NIHR Global Health Research Unit on Prevention of air pollution health impacts through clean energy transition in Africa: CLEAN-Air (Africa) 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. To reduce the dangers of reliance on these fuels, the UN established Sustainable Development Goal 7 (SDG7) has set a deadline of 2030 for “universal access to clean, modern energy”. Unfortunately, data show that the world is not on track to meet SDG7, particularly in Sub-Saharan Africa. Increasing use of liquefied petroleum gas (LPG), a clean burning fuel with much lower air pollution than traditional fuels and wide availability, is the best short to medium term solution promoted by most countries for its rapid scale-up potential.

The NIHR CLEAN-Air(Africa) Global Health Research Unit aims to inform national strategies to help achieve SDG7 through scaled adoption of LPG for clean cooking in Kenya, Uganda, Rwanda, Tanzania and Cameroon to address the negative health, gender, environment and climate impacts from reliance on polluting cooking fuels.  The Unit is a partnership of leading academic, research, health and public institutions in the UK and SSA and has an ambitious 5-year program of implementation research, capacity building and health systems strengthening across its five focus countries 1. The Unit will establish the first Air Pollution Centre of Excellence in SSA to be located at the Kenya Medical Research Institute (KEMRI) in Nairobi. The Centre will include state-of-the-art air monitoring equipment and measuring capabilities becoming a training hub from East Africa. It will support research to elucidate relationships between exposure to HAP, acute health symptoms and respiratory disease and cardiovascular health, while also supporting the Kenyan Government in setting new air quality standards.

2. The Unit will initiate a program of HAP related disease prevention (including promotion of clean household energy) leveraging expertise of community health workers (CHWs) as front-line workers in health promotion through implementation of standardised national Ministry of Health (MoH) led training of CHWs in HAP, health and prevention. This will include (i) provision of curricula/ job aids in Cameroon, Rwanda and Uganda with piloting of training, (ii) creation of a digital platform for CHW training and health surveillance to maximise reach of training and (iii) monitoring and evaluation of rollout of the training in Kenya to 140,000 CHWs, initiated as part of the CLEAN-Air(Africa) Global Health Research Group.

3. To inform national policies relevant to SDG7 the Unit will collaborate with several international organisations (e.g. WHO, World Food Programme) to investigate innovations that have potential to facilitate rapid scale of LPG for clean cooking in SSA. This will comprise five 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 and schools in East Africa (Kenya, Tanzania and Rwanda). The focus on schools is novel and important with widespread reliance on wood and charcoal for cooking school meals leading to a high degree of HAP exposure for school cooks and pupils. In addition an in depth mixed-methods evaluation will be conducted of a successful social entrepreneur company in Kenya providing LPG access to rural women (over 20,000 current users) to understand their ability to facilitate microfinance for clean cooking.

4. The Unit will also seek to describe hidden burdens from reliance on polluting solid fuels and kerosene for household energy including gender inequity (time poverty from fetching firewood and ill health/ lost time from cooking with these fuels through survey based research in Kenya, Rwanda and Tanzania) and the occurrence of fuel related burns/ scalds (establishment of surveillance systems at specialist hospitals and in the community in Cameroon and Uganda).