Biomass Reduction and Environmental Air Towards Health Effects in Africa - BREATHE partnership

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Clinical Sciences

Abstract

Biomass fuel smoke exposure presents a direct threat to health affecting more than a billion people world- wide. Further, biomass fuel use is ecologically destructive and an indirect threat to all by the effect on climate change. This Partnership of international experts, African investigators and other stakeholders will initiate and manage shared projects that make the best use of field sites and teams provided by £8m of recent grant investment directed at reducing the health effects of household air pollution.

Background

Half the world's population including 700 million people in Africa use biomass fuel (animal or plant material) to provide energy for cooking, heating and lighting. People (mainly women) using biomass fuel and young children - particularly babies carried on the backs of their mothers while cooking - experience substantial smoke exposure, due to both partial combustion of fuel and poor ventilation methods. This household air pollution (HAP) is an established threat to health in several ways including adverse pregnancy and neonatal outcomes, acute lower respiratory tract infections (WHO estimates 870,000 deaths among the under 5s in 2004), chronic obstructive pulmonary disease and lung cancer.

There are three current intervention trials designed to test the health impact of improved household air quality - two in Africa and one in Nepal. All of these investigators are involved in this Partnership. It is of critical importance to maximise the opportunities presented by these trials, both for measured health impact in all ages, capacity development in health related research and policy change in most affected countries.

The Global Alliance for Clean Cookstoves (www.cleancookstoves.org) formed in 2010 and is committed to " foster the adoption of clean cook stoves and fuels in 100 million households by 2020" in order to "save lives, improve livelihoods, empower women, and combat climate change". The GACC, together with WHO (which is is a fonding partner of GACC), have identified the need for a Partnership between studies and support this application, with WHO also actively contributing to the partnership. We will fill important knowledge gaps and offer research capacity building opportunities to African researchers within the Partnership by linking with a highly successful research capacity initiative that has been running in Africa for 6 years (Pan African Thoracic Society Methods in Clinical Epidemiologic and Operations Research).

Objectives of the Partnership

1. Draw together experts and investigators in major indoor air pollution trials in order to share current findings, plans and data.
2. Harmonise trial design to ensure that exposure monitoring and health effect evaluation are comparable among active trials and that new studies benefit from past experience.
3. Ensure intervention fuels/technologies used for trials (and subsequent scaling-up) meet household needs and deliver substantially reduced exposure levels.
4. Optimise the opportunity to discover measures of smoke exposure that can be used to show exposure reduction in human subjects, using resource made accessible by current trials but not yet funded by those studies.
5. Engage African trainees in new studies by a bottom-up approach offering mentored research training and new projects in the context of large, regionally relevant research projects.
6. Ensure that these objectives are achieved with active management including an Annual Meeting for a week and interim theme work such as trainee projects and trial site collaborations.

The BREATHE Partnership conference will include thematic sessions where data are presented but also
a) Workshops to harmonise case definitions, intervention implementation, sample and data collection and other aspects of household air pollution intervention trial practice that will benefit from collegiate working and
b) Working Groups to plan future activity.

Technical Summary

The BREATHE Africa Partnership will bring together experts in indoor air pollution in order to achieve maximum benefit from several large currently funded interventions in Africa by sharing data and plans and by learning from the study teams of previous studies which reduced indoor smoke exposure elsewhere. We will initiate, develop, link and manage themed projects which share major well-resourced study sites and research teams focused on improving health by reducing biomass fuel smoke exposure.

