Lung health in Africa across the life course

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

Abstract

Almost half of the world's population, including 700 million people in Africa, relies on biomass fuels (animal dung, crop residues, wood) for their everyday fuel-energy requirements. These fuels are typically burned in open fires, often indoors, that emit smoke into the household environment and lead to high levels of household air pollution. Women and children, especially young children, experience high exposures to air pollution in the home; this has been linked to a range of adverse health outcomes including non communicable lung diseases like chronic obstructive pulmonary disease (COPD) and lung cancer in adults and asthma in children. It is now recognised that household air pollution from biomass smoke is the third leading cause of global disability and death with 4 million deaths attributed to this exposure annually. This burden, much of which is represented by non-communicable respiratory disease, falls hardest on poor populations around the world and in countries in sub-Saharan Africa in particular.

To build the foundations for work to tackle this issue we have bought together a network of investigators from ten African countries (Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Africa, Sudan, The Gambia and Uganda) underpinned by support from the Pan African Thoracic Society (PATS), American Thoracic Society (ATS) Methods in Epidemiologic, Clinical and Operations Research (MECOR) programme, MRC BREATHE-Africa partnership, Malawi Liverpool Wellcome Trust (MLW), Burden of Obstructive Lung Disease (BOLD) Centre, Spirometry Training Services Africa, Global Asthma Network (GAN), and Collaboration for Applied Health Research and Delivery (CAHRD). This proposal offers an unprecedented opportunity to create a multi-site multi-disciplinary pan-African platform for clinical, epidemiological and applied health research underpinned by regional and international collaborative research and delivery networks that will allow us to conduct research into the causes, prevention and treatment of non-communicable respiratory disease across the life course. By addressing a major cause of morbidity and mortality across the life course of children and adults living in low or middle-income countries in Africa the proposal is fully aligned with the overall principle of Official Development Assistance (ODA) to promote welfare of developing countries.

Within the two years of this foundations-building grant we will work hard to create a thriving partnership whilst delivering on two specific research aims: to 1) develop and share methodology for the measurement of non-communicable respiratory disease exposures and outcomes tailored to the challenges of conducting research in resource-constrained African environments and 2) use this methodology to generate and share high quality preliminary data from multiple African sites.

Technical Summary

Almost half of the world's population, including 700 million people in Africa, relies on biomass fuels (animal dung, crop residues, wood) for their everyday fuel-energy requirements. These fuels are typically burned in open fires, often indoors, that emit smoke into the household environment and lead to high levels of household air pollution. Women and children, especially young children, experience high exposures to air pollution in the home; this has been linked to a range of adverse health outcomes including non communicable respiratory disease (NCD-Respiratory) in children and adults. We propose to create a multi-site multi-disciplinary pan-African platform for clinical, epidemiological and applied health research underpinned by regional and international collaborative research and delivery networks that will allow us to conduct research into the aetiology, prevention and treatment of NCD-Respiratory across the life course. We will create the foundations for internationally competitive North-South and South-South collaborative proposals in the near future by developing and sharing methodology for the measurement of NCD-Respiratory exposures and outcomes tailored to the challenges of conducting research in resource-constrained African environments and using this methodology to generate and share high quality preliminary data. Methodology development will centre around questionnaires, clinical measurements, air pollution exposures and biomarker evaluation.

