Title: NIHR CLEAN-Air(Africa) Unit “Clean modern energy for all”. Benefitting health, society, environment and climate in sub-Saharan Africa to achieve the 2030 Sustainable Development Goals.
Funder: Department of Health and Social Care

Abstract: Globally 3.8 billion people rely on polluting fuels (e.g. wood, charcoal, kerosene) for cooking. Household air pollution (HAP) from burning these fuels caused 2.3 million premature deaths in 2019 (more than HIV/AIDS, malaria and tuberculosis). With 695,000 premature deaths and 38 million Disability-Adjusted-Life-Years (DALYs) in 2019, Sub-Saharan Africa (SSA) bears a disproportionate fraction (30%) of the global HAP-related disease burden. The NIHR CLEAN-Air(Africa) Unit will accelerate the understanding of HAP-related disease burden through a unique set of studies that will (i) strengthen national health systems for community health prevention of HAP-related disease and (ii) provide evidence-based recommendations for population transition to clean household and institutional energy._x000D_ _x000D_ The Unit will leverage the expertise of community health workers (CHWs), an overlooked frontline health promotion workforce, via implementation of a national Ministry of Health (MoH) led training of CHWs in HAP, health and prevention. This will include (i) development of curricula/ job aids in Cameroon, Rwanda and Uganda, (ii) creation of a digital platform for CHW training and health surveillance to maximise reach of training and (iii) effective rollout of training in Kenya to 140,000 CHWs. _x000D_ _x000D_ To inform national strategies to achieve UN Sustainable Development Goal (SDG) 7 (ensuring universal access to clean, modern household energy by 2030) and address the associated negative health, gender, and climate impacts of reliance on polluting cooking fuels, the Unit will collaborate with several international organisations (e.g. WHO, World Food Programme) to investigate innovations that have potential for rapid scale in SSA. We will run 5 randomised controlled trials to test technological (pay-as-you-cook LPG smart meters and pressure cookers), nutritional (pre-cooked, vitamin enhanced beans) and behavioural (cooking classes) innovations for addressing barriers to adoption and exclusive use of clean cooking fuel for households (n=620) and schools (3,600 pupils) in East Africa. A focus on institutional cooking in schools is particularly novel, with a high degree of HAP exposure to school cooks and pupils offering high value for money in terms of population-level reductions in polluting fuel use._x000D_ _x000D_ An in-depth mixed-methods evaluation (n=400) will be conducted of a successful social entrepreneur company in Kenya providing LPG access to rural women (20,000 current users) to understand their ability to facilitate microfinance for clean cooking. Through Africa’s first Air Pollution Centre of Excellence at KEMRI, we will use state-of-the-art air monitoring equipment to elucidate relationships between exposure to HAP and respiratory disease (spirometry study; n=500) and cardiovascular health (heart rate variability study using wearable technology; n=100) in Cameroon. The Unit will also quantify hidden burdens related to gender inequity (time poverty from fetching firewood) and burns/ scalds (establishment of clinical/ primary care surveillance). Research activities will begin by Year 2 after Unit launch and start of the capacity building program in Year 1. The Unit’s academic trainee programme will run from Years 1-4. Our dissemination foci on (i) population awareness raising and (ii) rapid knowledge translation of research evidence to policy will be enabled through close engagement with ministerial stakeholders steering national energy strategy.

Lay abstract: Nearly half of the world relies on polluting fuels such as wood and kerosene for cooking. Years of research has uncovered that household air pollution (HAP) from burning these fuels is one of the biggest risk factors for global disease (responsible for >2 million deaths in 2019 – more than all deaths from COVID-19 in 2020). To reduce the dangers of cooking with polluting fuels, the UN created Sustainable Development Goal 7 (SDG 7) that sets a deadline of 2030 for “universal access to clean, modern energy”. Unfortunately, data show that the world is not on track to meet SDG 7, particularly in sub-Saharan Africa (SSA), due to population growth outpacing the rate of households acquiring clean cooking fuels. Increasing use of liquefied petroleum gas (LPG), a clean burning fuel with much lower air pollution emissions than traditional fuels, is the short-term solution promoted by most countries for its rapid scale up potential (see India and Indonesia). _x000D_ _x000D_ The NIHR CLEAN-Air(Africa) Global Health Research Group was launched in 2018 to research benefits of populations in SSA switching to LPG for clean cooking by 2030. In 3 years, CLEAN-Air(Africa) has (i) demonstrated substantial health benefits and mitigation of climate change from transition to LPG, (ii) identified technologies that can spur use of LPG in resource poor populations and (iii) developed a national community health workforce (CHW) training initiative in Kenya that was adopted by the Ministry of Health._x000D_ _x000D_ Building on successful partnerships in Kenya and Cameroon, the CLEAN-Air(Africa) Unit will expand in East Africa by collaborating with experienced researchers from Tanzania, Uganda and Rwanda. The Unit will establish an Air Pollution Centre of Excellence (APCE) at KEMRI in Nairobi, Kenya. The Centre will include state-of-the-art air monitoring equipment and training facilities to enable researchers in Kenya and SSA to conduct their own research. Through the APCE, the Unit will investigate relationships between HAP and chronic respiratory and cardiovascular disease. The Unit will also research understudied issues related to gender inequality and burns/ scalds (by creating a burns surveillance database). The Centre will further coordinate the Unit’s African academic trainee programme, building capacity for the future._x000D_ _x000D_ Working with international organisations (e.g. WHO, World Food Programme), the Unit will investigate the ability of new technologies to promote higher use of LPG in vulnerable communities. These technologies (e.g. pay-as-you-go LPG that enables smaller payments, pre-cooked beans that can be heated faster and cheaper than traditional beans) are already offered by companies in East Africa and have potential for rapid scale. The Unit will enhance the CHW national training program by (i) conducting an evaluation with the Kenyan MoH, (ii) adapting the training to a digital platform to facilitate greater reach and (iii) implementing the training in other SSA countries. The Unit will be directed by an experienced community engagement and involvement (CEI) team comprising African experts in the energy field who will ensure that our communities are positively impacted by the Unit through measurable actions. Finally, the Unit will expand an African health journalism course to foster an effective African media strategy to promote use of clean cooking to secure health and environmental benefits and achieve SDG7.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR;INJURIES AND ACCIDENTS;RESPIRATORY