We have identified knowledge gaps and translational opportunities in this field themed as (1) Exposure and Biomarkers, (2) Health Effects, (3) Mechanisms and (4) Interventions. Each Theme has an expert Lead, a team of Partners with PhD students and opportunity to engage more research trainees at an Annual Meeting including a substantial Research Capacity Development cross-cutting programme. The specific objectives, which are common to each Theme, are to (a) harmonise trial design to ensure that exposure monitoring and health effect evaluation are comparable among active trials and that new studies benefit from past experience, (b) undertake mechanistic work, including testing of new biomarkers, using resource made accessible by current trials but not yet funded by those studies, (c) engage African trainees in new studies by a bottom-up approach offering mentored research training and new projects in the context of large, regionally relevant research projects. The BREATHE Africa Partnership is a platform to allow new, collaborative grants to be submitted by international teams with close engagement at important African field sites.

The Partnership includes members from the African trials, previous trials published outside of the region, the Global Alliance for Clean Cookstoves and experts from the World Health Organisation, American Thoracic Society and Pan African Thoracic Society. It is set to be a "game changer" in the field of household air pollution.

Planned Impact

The BREATHE Partnership is committed to improving health and reducing poverty in sub Saharan Africa. The Partnership objectives will deliver new high quality evidence regarding health, societal and economic effects seen when households adopt advanced cook stove technologies. Direct impacts beyond the scientific themes and research capacity development (both covered in Academic Beneficiaries) will occur (a) in the locale of the studies, ( b) in the sub Saharan Africa region and (c) internationally:

IMPACT IN THE LOCALE OF THE STUDIES

In the locale of the studies, we will achieve economic, societal and environmental impact by engagement with research participants and staff.

Economic Impact
The Partnership studies will engage very impoverished households. Participating households' benefits include efficient-burning cook stoves, less time spent gathering wood and carbon credits for trial villages.

Societal Impact
Cook stove studies will be high profile in participant communities. Discussion around pollution, burns risk , long-term health and diet offer benefit beyond the direct health effects of cooking smoke.

Environmental Impact
The studies will directly reduce the amount of wood burned and will therefore immediately reduce environmental destruction.

Local staff: Local people employed on the projects will gain training and experience relevant to future employment, particularly in the NGO sector.

SUB SAHARAN AFRICA REGIONAL IMPACT

At regional level we will achieve health policy and commercial impact during the life of the grant by planned engagement with the public sector including Ministries of Health, with business and industry, with NGO partners and with Higher Educational Institutions including universities and medical schools.

Public Sector
We have engaged through the MECOR programme with regional conferences including the Kenya Lung Conference. This gives professional, government and NGO engagement with household air pollution. Further, we have Ministry of Health representation from Malawi, Kenya and Ghana in our Partnership, with other countries including Nigeria represented in the GACC.

Business/Industry
Some stove production has already been sponsored in the sub Saharan Africa region (Phillips, sponsoring production of a factory in Lesotho for the Malawi study) in anticipation of a sustainable production and sales pipeline.

Third Sector
NGOs implementing cook stove programmes require exposure-response in order to choose stoves that will have health effects by biomass smoke reduction. These data are not available but will be generated by the Partnership. We have worked with Concern Universal in published pilot studies to develop the Malawi CAPS study.

Higher Educational Institutions (HEI)
MECOR trainees will become the academic leaders of their parent HEIs as seen in the 14 year experience of MECOR-style training in Latin America. Our Partner, the American Thoracic Society, has seen international impact from the Latin America programme and will engage with our trainees in career development.

IMPACT ON INTERNATIONAL POLICY

At international level, we will inform international policy through WHO links with national governments and the Health Working Group of the Global Alliance for Clean Cookstoves.

WHO Indoor Air Quality Standards Panel
Bruce (Interventions Theme Lead) is the Chair of this advisory panel and will ensure that our data impact on future revisions of the standards.

Global Alliance for Clean Cookstoves
The GACC Health Working Group has been charged by the GACC with advising Wellcome Trust, Gates, MRC, DFID, NIH and other major donors on important changes in the field. The co-chairs of this Health Working Group have advised this Partnership proposal.

Carbon Finance Initiatives
Carbon credits offer a sustainable method of delivery for future cook stove initiatives and we have established partnerships to develop this benefit.

