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International Training Course on Household Air Pollution and Health

Welcome to this online training course that has been designed to provide a brief overview of innovative methods for epidemiological and in-depth qualitative research in the field of household air pollution and health and insights into publishing findings and seeking funding.

My name is Dr. Reginald Quansah from the University of Ghana and I am the coordinator for this course on behalf of the CLEAN-Air(Africa) partnership. 

The CLEAN-Air(Africa) partnership includes leading institutions in the field of global public health including the University of Liverpool (UK), Kintampo Health Research Centre (Ghana), Douala General Hospital (Cameroun), Moi and Amref International Universities (Kenya) and the University of Ghana. Between the collaboration are decades of impactful and innovative research into the global health burden from household air pollution and prevention strategies.  This course is designed to leverage expertise from across the partnership to provide insights into key epidemiological study designs conducted by our research leads – studies which have employed state of the art methods to highlight the global public health priority of household air pollution.  

The course is structured into three distinct modules:

  1. Household air pollution and health (epidemiology and quantitative methods)
  2. Qualitative research methods for HAP, health and clean energy
  3. Processes in successful publishing of papers/grant writing.

Experienced instructors from across the CLEAN-Air(Africa) partnership provide a series of lectures to compliment the course.  We hope you find it informative and would value any feedback you might have on its content (please use the contact us tab on the website).

We hope you will enjoy these presentations. When you have completed the course we would highly value any feedback you might have and would appreciate you spend a couple of minutes completing the online evaluation found here.

The course instructors from the CLEAN-Air(Africa) partnership include:

Dr. Matthew Shupler

A Postdoctoral research fellow, University of Liverpool

Dr. Diana Menya

Senior Lecturer, Moi University,Kenya

Dr. Reginald Quansah

Senior Lecturer,University of Ghana, Ghana

Prof. Dan Pope

Professor of Global Public Health,
University of Liverpool, UK

Prof. Bertrand MBatchou,

Professor of Pulmonary Medicine, University of Douala, Cameroon 

Dr. Rachel Anderson De Cuevas

Research Associate
University of Liverpool, UK

Dr. Kwaku Asante Poku

Director, Kintampo Health
Research Centre (KHRC), Ghana

Prof Martin O'Flaherty

Professor of Epidemiology, University of Liverpool, UK

To set the context for the course Prof. Dan Pope, Director for the NIHR CLEAN-Air(Africa) Global Health Research Group, describes the significance of household air pollution as a global public health issue and considers the latest evidence on health burden and prevention that has steered the research focus for CLEAN-Air(Africa).

Welcome to the first module of our training course for the NIHR CLEAN-Air(Africa) Global Health Research Group. The focus of this module is on epidemiology and quantitative research methods in the field of household air pollution and health. Measuring household air pollution is a technically challenging process and this course will introduce the latest technologies and methods involved in measuring two of the most recognizing pollutants that are damaging to health (fine particulate matter (PM2.5) and carbon monoxide (CO)). The module will consider how these technologies can measure emissions (e.g., at source from the combustion of fuels), concentrations (e.g. in the kitchen), and exposure (e.g. breathed in by people cooking). To relate levels of pollution to cooking it is necessary to understand what cooking activities are being carried out at the time when levels of pollution are being measured. To do this stove use monitoring (SUMs) is carried out using thermocouple probes (these probes assess the temperature of all stoves used within a household and help identify cooking events as and when they occur). During this module, we will explain the use of the latest state-of-the-art SUMS for measuring cooking. Finally, household air pollution data requires a unique way of analyzing and presenting the information. We will show some simple methods for looking at household air pollution data and how this can be related to fuel types and health outcomes. This module presentations from leading researchers from Ghana, Kenya, and Cameroon describing important research in the field of household air pollution and health. Each presentation describes a different epidemiological design that has been used to summarise either the burden of household air pollution (HAP) in vulnerable groups or the association of HAP with key health outcomes (for example obstructed lung function, cancer, or pregnancy/ child health outcomes). For each presentation, a description of the study is provided with links to additional information and publications.

Section 1: Measuring Household Air Pollution
Measurement of household air pollution: Examples from the PURE-AIR Study (Dr. Matt Shupler)
Dr. Matt Shupler introduces the Prospective Urban and Rural Epidemiology (PURE)-Air study, which was carried out among 2,500 households in 120 rural communities of eight countries: Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe. Using state-of-the-art air pollution monitoring technology, the study examined the socioeconomic and environmental determinants of concentrations and exposures to fine particulate matter (PM2.5) and black carbon, two pollutants that adversely impact health and the climate.