Planned Impact

Local staff: A number of local people will be employed to work on research and partnership building activities with many other local people involved indirectly. The training and experience gained should lead to improved work opportunities in the future. In addition there will be immediate financial benefits for individuals receiving a salary. Such financial benefits typically extend widely beyond these individuals to families and home villages.
People living in poverty in developing countries: The research and partnership-building activities are specifically focused on improving the health of people living in low and middle income countries though the improvement of lung health in Africa.
Local, national and international policy and decision makers: High quality evidence about how best to improve lung health across the life course in Africa is needed to inform policy and decision makers across commercial, health, development and community sectors at local, national and international levels. The results of the proposed work will be relevant to local policy makers in participating countries who will have new data to guide decisions about prioritising funding for research to improve lung health; to regional commercial, non-governmental (NGO) and governmental organisations in low and middle income countries providing health services; and to international funders, decision and policy makers (e.g. DFID, WHO) by contributing new evidence about how best to improve lung health in these settings that will have broadly generalisable relevance to areas of the world where household and other types of air pollution is high.
Public sector: Research and partnership building activities will be conducted in a way that exploits every opportunity to support local clinical services, research and teaching activities alongside the scientific focus of the work. Teaching and capacity building activities will help build knowledge and skills in applied health research and will have positive impacts on the management of children and adults in need of healthcare in Africa.
Business: The new scientific knowledge generated through this research and the partnership building activities could be exploited by businesses locally and internationally active in healthcare. This could contribute to wealth creation and economic prosperity in individual developing countries in Africa.
Third sector: Many different NGOs are highly active in the delivery of healthcare in the regions where our research partnership activities will concentrate. NGOs providing healthcare in low and middle income countries are expected to benefit in the short term from the foundation and partnership building activities and in the medium to long term from new knowledge about how to best to preserve and improve lung health in Africa.
Other: The outputs and processes of the research and partnership building activities will feed into the public engagement programmes of LSTM and others in the partnership. This will contribute to increasing public awareness and understanding of the scientific, economic and societal issues covered by this work.

Publications

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Lawin H (2018) Health Risks Associated with Occupational Exposure to Ambient Air Pollution in Commercial Drivers: A Systematic Review. in International journal of environmental research and public health

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Morton B (2018) The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis. in International journal of environmental research and public health

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Ozoh OB (2018) Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG). in International journal of environmental research and public health

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Saleh S (2018) Questionnaires for Lung Health in Africa across the Life Course. in International journal of environmental research and public health

 
Description MRC GCRF
Amount £218,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 06/2017 
End 12/2018
 
Description MRC NPIF Skills Development Fellowship
Amount £286,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 11/2017 
End 11/2020
 
Description MRC NPIF Studentships
Amount £260,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 09/2017 
End 08/2021
 
Description MRC Skills Development Fellowship Programme
Amount £600,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 04/2018 
End 04/2021
 
Description NIHR Global Health Research Group
Amount £2,000,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 06/2018 
End 04/2021
 
Description NIHR Global Health Research Unit
Amount £7,000,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 06/2017 
End 03/2021
 
Description Newton Advanced Fellowship: Biostatistical Methods for Bayesian Analysis of Multilevel Models of Lung Health in Africa.
Amount £92,600 (GBP)
Funding ID NAF\R2\180681 
Organisation Academy of Medical Sciences (AMS) 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2018 
End 12/2021
 
Description Non-communicable lung disease in Kenya: from burden and early life determinants to participatory inter-disciplinary solutions
Amount £561,855 (GBP)
Funding ID MR/S009027/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 01/2019 
End 01/2022
 