Publications

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Gordon S (2017) In control of ambient and household air pollution - how low should we go? in The Lancet. Respiratory medicine

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Gordon SB (2014) Respiratory risks from household air pollution in low and middle income countries. in The Lancet. Respiratory medicine

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Grigg J (2018) Air Pollution and Respiratory Infection: An Emerging and Troubling Association. in American journal of respiratory and critical care medicine

 
Title CAPS results dissemination film 
Description This film was developed to disseminate the results of CAPS (and another study) with a target audience of CAPS study participants. 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact This film was shown in CAPS communities to large groups as part of a science communication programme. Small groups also watched the film on a tablet in their own time. This was an innovative way of disseminating trial results and is a resource that can also be used in shortened form in presentations and workshops. 
URL https://vimeo.com/243190429
 
Title Cooking and Pneumonia Study: Information film 
Description The video outlines the two-year study that will track around 10,000 children aged under five years who live in randomised villages in Chikhwawa and Chilumba in Malawi. The homes of the children involved in the study are randomly selected to be supplied with two clean cookstoves or to continue cooking on open fires in the traditional way. The aim is to see if the new stoves, which can reduce emissions by up to 90%, will stop the children getting pneumonia, a major cause of death in this age group. 
Type Of Art Film/Video/Animation 
Year Produced 2014 
Impact TBC 
URL http://www.capstudy.org
 
Title Lancet Highlights 2016: Moving pictures 
Description Image published in Lancet with associated text 
Type Of Art Image 
Year Produced 2017 
Impact The image was published in the Lancet which reaches a wide audience of experts via the paper publication and a wider audience via open access on-line. The text associated with the image sets the context, drawing attention to the gendered dimension of the health risks associated with exposure to pollution from burning biomass fuels for cooking. 
URL http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32532-6/fulltext
 
Title PATS MECOR film 
Description A film about the BREATHE initiative, PATS MECOR was made at the 2016 Annual Scientific Meeting of which PATS MECOR 2016 was a part. The video describes the programme and attendees explain why they attend and what the programme means to them. The film is approximately 6 minutes long. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact The video is available on the BREATHE website as part of the publicity for the 2017 and 2018 courses. It is also available via the LSTM website and the link below is to the LSTM YouTube site. A link to the film has been used in a support letter for a grant opportunity applied for by one of the BREATHE partners in the US. In addition, an extract from the film was used in a presentation at an interview (21st of February) of the BREATHE team and partners for a proposal submitted for the RCUK Global Research Capacity grant scheme. It is planned to present the video at the LSTM staff forum during March 2017. 
URL https://www.youtube.com/watch?v=ZQrjtPZiyEs
 
Title Photovoice CAPS film 
Description As part of a pilot study of Photovoice methodology carried out in rural Chikhwawa as part of CAPS a film of the participants was produced. This pilot study was funded by the Wellcome Trust, through an Engaging Science Grant,'The Cooking and Pneumonia Study: a focus on food' (reference, 106977/Z/15/Z). The film shows the 6 participants discussing images they have taken about food and drink. 
Type Of Art Film/Video/Animation 
Year Produced 2015 
Impact This film has been shown to the pilot study participants and the CAPS fieldworkers as part of dissemination of the results of the pilot study. This activity is also an important part of sensitising both fieldworkers and study participants to a qualitative study nested within CAPS. The film forms an important part of a publication of this pilot study and has been used in several conference presentations. This has resulted in considerable interest in the use of this methodology both within cookstove adoption studies and other fields and the development of collaborative relationships. 
URL https://vimeo.com/153926407
 
Description Wellcome Trust Clinical PhD scheme
Amount £455,000 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2018 
End 09/2021
 
