Making science work for development

Household air pollution

Preventing household air pollution to improve public health

Household air pollution is a major health risk for people living in the world’s poorest communities, resulting in an estimated 4 million premature deaths every year. Research from the University of Liverpool has been reviewing the efficacy of several important preventive strategies and tools, and investigating the impact of pollution-reducing technologies on maternal and child health. Their work has fed directly into a number of international initiatives and policies, having the potential to improve the lives and health of almost 3 billion people.

Around 2.8 billion people worldwide, the great majority in developing countries, still rely on simple stoves using traditional solid fuels, such as wood, dung and coal, for cooking. Use of these fuels and technologies leads to toxic levels of household air pollution, typically 20 to 40 times higher than ‘safe’ levels recommended in the World Health Organisation (WHO) air quality guidelines.

Research from the University of Liverpool’s Energy, Air Pollution and Health (UoL-EAPH) research theme has made an important contribution to household air pollution (HAP) now being recognised as the 4th most important global risk factor – responsible for an estimated 4 million premature deaths and making up 4.3% of the Global Burden of Disease in 2010. As well as quantifying the burden and raising global awareness of the problem, their internationally respected work has investigated potential solutions to address the serious consequences of HAP and has mobilised action against this type of pollution.

Researchers from the University of Dar es Salaam discuss traditional single-walled metal cookstoves and improved ceramic-lined charcoal cookstoves (Photo Thomas Molony, UoE)

Their RESPIRE project – the first ever randomised controlled clinical trial (RCT) of low-cost technology to reduce HAP – tested the impact of reducing exposure to pollutants on childhood pneumonia. They found that a simple but good quality chimney stove could reduce pollutant exposure and showed some impact on pneumonia (particularly severe cases), but that ultimately much greater pollution protection was needed to prevent the majority of childhood pneumonia cases. Since this early innovative work their team has contributed to the development and implementation of other RCTs looking at the reductions in pollution and impacts on health of (i) ethanol clean fuel stoves in Madagascar and (ii) improved combustion stoves in Malawi (this project is now underway – jointly supported by the Wellcome Trust, the Department for International Development (DFID),  and the Medical Research Council).

Through their systematic review work UoL-EAPH researchers also steered the evidence-base for the burden of disease from HAP and a range of health outcomes (including childhood pneumonia, lung cancer, adverse pregnancy outcomes and childhood mortality) leading directly to several important preventive strategies and tools. Their work has helped to improve the effectiveness of the Global Action Plan for the Prevention and Control of Pneumonia & Diarrhoea, and inform the Lives-Saved Tool, which is used to prioritise interventions for child and maternal survival.

Further UoL-EAPH research helped to inform the best policies to encourage effective and long-lasting uptake of cleaner household energies. Key to this work has been mixed methods systematic review, supported by DFID, through which they identified key factors influencing uptake, from community preferences, to national and international energy policy, finance and regulation. They are currently working with international organisations to develop a tool which will support implementation of these findings.

There has been a significant effort to improve cookstoves by building on traditional designs (Image GERES Arnaudet)

The work of the UoL-EAPH researchers has had a truly international impact. As well as providing advice to the United Nations Foundation Global Alliance for Clean Cookstoves, and the United Nations initiative on Sustainable Energy for All initiative, Liverpool research has greatly influenced the new WHO Guidelines on indoor air quality – for which they took a leading role in development. These guidelines will be used by governments to develop their household air pollution policies, having the potential to produce widespread health improvements, lower energy costs for poor families and reduce global carbon emissions.

Read more about this research in the original impact case study submitted to the Research Excellence Framework 2014.

Department for International Development | Medical Research Council | Wellcome Trust