Lung health in Africa across the life course

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.

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.

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.