Applying Manchester’s pandemic expertise in Kenya

A team from The University of Manchester is sharing their clinical experience from working on the frontline during the coronavirus with colleagues in sub-Saharan Africa to help implement significant public health changes.

The experience of working with patients with severe forms of the COVID-19 disease at Manchester Royal Infirmary has provided some members of the University’s Faculty of Biology, Medicine and Health with a serendipitous opportunity to share some of their own clinical experiences with colleagues in Kenya and in Uganda.

Despite some enormous challenges at home, the team, led by Professor Mahesh Nirmalan, Vice Dean for Social Responsibility and Public Engagement and Professor of Medical Education in the Faculty, and Consultant in Intensive Care Medicine at Manchester Royal Infirmary

have used the well-established contacts and links between Manchester, Kenya and Uganda to initiate some important discussions on the management and prevention of COVID diseases that have led to substantial changes in these countries.

These discussions have now resulted in a research project funded by the University aimed at developing strategies to prevent the spread of COVID-19 infections in crowded informal settlements in sub-Saharan Africa.

From cancer care to coronavirus

In January 2020, the University and The Christie NHS Foundation Trust signed a Memorandum of Understanding to collaborate with Kenyatta University Teaching, Research and Referral Hospital in the prevention and management of non-communicable diseases, with a special emphasis on cancer and mental health.

The agreement provides training and exchange opportunities of health professionals, including Kenyan nurses, who will get an opportunity to work in Manchester.

As the coronavirus epidemic started, questions were being asked whether the virus would have the same ferocity in Africa. The new partnership has allowed the University to provide colleagues in Kenya with insight around what was happening in Manchester and some of the challenges faced here, including working with limited resources such as personal protective equipment.

This led to implementing some essential primary care interventions in Kenya to prevent the spread of the virus within African populations. In some informal sub-Saharan African countries, there is extreme crowding. It was recognised by the World Health Organization and other authorities that if the virus took hold within these settlements – referred to locally as slums – it would result in a major human catastrophe. 

“The University and clinicians in Kenya have been trying to find solutions to manage the coronavirus and have been discussing the possible preventative and isolation measures needed,” says Professor Nirmalan.

“As a group, we’ve spoken about the level of preparedness the Kenyan government is initiating in terms of providing oxygen treatment to large numbers of people.

Officials from Manchester and Kenya sign a Memorandum of Understanding
Prof Graham Lord (Dean of the Faculty of Biology, Medicine and Health) and Kenya’s High Commissioner sign the memorandum of understanding in January 2020, which paved the way for this collaboration.

“I felt quite privileged to have been involved in those discussions and as a result, we have catalysed a shift in thinking with a focus on prevention and primary care. Our discussions also focussed on developing capacity to provide simple oxygen therapy simultaneously to several unwell patients rather than the undue emphasis given by the Western media to the acquisition of new ventilators and ventilation strategies in these settings.

“Implementing the wearing of face masks or informal face coverings and increased spacing between subjects isolated in isolation centres have also been the focus of these discussions and have now been incorporated into the strategy adopted by the Kenyan government.”

University-wide approach

Professor Nirmalan, Professor Arpana Verma and Professor Keith Brennan from the Faculty of Biology, Medicine and Health are now working with colleagues from the Faculty of Humanities, Professor Diana Mitlin and Dr Jonathan Huck.

Together they’re developing a partnership with key institutions in Kenya, such as the Adventist Development and Relief Agency, African Population Health Research Centre, Kenya Medical Research Institute, Slum Dwellers International and several Kenyan universities. This partnership is intended to develop and deliver a research agenda around the primary prevention of the COVID-19 disease in the informal settlements in Kenya.

This team successfully bid for funding from the Global Challenges Research QR Funds to initiate a formal study around the effectiveness of wearing face masks in large, informal settlements. The pilot study is currently being conducted at three large informal settlements in Nairobi, Kissi County and Nakuru County. Members of the Kenyan diaspora in Manchester, led by Mr John Gutto, have helped the University team to build these partnerships and links within a relatively short time period.

“Despite these financially challenging times, The University of Manchester has committed a pump priming fund to support this project in Kenya, which is a reflection of our social responsibility priority,” says Professor Nirmalan.

“In this first phase, we are looking at the knowledge, skills and attitudes that currently prevail within these informal settlements on aspects related to the use of face masks, not how their use is affecting transmission, as that will be explored in Phase 2.”

Following this pilot phase, the University will be applying to the National Institute for Health Research to evaluate the effectiveness of a public health care bundle to prevent or reduce the transmission of acute viral diseases with pandemic potential. This study is likely to extend across multiple countries in East Africa, especially Kenya and Uganda.

Knowledge sharing with international peers

After caring for acutely ill patients in a high-intensity environment at Manchester Royal Infirmary, Manchester was in a position to share experiences with colleagues in Kenya to help them manage the current pandemic through treatment and prevention.

Colleagues across the University are also using this opportunity to undertake an ambitious, in-depth study on the prevention and reduction of viral transmissions within crowded settlements. As an example, the role of Faculty of Science and Engineering is to look at novel materials for the construction and design of face masks.

In another example, the Global Development Institute is looking at regional value chains (the most cost-effective way) in East Africa to source the best materials to make face masks, find reputable manufacturers and engage with the best distributors at a time of a future pandemic.

“This truly is a multidisciplinary project trying to look at the effectiveness of this public health care bundle we are putting together, whether it can be used now or in future pandemics in crowded settlements in Africa, South America or South East Asia,” says Professor Nirmalan.

“Preliminary work is currently underway and we’re also excited to work with the University of Nairobi, Kenya Medical Research Institute, Egerton University and the Kenyan diaspora in Manchester who have enabled us to establish invaluable links with Kenya.

“If this pilot is successful, we hope it will form the basis of a much bigger project across the whole of Kenya, Uganda and other East African countries and look at the impact of a multifactorial public healthcare bundle to prevent or slow down the transmission rates of acute viral diseases of pandemic potential in the future.

“Greater Manchester has a history of vaccine trials and neurological studies. This particular multidisciplinary research team has brought global health as an important dimension in the overall COVID-19 response to the University and across the region.”

How legacy outreach clinics in Uganda are supporting work in Kenya

Since 2015, Professor Nirmalan has been working closely with Dr Jonathan Huck, a lecturer in Geographical Information Science.

Their research in Gulu, northern Uganda, was supported by Medical Research Council grants and following the Ugandan civil war, they helped to establish the first outreach artificial limb clinics in the region. In 2019, the professors delivered more than 50 artificial limbs to people who had never received them before.

Professor Huck initiated a programme to map some of the most remote and unmapped areas in that part of the world. That experience has enabled the team to utilise those networks in the study taking place currently in Kenya, which in turn is helping to raise the University’s profile in sub-Saharan Africa. 

Tackling the world’s most recent pandemic has required new ways of thinking. The truly international, interdisciplinary approach of the team at Manchester is helping to ensure that the lessons learnt are shared for the good of communities around the world.

Meet the researchers