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 International Multi-disciplinary Partnership to Address Lung Health and TB in Africa - IMPALA 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution I led the writing of the grant to the NIHR to establish this Global Health Research Unit as part of a wider LSTM team and international Africa-focused partnership.
Collaborator Contribution International respiratory societies, organisations and health policy research consortia, with strong representation from LMICs, contributed to the development of the partnership. They were involved in prioritising research topics and themes and provide strategic guidance for the Unit: The INTERNATIONAL UNION AGAINST TB AND LUNG DISEASE (The Union) is dedicated to the prevention and control of TB and lung disease in LMICs. The Union brings participation in the NCD Alliance, Forum of International Respiratory Societies (FIRS) and Global Alliance Against Chronic Respiratory Disease. VITAL STRATEGIES is affiliated with The Union and will collaborate on public health systems improvement and research translation for communication and policy. The AMERICAN THORACIC SOCIETY (ATS) brings a strong established platform for international advocacy and the MECOR research capacity building programme. The GLOBAL ASTHMA NETWORK (GAN) aims to improve asthma care globally, with a focus on LMICs, through surveillance, research collaboration, capacity building and access to quality-assured essential medicines. GAN brings expertise, experience and standardised, tested methods for conducting asthma epidemiological studies in children and adults on scale. The BURDEN OF OBSTRUCTIVE LUNG DISEASE (BOLD) initiative collects country-specific data on the prevalence, risk factors and social and economic burden of chronic obstructive pulmonary disease (COPD). It brings standardised, tested methods for conducting COPD surveys on scale in the general population. The PAN AFRICAN THORACIC SOCIETY (PATS) is a respiratory society for the continent. Through its wide membership across Africa, communication networks and membership of FIRS, PATS brings networking and communication links within Africa and between international respiratory societies. SPIROMETRY TRAINING SERVICES AFRICA provides training and mentoring in child and adult spirometry. AFRICAN INSTITUTE FOR DEVELOPMENT POLICY (AFIDEP) is an African-led policy think tank. AFIDEP will help deliver on our impact activities. RESEARCH IN GENDER AND ETHICS (RiNGS) is an initiative linking researchers across 3 DfID funded health systems research consortia, which aims to galvanise research on gender and ethics analysis in health systems. The REACHOUT programme is helping to understand and develop the role of close-to-community providers of health care in preventing, diagnosing, and treating major illnesses and health conditions in rural and urban areas in Africa and Asia. The REBUILD consortium brings together a range of partners in Africa and Asia, to explore different approaches to health system development in countries that have been affected by political and social conflict focused on human resources and financing. ROYAL SOCIETY and AFRICAN ACADEMY OF SCIENCE bring multi-national collaborations for institutional research capacity strengthening.
Impact We have an extensive report on outputs and outcomes relating to this partnership which we can share on request. In summary: Conference abstract or presentation: 29 Conference poster: 6 Feature Article: 1 Further funding: 15 Guidelines / Standard Operating Procedures:1 Journal article / paper: 3 Media: 13 Other: 2 Presentation: 6 Project newsletter (self-generated): 2 Questionnaire: 1 Social media: 2 Training and training materials: 5
Start Year 2017
 
Description 49th Union 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 Invited talk at the 49th Union World Conference on Lung Health in The Hague, The Netherlands. The talk was on non-communicable lung disease in LMICs and where post TB lung disease fits. Following this talk there was discussion and a proposal to establish a post TB lung disease Working Group within the Adult and Child Lung Health Section of The Union. This Working Group is now in the process of being constituted and plans for a Workshop on post TB lung disease are being made for 2019.
Year(s) Of Engagement Activity 2018
 
Description Action for Interdisciplinary air pollution Research workshop 
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 Engagement with community of Mukuru informal settlement in Nairobi, Kenya to explore research priorities relating to air pollution from the community perspective and to start developing collaborative inter-disciplinary research project ideas.
Year(s) Of Engagement Activity 2018
 
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 Cambridge University Visit 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Seminar delivered at Cambridge University Hospitals' Respiratory Research event about household air pollution and lung disease in Africa. Questions and discussion followed. Opportunities for future clinical and academic collaboration explored.
Year(s) Of Engagement Activity 2017
 
Description Citizen News Service Webinar for World Asthma Day 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Approx. 50 media-linked participants linked in to this webinar.
Year(s) Of Engagement Activity 2017
URL http://www.citizen-news.org/2017/04/webinar-world-asthma-day-2017-manage.html
 
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 MRC Unit The Gambia talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk to academic audience at the MRC Unit in The Gambia about the Cooking And Pneumonia Study which led to questions and discussion about opportunities for future collaboration.
Year(s) Of Engagement Activity 2017
 
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 Symposium at Makerere University, Uganda 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited seminar at the 1st International non-communicable disease symposium hosted by Makerere University, Uganda.
Year(s) Of Engagement Activity 2018
 
Description Warwick University Visit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Talk to Doctoral students at Warwick University Medical School about 'life post PhD' which led to questions and discussion.
Year(s) Of Engagement Activity 2017