Description BREATHE are a member of the Planetary Health Alliance (PHA) 
Organisation Planetary Health Alliance
PI Contribution Information about this important initiative has been shared with BREATHE contacts. More collaboration will follow as PHA activities are developed
Collaborator Contribution This membership opens up opportunities for BREATHE partners that are still being developed by PHA.
Impact No outcomes as yet
Start Year 2017
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation American Thoracic Society
Country United States 
Sector Learned Society 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Center of Medical Research Lambaréné
Country Gabon 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Cooking and Pneumonia Study
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation European Respiratory Society (ERS)
Country European Union (EU) 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Ghana Randomized Air Pollution and Health Study
Country Ghana 
Sector Public 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Global Alliance for Clean Cookstoves (GACC)
Country United States 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Kenyan Institute for Medical Research (KEMRI)
Country Kenya 
Sector Public 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation National Institute for Medical Research, Tanzania
Country Tanzania, United Republic of 
Sector Public 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Pan African Thoracic Society (PATS)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Queen Mary University of London
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Research for Equity and Community Health (REACH) Trust
Country Malawi 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation Spirometry Training Services Africa
Country South Africa 
Sector Private 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation University of Aberdeen
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation University of Leuven
Country Belgium 
Sector Academic/University 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation University of Liverpool
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description Biomass Reduction and Environmental Air Towards Health Effects in Africa (BREATHE -Africa) 
Organisation World Lung Foundation
Country United States 
Sector Charity/Non Profit 
PI Contribution We lead the MRC Partnership grant, chair the meetings and organise the themes.
Collaborator Contribution •Draw together experts and investigators in major air pollution trials in order to share findings and plans •Harmonise specific aspects of trial methodology to ensure that exposure monitoring and health effect evaluation are comparable among active trials and those in development, as well as other research and evaluation with similar exposure and outcome assessment needs. •Optimise the opportunity to undertake mechanistic work, including testing of new biomarkers, not funded by current trials •Engage African researchers and trainees in existing and new studies by a bottom-up approach offering mentored research training and projects.
Impact The publication of a Commissioned Review for The Lancet Respiratory Medicine journal has been an early success for the Partnership. This is wide-ranging review of 'Respiratory risks from household air pollution in low and middle income countries' is available on the Lancet website. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70168-7/fulltext. CAHRD meeting [Centre for Applied Health Research & Delivery]
Start Year 2014
 
Description MECOR research training programme 
Organisation American Thoracic Society
Country United States 
Sector Learned Society 
PI Contribution BREATHE collaborates with ATS through the PATS MECOR research training programme which is based on the MECOR model initiated by ATS
Collaborator Contribution ATS provides no cost faculty members for PATS MECOR
Impact Through this collaboration, PATS MECOR attendees are exposed to expert teaching and guidance and many have received travel scholarships to the ATS annual conference and/or received grant funding
Start Year 2014
 
Description 47th World Conference on Lung Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Scientific presentation on the challenges of implementing new models of care in low- and middle- income countries which generated discussion .
Year(s) Of Engagement Activity 2016
 
Description African Utility Week 2016 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Presentation about the potential for clean energy solutions to improve health and save lives in Africa which was followed by questions and discussion and potential areas for future collaborative work.
Year(s) Of Engagement Activity 2016
 
Description American Thoracic Society Conference 2015 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Participation in American Thoracic Society Task Force Workshop and preparation of a report about the adverse health effects of household air pollution.
Year(s) Of Engagement Activity 2015
 
Description BBC News coverage of Cooking And Pneumonia Study programme of work 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Coverage of the story of the Cooking And Pneumonia Study (CAPS) by BBC News Science Reporter Victoria Gill who visited the study location in Malawi and prepared reports that were shown widely on BBC News outlets. This generated considerable global interest in the study and the topic of household air pollution and the adverse health effects associated with this.
Year(s) Of Engagement Activity 2014
URL http://www.bbc.co.uk/news/health-30448559
 
