As of May 2021 it is thought that Coronavirus (Covid-19) has caused around 3.5 million deaths worldwide. Low income, over-crowding, poor hygiene and existing chronic lung disease experienced by over 60% of sub-Saharan Africa’s urban population (approx. 213 million) living in informal settlements or slums provide optimum conditions for this air-borne disease to be transmitted, with devastating effects. Researchers from the University are helping to limit the spread of the virus in Kenya, where the authorities are faced with huge challenges.

Correct and appropriate face mask wearing is the best means of protecting people living in informal settlements against COVID-19. However, many socio-cultural barriers exist and a participatory approach is critical to public acceptability. Such settlements also typically have extremely high population density which prevents social distancing, limited access to soap and water preventing regular hand washing, and high levels of poverty meaning that people must go to work instead of staying at home.

The team – which is led by Professor Mahesh Nirmalan and includes Dr Jonny Huck and Professor Diana Mitlin alongside the University of Nairobi and NGO ADRA – are undertaking research into how non-medical interventions can effectively limit the spread of COVID-19 in places where conventional approaches to mitigating diseases are particularly challenging.

Dr Jonny Huck, from the School of Environment, Education and Development, explains:”Countries around the world have struggled to control COVID-19, but the challenge is intensified in places where people are living in extreme poverty and in crowded informal settlements. This means that many of the measures that we are used to in the UK such as social distancing, regular hand sanitising and lockdowns are almost impossible to implement effectively.”

Through this research, it is hoped that communities such as these will be helped in not only this outbreak, but any future outbreaks of respiratory disease, which they are so unkindly prone to.

Team lead, Professor Mahesh Nirmalan said: “The populations in these settlements are inherently very poor, they are malnourished and therefore they are very susceptible. One could call this the toxic triad; the greater susceptibility of the population, the increased potential for spread, and the grossly adverse outcomes because of existing poor infrastructures.”

This project engaged large informal settlement populations with education via a WHO-validated information campaign on using face masks to help reduce infection.

Unable to travel during the pandemic, the team engaged grassroots organisations such as Slum Dwellers International (SDI), Community Leaders, and the Kenyan Ministry of Health in order to deliver this project. They engaged the Adventist Development Relief Agency (ADRA) to deliver engagement events using trained volunteers, distribute over 45,000 locally sourced facemasks and leaflets, conduct focus groups and co-designed events on social media, via the arts, participatory theatre and dance, alongside the Kenyan Ministry of Health, enabling maximum participation, dissemination of information and influencing government policy.

Dr Jonny Huck said: “We hope that our work will help to limit the impact of COVID-19 in these settlements, as well as help some of the most vulnerable communities in the world to handle future outbreaks of respiratory disease, which have been seen with increasing frequency in recent years.”

The data collected will act as evidence-based guidance and will ensure non-medical interventions are more widely accepted and implemented effectively.

Professor Nirmalan said: “Change can only happen if people believe in the change that you are proposing. The best way to convince people is to actually show them the evidence in a comparable setting that the intervention works.”

The team are now working to attract more funding, allowing the scope of this research to be increased to more settlements, and to include regular testing for SARS-COV2 (which causes COVID-19) and a range of other respiratory diseases. It is hoped that the findings of this research will provide a much-needed evidence-based advancement in the ability to control respiratory disease in informal settlements around the world.

• Over 222,000 people have received educational training from the team around the spread of respiratory diseases
• 45,000 locally sourced face masks and information leaflets were distributed across large geographical areas
• The research conducted and data gathered is set to have a significant impact on policy relevant to the whole of sub-Saharan Africa