Research
Burden of Disease from Household Air Pollution (HAP)
Understanding the causal relationship and associated disease burden from household air pollution and adult and child health. Our work has previously contributed systematic review and meta-analyses (SRMA) evidence from HAP on child acute lower respiratory illness, child mortality, adverse pregnancy outcomes, and lung cancer used in comparative risk assessment for burden of disease estimation. We continue to explore how HAP exposure from combustion of solid fuels and kerosene is related to chronic respiratory and cardiovascular disease and how prevention through clean cooking impacts on these outcomes. We are also investigating less well articulated burdens from reliance on these fuels including fuel/ technology related burns and poisoning through ingestion of kerosene.
Prevention of household air pollution through transition clean cooking
We have studied prevention strategies both through interventions to burn biomass/ solid fuels cleaner (so called 'improved cookstoves') and through transition to clean domestic fuels such as gas and electricity. Research on improved cookstoves in Guatemala, Nepal, Kenya and Malawi found disappointing results in terms of reduced HAP exposure and reductions in health outcomes (e.g. child pneumonia). SRMA evidence reinforced this message identifying that few interventions designed to burn biomass more cleanly reduced levels of HAP exposure (PM2.5 and CO) to safe levels for health. This empirical primary and secondary research formulated the focus for our research group in its focus on primary prevention through scale of clean fuels and energy.
We are also tackling primary and secondary prevention of HAP disease burden through health systems strengthening via our CLEAN-Air(Africa) program:
1.Through training community health workers (CHWs) in HAP, health and prevention to raise awareness of the health issue of HAP and how to minimise exposure at a population level. Our national CHW training initiative in Kenya has been effectively implemented in all 47 counties under Kenyan Universal Health Coverage.
2. Through training clinicians, physicians and medical students on health risk and secondary prevention of HAP to raise the profile of household fuel combustion as a leading risk factor for cardiovascular and respiratory health in LMICs. Working with the WHO we have developed training symposia for African medical students and clinical specialists that have been successfully piloted and implemented in Cameroon.
Addressing the Global Burden of Disease from Household Air Pollution
Our group help steer development of the WHO Indoor Air Quality Guidelines (IAQG) for Household Fuel Combustion which set emissions targets to benefit health and made explicit recommendations on how these should be achieved including scaling access to and adoption of clean fuels for household energy. The current context for our research is to implement IAQG recommendations by providing an evidence-base for policy and practice to help achieve the UN Sustainable Development Goal 7 target of "universal access to clean modern energy" by 2030. Working in sub-Saharan Africa, where the burden of solid fuel reliance is at its greatest, we have led programmes of research funded by NIH, CDC and African Development Bank (in Cameroon), NIHR (in Cameroon, Kenya and Ghana), MRC Newton (Kenya), MECS/ FCDO (Kenya and Cameroon) and NORGLOBAL (Tanzania) that has sought to understand how populations can be supported to adopt clean fuels for cooking, heating and lighting. At the same time we quantify the positive impacts on health, gender, environment and climate that these energy transitions can have to reinforce the SDG agenda. Working with partners from Kenya, Cameroon, Tanzania, Rwanda and Uganda, our NIHR CLEAN-Air(Africa) Global Health Research Unit (2022-2027) (see www.cleanairafrica.com) aims to accelerate adoption of clean cooking for households and institutions by providing an evidence-base for national policies set by government stakeholders to achieve SDG7.
Research groups
Research grants
Fleming Fund Fellowship Fund
THE FLEMING FUND (UK)
February 2024 - December 2025
CLEAN-Air(Africa) Unit
DEPARTMENT OF HEALTH & SOCIAL CARE (UK)
June 2022 - May 2027
NIHR ARC 2 national social care implementation projects
DEPARTMENT OF HEALTH & SOCIAL CARE (UK), LCCG - LIVERPOOL CLINICAL COMMISSIONING GROUP (UK)
October 2019 - March 2026
Modern Energy Cooking Services Programme
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) (UK)
October 2018 - September 2023
Modern Energy Cooking Services: Cameroon MECS Evaluation
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) (UK)
September 2020 - August 2022
Universal Energy Access: the role of Clean Cooking and Climate Change Impacts
THE RESEARCH COUNCIL OF NORWAY (NORWAY)
January 2020 - August 2023
Household air pollution and risk of esophageal cancer: a case-control study in Western Kenya
DEPARTMENT FOR BUSINESS, ENERGY AND INDUSTRIAL STRATEGY (BEIS) (UK)
January 2019 - March 2022
NIHR Global Health Research Group on Clean Energy Access for the prevention of Non-communicable disease in Africa through clean Air: CLEAN-AIR(Africa)
DEPARTMENT OF HEALTH & SOCIAL CARE (UK)
April 2018 - June 2022
National Program for Scale-up of LPG for cooking in Cameroon
NATIONAL INSTITUTES OF HEALTH (USA)
June 2017 - May 2018
Modelling the health and climate co-benefits of scaled-up LPG adoption in Cameroon
AFRICAN DEVELOPMENT BANK (IVORY COAST)
February 2017 - August 2018
Enhancing adoption and use of LPG: an implementation science approach to understanding key determinants and impacts of local interventions to address financial constraints. The LPG Adoption in Cameroon Evaluation-2 Study (LACE-2).