Description BREATHE Interventions PhD research part of Photovoice exhibition at Health Systems Research Conference 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact At the Fifth Global Symposium on Health Systems Research (HSR2018), the Local Organizing Committee introduced a multi-project Photovoice exhibition, inviting delegates to submit their Photovoice images for ongoing or completed projects that were in line with the Symposium sub-themes. The Photovoice exhibition at HSR2018 created a platform for critical dialogue and learning throughout the symposium.
The physical exhibition was displayed at the conference venue and accessible to all delegates and is now also available on the HSR2018 website for general viewing (see URL).
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/photovoice/
 
Description BREATHE Programme Manager attended Wellcome Trust Public Engagement Workshop for 'The Crunch' 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact BREATHE Programme Manager Jane Ardrey has partipated in the Wellcome Trust Public Engagement Iniatiave 'The Crunch' (previously known as Food and Drink PE initiative) since early 2015. This was a workshop attended by Ambassadors for 'The Crunch' - a mix of interested members of the public, researchers and representatives of 3rd sector organisations. Jane is signed up as an Ambassador and was given the opportunity to present an informal presentation about household air pollution, the Cooking and Pneumonia Study (CAPS) and BREATHE, with reference to a poster used at the event about CAPS. The poster will be displayed at all ambassador events nationally. At this event there was a lively discussion about cookstoves and the wider issue of HAP in Africa.
Year(s) Of Engagement Activity 2016
URL https://thecrunch.wellcome.ac.uk/explore
 
Description BREATHE Theme Leads and other partners participate in PATS MECOR 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Combining BREATHE annual meetings with the PATS MECOR research programme allows for networking with and participation of the PATS MECOR group. This includes trainees who attend over 3 years, African and international faculty members. As well as specific BREATHE theme meetings which are open to all, BREATHE members also participate as faculty members, make presentations and meet with local contacts. In 2016 the programme was held in Malawi and there was also a field visit to a rural research site.
Year(s) Of Engagement Activity 2015,2016
URL http://www.breatheafrica.org/newsletter/
 
Description BREATHE community event held in Chikhwawa Malawi 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A community event was held in Gumba Full Primary School at Kavalo Village in Chikhwawa, Malawi. This was attended by school children, their parents and community members. This was facilitated by BREATHE with assistance from Lindsay Zurba (Spirometry Training Services Africa) and the Malawi-Liverpool-Wellcome Science Communications Team as part of the European Respiratory Society initiative 'Health Lungs for Life' initiative. The aim of the event was to explain in simple terms how the lungs work and what can be done to maintain good lung health. There was a great deal of community interest in the event which was also attended by local media representatives. An article was published in the Malawi Nation on the 2nd of August 2016 containing a quote from the Village Head 'The district hospital is about 100 kilometres from here. Some of us would die on the way to the hospital. So, this initiative has helped us to know how to prevent certain diseases'.
Year(s) Of Engagement Activity 2016
URL http://www.mlw.medcol.mw/index.php/media-centre/media-centre/601-malawi-liverpool-wellcome-trust-bre...
 
Description BREATHE theme leaders visit Malawi CAPS sites 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact We planned exposure monitoring for 10000 children, and wrote 2 new grants.

New grants including MRC NIRG and NIH RO1
Year(s) Of Engagement Activity 2013
URL http://www.capstudy.org/
 
Description BREATHE theme leaders visit Malawi CAPS sites 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact We planned exposure monitoring for 10000 children, and wrote 2 new grants.

