KUTRRH CEO Dr Zeinab Gura, Dr Manu Chandaria, Prof Keith Brennan, Priti Chandaria, Helen Hawthorne, and Amb. Prof. Manoah Esipisu. Photo/Richard Kanguru.
Kenya’s ability to prevent, detect
and treat oesophageal cancer has improved markedly over the past three years,
following a strategic partnership between the University of Manchester, The
Christie NHS Foundation Trust and Kenyatta University Teaching, Referral and
Research Hospital (KUTRRH).
The collaboration, launched on
September 30, 2022, with funding from the National Institute for Health and
Care Research (NIHR), was designed to improve early detection, diagnosis and
treatment of oesophageal cancer — one of the most common and deadliest cancers
in parts of Kenya.
The programme has been piloted in
Kiambu, Nyeri, Ikuru, Kisii and Meru counties, bringing screening services and
improved diagnostics closer to communities where patients often present late
with advanced disease.
Prof Keith Brennan, Vice Dean for
Internationalisation at the University of Manchester and lead of the strategic
partnership, said one of the project’s most important gains has been diagnosing
the disease earlier.
“Previously, oesophageal cancer was
only seen at stage 3-4. We are now seeing it at stage 1-2, when it’s curative;
there are curative options. Stage 3-4, it’s not. It’s palliative, and it’s
end-of-life. Whereas at stage 1-2, there are curative options. So, that is a
success,” he said.
In Kenya, late diagnosis has long
undermined cancer outcomes, with many patients seeking care only when symptoms
become severe. By introducing structured screening and strengthening community
awareness, the partnership is beginning to reverse this trend.
Capacity building has been central
to the intervention. Thousands of frontline health workers have been equipped
with skills to identify symptoms early and refer patients promptly.
“We have trained 14 surgeons in
endoscopy so that they can look for the cancer. We’ve trained two pathologists
who can then screen the samples and actually understand whether there’s a
cancer present or not,” Prof. Brennan said.
In addition, about 15,000 Community
Health Promoters have been trained to recognise early warning signs and guide
patients into the health system — a move expected to significantly shorten the
time between symptom onset and diagnosis.
The partnership has also enabled a
two-way exchange of expertise between Kenya and the United Kingdom. Kenyan
clinicians have travelled to Manchester for specialised training at The
Christie Hospital, while UK experts have supported local teams through on-site
mentorship and the rollout of screening and treatment protocols.
Beyond individual skills, the
initiative has helped strengthen institutions — particularly KUTRRH, which has
rapidly grown into a major referral and research centre.
“So, when I first came here, that
hospital was just starting to open; they might have had a handful of patients,
if that. Now, it’s a successful, thriving hospital that teaches medical
students, does research and is clearly a referral centre for the nation,” Prof.
Brennan said.
KUTRRH is now playing a central role
in cancer care, research and training, with the oesophageal cancer project
embedding new technologies, clinical practices and research capacity within the
facility.
The origins of the collaboration
trace back to a request by former President Uhuru Kenyatta to explore
partnerships in oncology. While cancer care was the broad focus, the decision
to prioritise oesophageal cancer came from Kenyan partners.
“When it came to thinking about the
particular cancer type, that came as a question from KUTRRH. It came because it’s
the fourth most common cancer in Kenya, and at the time, it was causing the most
deaths from cancer. For us, it was a huge learning experience, listening to what your
partner sees as important,” he explained.
Implementation has not been without
challenges. Kenya’s devolved health system meant the programme had to negotiate
agreements separately with county governments during the pilot phase. While
this required more time and coordination, it also helped build ownership at the
local level.
With the pilot phase nearing
completion and early results showing promise, attention is now shifting to
national expansion. Discussions are expected with the Ministry of Health on
scaling up the programme to all 47 counties.
The long-term goal, according to
Prof. Brennan, is to ensure that the expertise developed through the
partnership becomes embedded within Kenya’s health system, rather than
remaining a time-limited intervention.
Looking ahead, researchers are also
turning to genomics to better understand why the disease is more common in
certain regions of the country.
“There are more cases of oesophageal
cancer as you go across the Rift Valley and Western Kenya than there are in
Eastern Kenya. This tells you it might be something present in the environment, or it might be something missing from the environment. But the genomics might
tell us what it is in the environment that we want to get rid of or it will
tell us what’s missing from the environment we need to add. This will be a good
preventive measure,” he said.
Genomic studies could also help
tailor treatment by identifying the specific genetic mutations driving the
disease.
“The issue is that a lot of those
targeted, very precise therapies are very expensive. So you need the evidence
to explain why you actually need that drug. So the genomics will give that
evidence too. So that will make the treatment of patients much better,” he said.