NIHR CLEAN-Air(Africa) Global Health Research Unit

CLean Energy Access for the prevention of Non-communicable disease through clean Air in Africa: NIHR Global Health Research Unit on CLEAN-Air(Africa)

In 2018, CLEAN-Air(Africa) was established as a Global Health Research Group including a collaboration of researchers from the UK and sub-Saharan Africa (Cameroon, Ghana and Kenya). The aims of the Group were to conduct policy relevant research and health systems strengthening to address non-communicable disease burden associated with reliance on polluting solid fuels and kerosene for household energy.  With funding from the UK National Institute for Health and Care Research (NIHR) (£3m: 4 year programme), CLEAN-Air(Africa) conducted impactful action research that informed policy and practice in its focus countries to raise population awareness of household air pollution and its health impacts and to scale adoption of clean household and institutional cooking to address these impacts. 

Building on the success of this formative work, in 2022 CLEAN-Air(Africa) became a Global Health Research Unit (£7m: 5 year programme) with a scaled research and capacity building agenda in Kenya, Cameroon, Rwanda, Tanzania and Uganda involving international public health research and clinical experts from the UK and sub-Saharan Africa.  The Unit is led by the University of Liverpool, UK (co-Directors Prof Daniel Pope and Dr Elisa Puzzolo) and Kenya Medical Research Institute, Kenya (co-Director Dr James Mwitari).  The Unit’s primary aims are to provide research evidence, health systems strengthening, population awareness raising and advocacy to address the burden of disease from air pollution through universal access to clean modern energy (Sustainable Development Goal (SDG) 7). 

The problem: the largest environmental risk factor for global disease burden

Globally 3.8 billion people still rely on polluting fuels (e.g. wood, charcoal, kerosene), for cooking, heating and lighting. While the total number of individuals using clean household energy has increased over the last two decades, population growth in low- and middle income countries (LMICs) has exceeded gains in access, thereby maintaining the proportion of the global population relying on polluting fuels at around 40%. Exposure to fine particulate matter (PM2.5) found in household air pollution (HAP) from combustion of these fuels is the ninth risk factor for global morbidity and mortality, responsible for 2.3 million deaths every year (greater than the total mortality from COVID-19 in 2020). Currently, more people die annually from HAP exposure than those who die from HIV/AIDS, malaria or tuberculosis. 

In sub-Saharan Africa almost 900 million people rely on solid fuels and kerosene for household energy, 85% of the total population. Typically burned in inefficient rudimentary stoves, this fuel leads to very high of PM2.5 in addition to other toxic pollutants. 

HAP is causally associated with ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, acute lower respiratory infection, type 2 diabetes mellitus, low birth weight and pre-term birth. With 695,000 premature deaths and 38 million Disability-Adjusted-Life-Years (DALYs) in 2019, sub-Saharan Africa (SAA) bears a large proportion (30%) of the global burden of disease related to HAP). However, progress in SSA has lagged substantially behind other regions, with only a 24% decrease in deaths over the last 20 years compared to a 56% decrease globally.   

Non-sustainable use of firewood also results in substantive degradation of forests, contributing to increased atmospheric CO2 and loss of biodiversity, and burning of these fuels in inefficient cookstoves produce 25% of total anthropogenic black carbon (BC) – a significant short-lived climate forcing pollutant. The gathering of fuel, mainly by women and children, has negative social impacts due to lost productive time, education attainment, and gender equality.  CLEAN-Air(Africa) research therefore has a focus on climate action and gender equality.

The solution: scale of adoption and sustained use of clean modern energy

CLEAN-Air(Africa) is conducting research, health systems strengthening and capacity building programmes within the policy time horizon set by SDG7 “Universal access to clean modern energy by 2030”. The latest evidence by the International Energy Agency suggests that SDG7 will currently fall short without substantive action by donors, policy makers, researchers and other actors to rapidly scale progress. To reach SDG7 the IEA estimates that the 75% or more of the region’s population reliant on polluting biomass and kerosene for cooking will need to switch to clean fuels/ energy including liquefied petroleum gas (44%), electricity or eCooking (12%) and the rest using biogas, bioethanol or improved biomass cookstoves (which are unlikely to achieve significant health gain). CLEAN-Air(Africa) aims to provide research evidence, population sensitisation on HAP, health and prevention and advocacy for policy to positively impact progress towards SDG7. Accelerating progress in the energy sector to achieve SDG7 is critical for “good health and wellbeing” (SDG3), “gender equality” (SDG5), and for “climate action” (SDG13). 


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