For more information on the PURE-Air Study please access the core publication on the study here.
Section 2: Epidemiological study designs for household air pollution and health
Part 1: Case-control study of esophageal cancer in West Kenya – suggestions of a link to household air pollution – the ESCCAPE study (Dr. Diana Menya)
Dr. Diana Menya describes the utility of case-control studies for health research, particularly for rare outcomes like cancer, including their conduct and analysis. She then describes how the design has been used to investigate a crucial public health issue in West Kenya, risk factors for Esophageal Squamous Cell Carcinoma for which the incidence is unexpectedly high in parts of West Kenya.  Dr. Menya presents key results from the ESCCAPE case-control studies and discusses how such results lead to hypothesis generation for further studies when searching for risk factors for cancers. Indeed, it is in this way that Dr Menya’s team established the hypothesis that household air pollution could be a key risk factor for esophageal cancer in women, for which more traditional risk factors like alcohol consumption and smoking were less relevant. The ESCCAPE studies were conducted in collaboration with the International Agency for Research on Cancer (IARC) which initially provided funding, later supplemented by an NIH grant. CLEAN-Air (Africa) facilitated the collaboration between Moi University and the University of Liverpool to investigate the role of household air pollution and esophageal cancer through the HAP ESCCAPE study, with funding from the Kenyan National Research Fund and UK Medical Research Council – Newton fund.

For more information on the ESCCAPE studies please see the publications below:

i.    Menya et al (2018). Cancer epidemiology fieldwork in a resource-limited setting: Experience from the western Kenya ESCCAPE esophageal cancer case-control pilot study. Cancer Epidemiol. 57:45-52.  doi: 10.1016/j.canep.2018.09.006.
ii.    Menya et al (2019). Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control study and a pan-African perspective. Int J Cancer. 2019 Jul 1;145(1):99-109. doi: 10.1002/ijc.32086.
iii.    Middleton et al (2019). Hot beverages and oesophageal cancer risk in western Kenya: Findings from the ESCCAPE case-control study. Int J Cancer. 144(11):2669-2676. doi: 10.1002/ijc.32032.
iv.    Menya et al (2019). Traditional and commercial alcohols and esophageal cancer risk in Kenya. Int J Cancer.144(3):459-469. doi: 10.1002/ijc.31804. 

Part 2: Cross-sectional survey of chronic obstructive pulmonary disease (COPD) in Cameroon – the BOLD Study (Prof. Bertrand Mbatchou)
Professor Bertrand MBatchou is a consultant respiratory physician at Douala General Hospital, Cameroon, and is the Cameroon principal investigator for CLEAN-Air(Africa). In this presentation, Prof MBatchou describes The Cameroon Burden of Obstructive Lung Disease (BOLD) Study, part of a wider important public health initiative that has defined the prevalence of Chronic Obstructive Pulmonary Disease (COPD) worldwide. The BOLD study has helped to document the effect of COPD globally on disability, health care costs, and impaired quality of life and to inform governments and health planners. The BOLD Study Initiative has developed a set of methods for estimating COPD prevalence and Professor MBatchou describes the cross-sectional results from BOLD Cameroon, considering the implications for future work on prevention through clean cooking.

For more information on the BOLD study please see the publication here.
Part 3: Randomized trial of an Improved Oven Technology to improve air quality in Commercial Fish Smoking Environments in Ghana – The Invisible Fishers’ pilot project (Dr. Reginald Quansah)
In this presentation, Dr. Reginald Quansah describes the Invisible Fishers’ pilot project . This project was undertaken by a team of researchers from the University of Michigan and the University of Ghana in partnership with SNV (Netherlands Development Organization), VotoMobile and Innovations for Poverty Action and funded by the Bill and Melinda Gates Foundation and aims to test a number of interventions to reduce anaemia prevalence among women in the fish processing industry in Ghana. About 80% of landed fresh water and marine fish in Ghana is smoked and the majority of workers in the fish smoking industry are women. Use of traditional ovens for the smoking process results in smoke exposure related diseases, heat burns and many other negative impacts. Dr. Quansah describes how the pilot project (a randomized controlled trial) tests an improved cooking intervention, the Ahotor Oven, aimed at mitigating anemia through improved air quality among reproductive-age women employed in the Ghanaian fish smoking industry.

For more information on the Invisible Fishers’ pilot project please see the publication below:

Part 4: Randomised controlled trial of an LPG cooking intervention on pregnancy/ child health outcomes in Ghana – the GRAPHS trial (Dr. Kwaku-Poku Asante)
Dr. Kwaku-Poku Asante is the Director at Kintampo Health Research Centre in Ghana and the Trial Director for the Ghana Randomized Air Pollution and Health Study (GRAPHS). In this presentation Dr. Asante describes the GRAPHS Study - a ground-breaking community-based cluster-randomized trial that evaluates the efficacy of using cleaner cooking technologies (efficient combustion stove) and clean fuels (LPG) for cooking in reducing adverse pregnancy and child health outcomes through improved air quality. The GRAPHS study was conducted in the Brong-Ahafo region of central Ghana and was funded by the US NIH. Results from the exposure assessment employed in the GRAPHS study have been published in Nature (see it here).

