Kevin“Four million people around the world die every year simply because they lack access to clean energy for their basic cooking, heating and lighting needs”

Exclusive interview with Dr Kevin Mortimer, Senior Clinical Lecturer in Respiratory Medicine, Liverpool School of Tropical Medicine, United Kingdom. He will address African Utility Week in May 2016 on “Can clean energy solutions improve health and save lives in Africa?”

A mother with child on her back cooking over a clean burning advanced cook-stove in Malawi as part of the Cooking and Pneumonia Study.

Tell us about projects that you are involved in regarding energy-related health issue that you can share?

I lead a village level cluster randomised controlled trial of an advanced cook-stove intervention to prevent pneumonia in children under the age of five in rural Malawi (www.capstudy.org). I am part of the leadership team for the BREATHE-Africa partnership, which brings African research leaders and trainees together with experts in all key aspects of household air pollution research (http://www.breatheafrica.org).

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A woman participating in the adult lung health sub-study of CAPS undergoing measurement of her lung function using a portable spirometer.

Malawi has one of the highest rates of death among infants and the under-fives (69 and 110 per 1,000 live births respectively in 2009) despite having made progress towards meeting the Millennium Development Goal of reducing child mortality. Pneumonia is the leading cause of death and one of the commonest causes of morbidity: around 300 per 1,000 children under the age of five are diagnosed with pneumonia every year. Exposure to smoke produced when biomass fuels (animal or plant material) are burned in open fires, is a major avoidable risk factor for pneumonia.

In Malawi, where at least 95% of households depend on biomass as their main source of fuel, biomass smoke exposure is likely to be responsible for a substantial burden of this disease. Smoke from burning biomass in open fires also causes other health problems including chronic lung disease, lung cancer, heart disease, stillbirth and low birth weight; it is also thought to be an important driver of global climate change.

The problem of biomass smoke exposure is seen across Africa where around 700 million people burn biomass fuels to provide energy for cooking, heating and lighting. The problem extends right around the globe where around half the world’s population are dependent on biomass fuels for their day-to-day energy requirements. Around four million people die every year around the world from the effects of biomass smoke.

A CAPS fieldworker prepares an Aprovecho Indoor Air Pollution meter for use measuring personal exposure to carbon monoxide and particulate matter in the adult lung health sub-study of CAPS.

There are now particularly efficient biomass-burning cook-stoves that substantially reduce smoke emissions and exposures. Some of the more advanced biomass-burning cook-stoves reduce emissions by as much as 90% by incorporating technologies (e.g. fans) that improve combustion efficiency. Other ways of reducing biomass fuel use and smoke exposure include cleaner fuels, better ventilation and changes in cooking behaviour. Access to smoke exposure reduction technologies is limited by poverty in much of the developing world. The Global Alliance for Clean Cook-stoves (GACC) was launched in 2010 to tackle the lack of access to clean affordable energy through public-private partnerships. A central aim of the alliance is for 100 million homes to adopt clean and efficient stoves and fuels by 2020.

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A CAPS fieldworker sets up air pollution monitoring equipment for use under the watchful gaze of a group of Malawian children.

The two-year Cooking and Pneumonia Study is tracking children who live in randomised villages in Chikhwawa and Chilumba in Malawi. The homes of the children involved in the study have been supplied with two clean cook-stoves to see if the new stoves, which can reduce emissions by up to 90%, will stop the children getting pneumonia, a major cause of death in this age group. Over 10,000 children from 150 villages in rural Malawi have been recruited into this study making this the largest clinical trial ever conducted anywhere in the world of a clean cooking solution. BBC News has been to Malawi to cover the story: http://www.bbc.co.uk/news/health-30448559
 
What are the main challenges in Africa?

To improve and save the lives of the 700 million people in Africa who use dirty burning biomass fuels (animal or plant material) for cooking, heating and lighting.

Women and young children experience high levels of smoke exposure when meals are cooked over open fires in the home due to partial combustion of fuel and poor ventilation. Household air pollution from open fires is a major threat to health, ranking third as a cause of disability adjusted life years in the 2010 global burden of disease comparative risk assessment.

