence of respiratory, gastrointestinal, and skin infections which are the key drivers of antibiotic use in urban populations.