New grants including MRC NIRG and NIH RO1
Year(s) Of Engagement Activity 2013
URL http://www.capstudy.org/
 
Description BREATHE website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A website was set up to: communicate the aims of BREATHE; provide a forum for BREATHE related news; improve access to PATS MECOR application forms and details. The QR code for the website has been added to team business cards and PATS MECOR t-shirts expanding the reach of the BREATHE Partnership. The contact link on the webpage allows interested researchers and members of the public to easily contact the BREATHE Programme Manager
Year(s) Of Engagement Activity 2015,2016,2017
URL http://www.breatheafrica.org/
 
Description Blog about Photovoice exhibition at HSR2018 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A blog about a Photovoice exhibition at the HSR2018 conference and associated activities was created to encourage critical reflection of the methodology and the use of images in exhibitions. It was highlighted on a Health Systems Global update email and is freely available on the HSR2018 website.
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/news/exploring-power-and-privilege-through-photovoice/
 
Description CAPS results dissemination using film in study community 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact A film about the Cooking and Pneumonia Study (CAPS) was shown in participant villages in the 2 study sites, Chikhwawa in the South and Chilmba in the North.
In Chikhwawa, a total of 3680 people were reached through the film in 5 days that the film was shown. The people came from about 15 villages. There were 2020 males and 1660 females.
In Chilumba, the film was shown in all study districts and on average the gathering was of 90 people ranging from 60 to 150 people.
In both study sites, an interactive programme was designed to check that the film was understood and to allow questions to be asked about the results.

Film can be accessed here: https://vimeo.com/243190429
Year(s) Of Engagement Activity 2018
URL https://www.lstmed.ac.uk/news-events/news/novel-use-of-film-to-disseminate-cooking-and-pneumonia-stu...
 
Description COPD conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited talk as Long Investigator at the COPD11 conference on 'learning from global studies'. Following this I was invited to participate in a Global Initiative for Chronic Obstructive Lung Disease (GOLD) meeting on how to make the international GOLD guidelines more relevant to LMIC populations. An output from this meeting was the drafting of a position statement.
Year(s) Of Engagement Activity 2018
 
Description Community activities in conjunction with the IUATLD Conference 2016 in Liverpool 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact As part of Community Commons activity at the 47th Union International Conference of Lung Health held in Liverpool, activities related to air pollution and cookstoves were held immediately outside the conference entrance and inside in the community area.

The display was organised in conjunction with firefighters from Operation Florian and young adults from a local college. There were sessions at various times showing the immediate risks from fire and how these can be mitigated and the longer term risks to lung health from cooking using biomass.

Young people from the local college build replica African houses and also carried out other in-school activities. In addition Florian, the college and Kevin Mortimer (CAPS Co-PI and BREATHE Health Effects theme lead) participated in a joint presentation session inside the conference arena.
Year(s) Of Engagement Activity 2016
URL http://liverpool.worldlunghealth.org/updates/the-union-world-conference-opens-with-fiery-display-of-...
 
Description Conference (The Union 2016) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Raising awareness about the global health problem of household air pollution to a wide range of audiences through engagement with community activities of the 2016 World Lung Health Conference.
Year(s) Of Engagement Activity 2016
URL http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(16)30413-1/abstract?cc=y=
 
Description Ethiopian Thoracic Society Conference 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited talk on the effects of air pollution on lung health at the 2nd annual meeting of the Ethiopian Thoracic Society which generated interest in the topic and discussion of potential future research and collaboration in this area.
Year(s) Of Engagement Activity 2016
 
Description Exhibition of Photovoice images held in CAPS villages 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact As part of the dissemination of CAPS results using film, a Photovoice exhibition of images collected by participants in the Interventions Theme PhD research study was held in CAPS villages. The 10 participants from each of the 5 villages in the Photovoice study were asked to select 10 of their photographs for exhibition. Representatives from each village then attended the filmshow/Photovoice exhibition to explain the story behind each of the chosen images. This resulted in lively discussions, the expertise of the photographers was recognised, and attendees of the exhibition enjoyed seeing their community represented.
Year(s) Of Engagement Activity 2018
URL http://www.breatheafrica.org/news-breathe/2018/5/31/breathe-interventions-phd-caps-photovoice-exhibi...
 
