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OFFICIAL FLAGGING-OFF OF THE OSCC SCREENINGS MOBILE ENDOSCOPY TRUCK IN NYERI COUNTY

KUTRRH Ag. CEO, Dr. Zeinab Gura joined Nyeri County Governor, H.E Mwalimu Mutahi Kahiga, EGH in flagging off the mobile endoscopy truck to support screening services for oesophageal cancer in Nyeri County. The initiative is part of an ongoing research on improving oesophageal cancer survival in Kenya. The Project is funded by the National Institute for Health and Care Research (NIHR) and implemented by KUTRRH in partnership with the University of Manchester, the Christie and NHS Foundation Trust. The project is implemented through a hub and spoke model with KUTRRH being the hub and Nyeri County being one of the participating counties as spokes.

Nyeri County is the second county to have rollout of endoscopy screening services after successful rollout in Meru County. The services are expected to continue through the Month of June in the County. The CEO was accompanied by project’s principal investigator, Prof. George, Njoroge, Training & Research Director, Dr. Caroline Ngugi, and members from the KUTRRH research team.

OFFICIAL FLAGGING-OFF OF THE OSCC SCREENINGS MOBILE ENDOSCOPY TRUCK IN MERU COUNTY

Meru County Health CECM, Dr. Dennis Mugambi presided over the flagging off of a mobile endoscopy truck for screening for the cancer of the oesophagus. The event took place at Mwariama Stadium, Meru County where screening for other cancers was also launched. In his remarks during the flagging off ceremony, Dr. Mugambi noted that the ongoing endoscopy screenings for the cancer of the oesophagus in Meru County courtesy of the National Institute for Health and Care Research (NIHR) and the partners including The University of Manchester, KUTRRH, Manchester Cancer Research Centre, The Christie and Northern Care Alliance NHS Foundation Trusts will go a long way in providing much needed access to the sub-county levels. This from his observations is not only providing much needed opportunities for early detection but also supplementing a constrained capacity for diagnostic services at the County.

Dr. Mugambi urged residents of the county to utilize the recruitment period offered by the research project between 22nd April and 9th May to avail themselves at the nearest level 3 and level 4 hospitals to be checked for onward referral for endoscopy screenings. He further lauded participation by both private and faith-based health facilities in the county in their support for health outreach.

In remarks read on her behalf by the Director, Training & Research, Dr. Caroline Ngugi, KUTRRH CEO, Dr. Zeinab Gura expressed appreciation to the support extended by the NIHR and partnership with The University of Manchester as well as participating Counties and collaborating institutions including JKUAT, National Cancer Institute and KEMRI for making the project rollout a success. Dr. Gura singled out Meru County for the immense support extended to the research team which has led to the progress realized. She reiterated her commitment to foster closer cooperation to address health challenges including collaborative research.

Oesophageal cancer is the fourth most common cancer in Kenya and the third leading cause of death. Unlike other cancers, it has the highest mortality rates largely owing to late diagnosis. This hampers attainment of positive health outcomes as reflected high mortality rates.

The free screening services for oesophageal cancer are part of ongoing research funded by the National Institute of Health and Care Research (NIHR) and implemented by The University of Manchester in partnership with Kenyatta University Teaching, Referral & Research Hospital (KUTRRH) through a hub and spoke model. Meru County is one of the participating counties as spokes for the project. The project also draws collaboration from KEMRI, JKUAT, MKU, and the National Cancer Institute (NCI).

The ongoing project is anchored on three (3) core aims. The first aim entails community engagement and involvement to learn the early signs and symptoms of oesophageal cancer, understanding accessibility of cancer services to community members, and how to build an effective awareness campaign and recruit to a screening service for oesophageal. The second aim entails clinical outcomes unit and telemedicine to establish whether endoscopy screening and early diagnosis in a Hub and spoke model enable best clinical outcome for patients with oesophageal cancer. The third aim of the project involves pathology and early detection signatures through building capacity for high-throughput analysis of specimens to improve early detection of oesophageal cancer, learn about what mutational signatures tell us about the aetiology of oesophageal cancer in Kenya, and find out how the biology of oesophageal cancer in Kenya differs from that in other countries.

NIHR 133382 Project Summary

As the 3rd leading cause of death in Kenya, cancer places an increasing burden on the country’s healthcare resources. In 2020, The Christie NHS Foundation Trust and The University of Manchester signed Memoranda of Understanding with Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) and Ministry of Health, Kenya to develop a long-term equitable partnership that seeks to improve cancer outcomes within Kenya and East Africa.

This government interest and backing provides the perfect backdrop for initiating our NIHR Group between Kenya and Manchester. This partnership brings together researchers from a variety of scientific and clinical backgrounds to focus on the early detection of lethal squamous cell carcinoma of the oesophagus (OSCC). It is the third most common cancer and the most lethal (99% of patients die from their disease within 5 years) due to patients being diagnosed too late when they have advanced, incurable disease. OSCC needs better early detection strategies to diagnose cancers at a much earlier stage whereby 40-50% of Kenyan patients could potentially be cured with surgery. However, there are obstacles to quickly introduce this early detection programme. The majority of Kenyans (~75%) live in rural areas with very low incomes, many of which are cut off from cancer care. There are also marked differences in the number of OSCC cases between different Kenyan counties, and even between East, West and South Africa. We do not know all the factors that lead to these different rates of OSCC presentation, but they could include late recognition of symptoms by the patient and general practitioner, social stigma of a cancer diagnosis, different access to healthcare, lifestyle and genetic factors or other environmental and exposure factors. We will overcome these research obstructions and develop interventions to improve OSCC early detection. By pairing expertise within our joint NIHR GACD Group, we seek to address the problem of OSCC early detection through the following AIMs:

• AIM 1: Co-develop best engagement and research practices for OSCC detection amongst local health leads and their communities;

• AIM 2: Co-create a KUTRRH “Hub and Spoke” model whereby mobile units address cancer detection directly within rural communities and sends back clinical and imaging digital data and biological specimens to KUTRRH. It uses telemedicine to communicate regularly to rural settings and to Manchester collaborating clinicians;

• AIM 3: Increase the capability for pathology high-throughput analysis of the extra specimens associated with increased early detection. Also to partner with world leading genetics experts to discover mutations in the OSCC tumour DNA that might explain why a cancer came to be in certain Kenyans – to describe how best to detect them or one day, to prevent them entirely. We will work with local community partners and the Kenyan Network of Cancer Organisations (KENCO) to optimise a national Cancer Early Detection network to support research on OSCC and all cancers. Success in this first 3-year project could lead to further success in long-term goals in which we can show improved survival and quality of life in patients with OSCC, which will in turn decrease family separation or fragmentation due to treatment or worse, death. We see this as a way to improve Kenyan and East African healthcare for all cancers and success in this grant would lead to future larger applications