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A CAPS fieldworker takes non-invasive measurements of blood carbon monoxide levels of a study participant.

WHO estimates four million premature deaths are caused by household air pollution worldwide every year. Around half a million of these deaths are due to pneumonia in young children. Effective strategies for reducing both biomass fuel consumption and smoke exposure include improved stoves, ventilation, cleaner fuels and behaviour modification. There is an urgent need to establish the potential health benefits of these approaches and scale up effective clean power solutions.

What strategies can help to improve Africans’ lives?

The delivery of affordable, accessible, acceptable and sustainable clean energy solutions for cooking, heating and lighting for Africa’s poorest people.

Are renewables the only answer?

Renewables are not the only answer but they are a large part of the answer if we are to save lives through the provision of affordable clean energy for all.

What surprises you about your work?

That four million people die every year around the world simply because they lack access to clean energy for their basic cooking, heating and lighting needs.

You will have an opportunity to address power professionals at African Utility Week – what will be your specific message to them?

We have the opportunity to save millions of lives in Africa and internationally by working together to deliver clean energy solutions for the world’s poorest people.

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A Malawian family participating in CAPS.

Tell us about the history of the Liverpool School of Tropical Medicine (LSTM)

LSTM was founded on 12 November 1898 by Sir Alfred Lewis Jones, an influential shipping magnate, when Liverpool was a prominent port city with extensive trade with overseas regions such as West and Southern Africa. As a result, the number of patients in the region admitted to hospital with ‘tropical’ diseases soared. Sir Jones donated £350 to set up a School of Tropical Medicine to investigate these outbreaks.

In its first decades, LSTM relied on the facilities of University College, now known as the University of Liverpool. This lasted until 1915 when it had its own purpose build facility ready at Pembroke Place. However, World War I delayed full occupation until 1920 as the building was initially used as a military hospital.

Rubert Boyce was the inaugural Dean of the School of Tropical Medicine. He succeeded in recruiting Ronald Ross as LSTM’s first lecturer in Tropical Medicine. In 1902 Ross became the first British recipient of the Nobel Prize in Physiology or Medicine for his work on malaria transmission.

Other notable staff of the time included Joseph Everett Dutton who discovered one of the trypanosomes that cause sleeping sickness, Wolferstan Thomas who developed the first effective treatment for the disease, and his collaborator Anton Breinl, who later became ‘the father of tropical medicine’ in Australia.

In 1921, Sir Alfred Lewis Jones funded the development of the school’s first overseas research laboratory in Freetown, Sierra Leone. Until the early stages of World War II, the laboratory made many important discoveries in West Africa, including demonstrating that a species of black fly was responsible for transmission of filarial worm to humans, causing river blindness.

In 1946, the appointment of LSTM’s longest serving Dean, Brian Maegraith, marked a broadening of the School’s size and curriculum. Maegraith famously declared: ‘Our impact on the tropics should be in the tropics!’ which resulted in the school forging links with other research institutions across the globe and bringing research innovations to those most in need. An ongoing example of this is the Malawi Liverpool Wellcome Trust Clinical Research Programme, which conducts research into local diseases of importance to Malawi.

Since 2000, LSTM has been directed by Professor Janet Hemingway, who has spearheaded a period of large investment and expansion. LSTM was awarded higher education institution status in 2013.

About Kevin Mortimer
Kevin Mortimer went to medical school in Cambridge and then trained in General Internal Medicine and Respiratory Medicine in Nottingham. He did a PhD at the University of Nottingham where he subsequently took up a Clinical Lecturer post, developing his interest in clinical trials and airways diseases. He moved to the Liverpool School of Tropical Medicine in 2011 as Senior Clinical Lecturer. He is an Honorary Consultant in Respiratory Medicine at Aintree University Hospitals NHS Foundation Trust and Co-Principal Investigator in the Cooking and Pneumonia Study CAPS (www.capstudy.org).