Description Global Health Film Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Contributed to the development and implementation of a Workshop at the Global Health Film Festival: "Research in Focus - the role of video film in global health research". Discussion followed and interest was expressed in further Workshops being held at the Festival in the future.
Year(s) Of Engagement Activity 2018
 
Description Ministerial Visit re BREATHE. Lynne Featherstone briefing on HouseHold Air pollution 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact It was a round table discussion with members of LSTM, the University of Liverpool and DFID Minister Lynne Featherstone visits LSTM The Rt Hon Lynne Featherstone MP, Minister for International Development, visited LSTM to receive a briefing on the impacts of household air pollution on the health of women and children in developing countries. The visit was in preparation of the upcoming Cookstove Future Summit 20th and 21st November in New York. Together with former US Secretary of State Hilary Clinton and the Norwegian and Ghanaian foreign ministers, the Minister will co-chair the summit aiming to spur investment in clean cooking.

It is hoped that the visit will enable the Minister to co-chair a successful summit enabling the host, the Global Alliance for Clean Cookstoves to reach its goal of 100 million households adopting clean and efficient cookstove and fuels by 2020 guided by the evidence from the known and upcoming results of the various trials.
Year(s) Of Engagement Activity 2014
URL http://cookstovesfuturesummit.org/
 
Description PATS MECOR Facebook 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The PATS MECOR Facebook page expands the reach of BREATHE through the 'friends' of PATS MECOR attendees. News about grant or other opportunities relevant to the PATS MECOR group can easily be disseminated.

The page is also used to facilitate informal networking meetings, for example at the annual American Thoracic Society conference
Year(s) Of Engagement Activity 2015,2016,2017
URL https://www.facebook.com/pats.mecor
 
Description Presentations at meetings in Nepal 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Invited talks in Nepal - at Patan Hospital and the Institute of Medicine - on "Household air pollution and the improved cookstove: a story of smoke and mirrors?" These talks led to discussion and meetings particularly focused on opportunities to collaborate in the future
Year(s) Of Engagement Activity 2018
 
Description Regular BREATHE newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A regular newsletter (sent out approximately every 3 months) is used to communicate with BREATHE partners - this encourages networking and interaction outside the annual meeting.
Year(s) Of Engagement Activity 2016,2017
URL http://www.breatheafrica.org/newsletter-1/
 
Description School Visit (Liverpool) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Involved Liverpool Life Sciences UTC students in discussing Malawi-based work and preparing for community participation in The World Lung Health Conference in Liverpool 2016
Year(s) Of Engagement Activity 2016
 
Description Smart Villages Webinar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Participation as panelist in seminar: Healthy villages are smart villages: Health, energy, and development which generated questions and discussion and potentially influenced future decision making.
Year(s) Of Engagement Activity 2017
 
Description TV appearance BBC World news Jonathan Grigg from Doctors Against Diesel - Air Pollution 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Professor Grigg has made several appearances on news television programmes - most recently on the 17th of February (no URL available) when he spoke specifically about indoor generated particulate matter (from cooking). These activities raise awareness of the health impacts of air pollution in the UK and internationally to a wide audience.
Year(s) Of Engagement Activity 2018
URL https://www.youtube.com/watch?v=QHthL8t1__4
 
Description The BREATHE PI, Programme Manager and Theme Leads all participated in the inaugural meeting of the Global Health Research Unit in applied research on lung health and tuberculosis 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The BREATHE PI, Programme Manager and theme leads will contribute to this newly funded initiative - the NIHR funded Global Health Research Unit in applied research on lung health and tuberculosis (IMPALA) in various ways, either as Co-Is, partners or affiliated persons. At this meeting, all attendees were given the opportunity to share their background and objectives and worked together to plan how this inter-disciplinary unit will fulfil research and capacity building objectives over the next 4 years. More detail about IMPALA is here: http://www.lstmed.ac.uk/impala
Year(s) Of Engagement Activity 2017
URL http://www.lstmed.ac.uk/news-events/news/lstm-awarded-%C2%A311-million-by-national-institute-for-hea...