NATIONAL INSTITUTES OF HEALTH (USA), PUBLIC HEALTH INSTITUTE (USA)
October 2016 - September 2018
Impact of an improved stove on reductions in PM2.5 exposure and nasopharyngeal carriage of streptococcus pneumoniae in 6 month old Malawian children.
BILL & MELINDA GATES FOUNDATION (USA)
July 2015 - September 2017
An advanced cookstove intervention to prevent pneumonia in children under 5 years old in Malawi: a cluster randomised controlled trial.
MEDICAL RESEARCH COUNCIL
September 2013 - February 2017
Researching pathways to scaling up sustainable and effective kitchen smoke alleviation.
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) (UK)
December 2003 - May 2008
International Society for Environmental Epidemiology, 19th Conference.
ROYAL SOCIETY (CHARITABLE)
September 2007 - December 2008
"Burns, Scalds and Poisoning" reviewing the evidence on the topic for the WHO Indoor Air Quality Guidelines: Household Fuel Combustion
WORLD HEALTH ORGANISATION (SWITZERLAND)
December 2011 - June 2012
Student Elective Prize for Hannah V Giles
WELLCOME TRUST (UK)
June 2008 - July 2008
What are the enabling or limiting factors influencing the large scale uptake by households of cleaner and more efficient household energy technologies, covering cleaner fuel (including liquefied petroleum gas, ethanol and biogas) and improved solid fuel cookstoves?”
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) (UK)
May 2011 - July 2012
European Urban Health Indicators Part Two: Using indicators to inform policy (EURO-URHIS 2)
EUROPEAN COMMISSION
January 2009 - June 2013
Review of evidence for household air pollution as intervention for child survival
BILL & MELINDA GATES FOUNDATION (USA)
December 2011 - September 2012
Research collaborations
Dr Bruce Kirenga
CLEAN-Air(Africa) Uganda Lead
Makerere Lung Institute
Ugandan PI for CLEAN-Air(Africa).
Prof Bertrand MBatchou
LACE Studies and CLEAN-Air(Africa)
Douala General Hospital (DGH), Cameroon
Prof MBatchou has been a research partner with the University of Liverpool since 2015 and has coordinated foundation studies in Cameroon (LACE) leading to the CLEAN-Air(Africa) research program. Now a senior member of the CLEAN-Air(Africa) Project Management Board.
Dr Diana Menya
HAP ESCCAPE and CLEAN-Air(Africa)
Moi University, Eldoret, Kenya
Research and capacity building partner since 2018 collaborating with the University of Liverpool to conduct research in Western Kenya on household air pollution, prevention through clean energy access and health impacts (including esophageal cancer).
Dr James Mwitari
Research and Capacity Building Leadership - CLEAN-Air(Africa)
Kenya Medical Research Institute (KEMRI)
Dr Mwitari is the Kenyan Co-director for NIHR CLEAN-Air(Africa) Global Health Research Unit. He has worked with the Energy, Air Pollution and Health Research Group since 2018 (when he was previously Deputy Director of Public Health at the Kenyan Ministry of Health). He assists in steering the current research program for CLEAN-Air(Africa).
Dr Ryan Chartier
Air Pollution Monitoring and Analysis
Research Traingle Institute
Expert in collection and analysis of air quality data including assessment of health impacts. Long term collaborator for Energy, Air Pollution and Health Research Group. Scientific advisor across research programs.
Dr Michael Johnson
Air Pollution Monitoring and Analysis
Berkeley Air Monitoring Group, USA
Expert in air pollution monitoring research and long term collaborator with Energy, Air Pollution and Health research group. Current advisor for Air Pollution Centre of Excellence at KEMRI (under CLEAN-Air(Africa)).
Dr Kwaku-Poku Asante
NIH Implementation Science Network on Clean Cooking
Kintampo Health Research Centre (KHRC), Ghana
Director of KHRC. Partner for CLEAN-Air(Africa) research program including on scale of LPG for clean cooking in Ghana. Expert in the field of air pollution, health and clean energy access.
Stuart Blatston
Digital education for health systems strengthening
The 625
Innovators of digital training and health surveillance technology supporting national training of community health workforces. CLEAN-Air(Africa) is utilising this technology for scaling national training of LMIC health workforces.
Dr Heather Adair-Rohani
WHO Initiatives to scale clean energy adoption
World Health Organisation, Dept of Environment, Climate Change and Health, Geneva
As WHO technical lead, Dr Adair-Rohani supports the Energy, Air Pollution and Health group in its capacity building program relevant to implementation of WHO IAQG recommendations. Has collaborated with the group for 20 years.
Dr Debbi Stanistreet
The Smokeless Village Project - Malawi
Royal College of Surgeons in Ireland, Dublin
Senior external advisor to the project.
Prof Ed Brown
Modern Energy Cooking Solutions (MECS)
Loughborough University
Originally collaborated with MECS in a public health advisory role. MECS are leading efforts to scale adoption of electricity for clean cooking in LMICs.
Dr Arpana Verma
UK Public Health Expert and Agenda Lead
University of Manchester, UK
Long term collaboration through research agenda on urban health and related policy. Continued collaboration on UK Public Health Agenda.