For more information on the GRAPHS study please see the publications below:

i.    Jack DW et al (2015). Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial. Trials. 2015 Sep 22;16:420. doi: 10.1186/s13063-015-0930-8.
ii.    Chillrud SN et al (2021). The effect of clean cooking interventions on mother and child personal exposure to air pollution: results from the Ghana Randomized Air Pollution and Health Study (GRAPHS). J Expo Sci Environ Epidemiol. 2021 Mar 3. doi: 10.1038/s41370-021-00309-5.
iii.    Boamah EA et al (2014). Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control. JMIR Res Protoc. 2014 Dec 18;3(4):e77. doi: 10.2196/resprot.3797.
iv.    Carrión D et al (2019). Examining the relationship between household air pollution and infant microbial nasal carriage in a Ghanaian cohort. Environ Int. 133(Pt A):105150. doi: 10.1016/j.envint.2019.105150.Lee AG et al (2019). Prenatal Household Air Pollution Is Associated with Impaired Infant Lung Function with Sex-Specific Effects. Evidence from GRAPHS, a Cluster Randomized Cookstove Intervention Trial. Am J Respir Crit Care Med. 199(6):738-746. doi: 10.1164/rccm.201804-0694OC.PMID: 

Welcome to the second module of our training course for the NIHR CLEAN-Air(Africa) Global Health Research Group. This module focuses on qualitative approaches to research to improve public health by facilitating equitable access to clean household energy to reduce household air pollution. A range of speakers will present applied examples of qualitative research designs, tools, and techniques in different Sub-Saharan African contexts.

Part 1- Introduction to qualitative and mixed methods approaches to research into clean household air for improved population health – (Dr. Rachel Anderson de Cuevas)

In this first presentation Dr. Rachel Anderson de Cuevas, a social science research expert at the University of Liverpool, gives an overview of qualitative and mixed-methods approaches to household air pollution research in countries with a high associated disease burden and explores the types of research question these approaches can address.  The presentation draws on relevant examples from CLEAN-Air(Africa) research conducted in Ghana, Kenya, and Cameroon. Dr Anderson de Cuevas discusses factors influencing the choice of research approach and presents different types of qualitative research design, data collection methods, and sampling techniques.

For information about how an innovative qualitative research method (photovoice) has been employed by the research group in the field of clean energy access to reduce disease burden from household air pollution, please see the publication here.
Part 2- Introduction to qualitative and mixed methods approaches to research into clean household air for improved population health – (Dr. Rachel Anderson de Cuevas) 

In this second presentation Dr Anderson de Cuevas introduces further applied qualitative research in the field of household air pollution and clean energy access.  The presentation, chaired by Dr Anderson de Cuevas, includes discussions by key international mixed-methods researchers who discuss their work drawing from relevant studies conducted in Cameroon, Ghana and Kenya.  Dr Debbi Stanistreet (Senior Lecturer from the Royal College of Surgeons Ireland, Dublin) presents qualitative research conducted in Cameroon by the University of Liverpool and Douala General Hospital that summarises end-user perspectives on barriers to adoption and sustained use of LPG as a clean burning fuel. Ms Theresa Tawiah (research coordinator from the Kintampo Health Research Centre, Ghana) presents on the method of purposive sampling in a mixed-methods study to understand changes in clean fuel use in the Ashanti Region of Ghana.  Ms Edna Sang (research coordinator from Moi University, Kenya) describes using telephone-based interviews to understand barriers and enablers to clean cooking in Uasin Gishu county in Kenya.  Mr Emmanuel Betang (research coordinator from Douala General Hospital, Cameroon) presents methodological triangulation in qualitative research in relation to stakeholder and public perspectives to evaluate a microloan intervention supporting LPG acquisition in Cameroon. Ms Miranda Esong Lukong (fieldwork coordinator from Douala General Hospital, Cameroon) presents a study of male perspectives via focus group discussions on factors influencing clean fuel use for cooking in Mbalmayo, Cameroon.

Welcome to this third and final module of our training course for the NIHR CLEAN-Air (Africa) Global Health Research Group. This module focusses on dissemination of research through successful publication and how to develop successful grant application for competitive tenders for funding. Professor Martin O’Flaherty is a highly accomplished research lead in global public health based at the Department of Public Health, Policy and Systems at the University of Liverpool and is an adviser to CLEAN-Air(Africa).  In these two presentations Prof O’Flaherty shares tips based on his experience of successful publication in the highest impact factor journals and through successful research council funding both in the UK and internationally. 

Part 1: How to get your research findings published (Prof Martin O’Flaherty)

During this presentation, Prof O’Flaherty explains strategies, tips, and approaches to writing compelling research papers. Writing a manuscript is about telling the story of your research in a precisely structured way. To hear the presentation please click on the video below.


Part 2: How to write a competitive funding application (Prof Martin O’Flaherty)

During this presentation, Prof O’Flaherty provides an overview of the process of writing a successful grant. He provides ideas and techniques to be able to write grants using a flexible structure to make it easier to understand for collaborators during the writing process and funders at the evaluation stage. To listen to the presentation please click on the video below.