Non-communicable lung disease in Kenya: from burden and early life determinants to participatory inter-disciplinary solutions (Tupumue)

The lung diseases asthma and chronic obstructive pulmonary disease (COPD) are very common. Around the world 300 million people have asthma and 200 million have COPD. Low- to middle-income countries (LMICs) such as Kenya shoulder the burden of asthma and COPD. These diseases interfere with the lives of people, they stop people working and cost them money. The diseases also hold back countries from developing. The Kenyan Government has highlighted asthma and COPD as national priorities. Research from high income countries shows that the process of developing asthma and COPD starts early in life when we are children, or even earlier. Although research has shown that many adults in Africa have reduced lung function, no one has looked to see if this starts early in life.

Our team of researchers and doctors from Kenya and the UK will work closely with two communities in Nairobi, Kenya, to design and carry out a project looking into the early life origins of lung disease. We are interested in what causes lung disease and how people experience lung disease. We want to find out how early these diseases start, so that eventually we can prevent lung diseases by targeting the right age groups.

Our focus is on children and young adults aged 5 to 18 years because this is the age at which lungs are developing, and ill-effects at this time of life can impact the rest of people's lives. We will work in two areas: an informal settlement (Mukuru) and a wealthier area (Bura Bura). These two areas are geographically very close but very different in terms of their socio-economic make up. We will involve community members in all stages of the scientific process (including bid-writing, design, data collection, communication and project evaluation). We want to do this because it ensures that our research is directly relevant to community members and the results are more likely to be acted upon. We are particularly interested to look at the effects of indoor and outdoor air pollution, birth weight and early life chest infections.

We will conduct a survey of children/young adults aged 5-18 years - 1000 in Mukuru and 1000 in Bura Bura. The children and young adults will be recruited through local schools. The parents of the young people who want to take part will be visited by local field workers. The field workers will ask questions about lung symptoms, sources of indoor air pollution and any known lung problems. We will ask mothers if we can look at the Child Health Card that records birth weight, childhood weights and chest infections. We will measure the lung function of the young people using a simple blowing test called spirometry. We will do this before and after they run for 6 minutes, a simple way of looking for a form of asthma. To look at the effect of air pollution we will measure the air pollution experienced for a day by 100 young people from each community. They will be asked if they would wear a bag with some light-weight monitoring equipment for a day. The results of this monitoring will be used with the questionnaires to estimate exposure to air pollution for all those taking part.

The information gathered will be used to see if more children than expected have reduced lung function and at what age this appears. We will also see if air pollution, birth weight and early life chest infections affect the lung function of children. This has never been done before in Africa. The study is large enough to make fairly precise estimates of prevalence and to look for associations.

The results of this study will be fed back to the two communities in easily understandable ways, including theatre and comics. We will also let scientists, doctors and those interested in lung disease know the findings of the study. Although this study will not provide definitive proof, it is the first step for showing that lung diseases in Africa start early in life and can be prevented by targeting the right age group.