Uptake Of Preventive Measures, Sero-Surveillance And Complementary Management Of Covid-19 In Kenya

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan City in Hubei Province, China on December 31, 2019 The outbreak began with clusters of patients presenting with symptoms of SARS. Some of the patients rapidly degenerated and died within 7 to 14 days with the initial survivors recovering and being presumed to be immune to reinfection. Cases of re-emergence have been reported in South Korea, China, Singapore and other countries and have been attributed to importation by those traveling from regions of active outbreaks. The World Health Organization (WHO) declared it a 'Pandemic' in January and March 2020, COVID-19 has occasioned one of the worst global health crises in the last century. Transmission of COVID-19 occurs mainly from person to person through infected respiratory droplets expelled during coughing or sneezing or after contact with body fluids during certain medical interventions. This is propelled by the fact that majority of the infected persons are asymptomatic or have only mild symptoms The case fatality rate (CFR) has been seen to be higher among the elderly (14.8%) and those with comorbidities such as cardiovascular, diabetes, chronic respiratory disease, hypertension, and cancer. In low- and middle-income countries such as Kenya, the health protection systems are weaker and laboratory resources meagre, contact tracing efforts are less efficient and public health infrastructure is not well established rendering disease surveillance systems ineffective. A raft of preventive and control measures including quarantine and movement restrictions have been taken by authorities and regulatory bodies to contain the spread of the disease given its serious nature. The government invoked the Public Health Act Cap 242, issued advisories on travel, instituted preventive measures including hand washing or sanitization, social distancing, use of masks, fourteen days self-or mandatory quarantine for high risk persons, closure of educational institutions, embargos on passenger air traffic and restriction of travel into and out of the hot-spot areas or Counties. In the past several months, every effort has been geared towards the resumption of normalcy in educational, religious, social and economic institutions that were closed since March, 2020. This study will seek to evaluate the level of uptake and population behavioral attitudes towards the MoH preventive and control measures as well as to survey the persistence and effectiveness of anti-SARS-CoV-2 humoral immunity in COVID-19 patients over a period of 2 years. Additionally, the study is designed to evaluate the biochemical profiles and clinical characteristics of COVID-19 patients for potential use as prognostic markers in confirmed cases and determine the anti-SARS-CoV-2 activity of selected medicinal plants for potential treatment COVID-19 patients in Kenya as part of home-grown solutions that can inform any future Government's strategies and guidelines. The survey will be a cross-sectional prospective study focusing on demographic characteristics and uptake and attitudes towards the MoH preventive measures among the sampled residents of the counties. The other parts of the study will adopt prospective and experimental study designs with appropriate and referenced techniques being employed. The study will be carried out in five different study sites. The survey on the level of uptake and attitudes towards the MoH COVID-19 infection prevention guidelines will be done in two counties: Mombasa (was considered a hot-spot) and Kisumu (was considered a non-hotspot) counties. The study on humoral immunity will take place at the Centre for Virus Research at the Kenya Medical Research Institute (KEMRI), Nairobi while the biochemical profiling for prediction of course of COVID-19 disease patients will be carried out at Kenyatta National Hospital (KNH) and Kenya Medical Research Institute (KEMRI), Nairobi. Experiments on the activity of selected medicinal plants will be done at Kenyatta University and Kenya Medical Research Institute (KEMRI), Nairobi. To ensure that ethical standards are maintained at every stage of the study, this research proposal will be presented to the ethical review committees at Kenyatta University, KNH and KEMRI for consideration and approval before starting the study. Additionally, approval will also be sought from the National Commission for Science, Technology and Innovation (NACOSTI) and the Mombasa, Kisumu and Nairobi City county authorities. Concerted efforts during recruitment of study participants will be geared towards ensuring that neither gender predominates by more than two thirds and that respect and dignity are accorded to them. Accordingly, there will be gender balance among the research team to ensure gender-sensitive and gender-responsive approach to the components and outcome(s) of the study. Finally, the study findings in form of reports, policy briefs and publications will be disseminated appropriately to the relevant bodies and in the form(s) required by NRF, South Africa Expected Outputs 1. A report on the uptake and attitudes towards the MoH COVID-19 infection prevention measures and recommendations for strengthening the evidence-based strategies on how to improve public health outcomes (Obj. 1). 2. Socio-demographic characteristics of a cross section of Kenyans and COVID-19 patients for enhanced disease surveillance in Kenya (Obj. 1-2). 3. An immunity status and persistence report of the COVID-19 patients and recommendations to relevant authorities to inform resumption of normalcy in Kenya over two year (Obj. 2). 4. A recommendation on the potential use of convalescent sera for management of COVID-19 patients. 5. A report of the biochemical profiles and clinical characteristics of COVID-19 patients as predictors of the course of disease in Kenya (Obj. 3). 6. A report on antiviral activities of selected medicinal plant preparations against SARSCoV-2 for improved case management and health outcomes in COVID-19 patients in Kenya (Obj. 4). 7. Findings and recommendations disseminated in workshops, conferences and published in refereed journals for access and use by relevant authorities and the medical and scientific community globally (Obj. 1-4). 8. Establishing and enhancing multi-disciplinary research with consequent multiinstitution and multinational collaborations (Obj.1-4). 9. Potential for patenting of innovation and/or any intellectual property as an outcome of the study (Obj.2-4).