GB-COH-RC000660-War-PATH University Of Liverpool The War-PATH NIHR Global Research Group is between the University of Liverpool and two low and middle income countries (LMICs), Uganda and South Africa. It will focus on a clinically important noncommunicable disease area which requires the use of anticoagulation. Anticoagulants, in particular warfarin, are used in these countries for the treatment of venous thromboembolism, rheumatic heart disease and prevention of strokes in patients with irregular heart rhythms (atrial fibrillation). Anticoagulation represents an unmet clinical need in Sub-Saharan Africa as patients either do not receive anticoagulation (because of difficulties in monitoring) or are poorly anticoagulated because of poor dosing guidelines. This results in potentially preventable morbidity and mortality which affects the poorer sectors of the population in particular. We have extensive expertise in the UK and EU of improving the use of warfarin through the development of novel dosing algorithms, which have now began incorporating genetic factors. By contrast, in our two collaborating partner countries, no good dosing algorithms exist, even those which only take into account clinical factors. The situation in these 2 countries is further complicated by the fact that there is a high prevalence of HIV and TB, which make anticoagulation harder because (a) they increase the risk of thrombosis, and (b) the drugs used for treatment interact with warfarin. Our research will focus on: (a) evaluating the quality of anticoagulant services in Cape Town and Kampala taking into account the indications, anticoagulant clinic set-up and quality of anticoagulation control; (b) recruiting patients currently on warfarin to identify clinical factors determining anticoagulation quality to develop a dosing algorithm; (c) a study to implement the clinical algorithm in the two sites; and (d) evaluating genes specific to the African population that can impact on anticoagulation control, and the development of novel genetic dosing algorithms. The work will be accompanied by education and training of the local workforce to improve local capability and capacity. We will also train 4 students to Masters level, and 2 post-doctoral researchers will be seconded to Liverpool to gain training in high-end genomics. We will also engage with regional health policy makers in both countries to develop the best pathways for implementing the research findings to improve anticoagulation care, for the benefit of patients, the local society and ultimately the economy. We will also work with technology companies to develop long-term cost-effective strategies to implement novel technologies that will allow for point-of-care testing of anticoagulation, and also of genetic markers. • Evaluate the quality of anticoagulant services in Cape Town and rural and urban Uganda taking into account the indications, anticoagulant clinic set-up and quality of anticoagulation control (phase 1); • Recruit patients currently on warfarin to identify clinical and other non-genetic factors associated with poor anticoagulation control (phase 2). • Develop a warfarin clinical dosing algorithm (phase 2); • Evaluate genes specific to the local African populations in Uganda and South Africa that can impact on anticoagulation control, and the development of a novel genetic dosing algorithm (Phase 2). • Initiate a study to implement the clinical dosing algorithm in the two sites (phase 3). In the 3-year timeframe of the programme of work, we will not have time to evaluate the utility of the genetic algorithm, but will be evaluating some novel point-of-care INR testing and genotyping technologies. The involvement of Ugandan and South African partners will ensure that the solution being developed is appropriate to and informed by local contexts. Both partners have already played a large role in identifying needs and will continue to do so in all stages through to evaluation. Correct identification of indications for warfarin therapy is limited outside national referral centres in Uganda. Once a diagnosis is made, there are challenges in terms of INR monitoring due to expense and the need to travel to different facilities. In South Africa, INR monitoring is available via the national health laboratory service but results are frequently only available the following day. Thus, strengthening laboratory facilities and consideration of near-patient testing has the potential to significantly reduce these barriers. The health systems research will elucidate these challenges, enabling specific solutions to be designed. We are developing an educational package to improve local capacity in anticoagulation practices and capability to perform drug safety research. This includes training from UK nurses, CPD lectures and a website. The capabilities of the local healthcare workforce will also be developed through Masters level qualifications (4 one year MRes students), as well as placements within our facilities at UoL for training in high-end genomics, statistical genetics and bioinformatics. Regional health policy experts will be engaged form the beginning of the program to ensure that health policy outcomes are capable of implementation. We will work with technology companies to develop long-term cost-effective implementation strategies including the use of point of care platforms (INR and genetic testing) and mobile health approaches. Success will be measured by the quality of anticoagulation practices before and after our project. The development of better dosing algorithms is likely to have the greatest impact on the poorest sector. Better anticoagulation practices, and better INR control strategies, will improve the benefit-risk ratio of warfarin, improving its effectiveness and reducing its risk, which will impact on the economy. NIHR Makerere University University of Cape Town University Of Liverpool University of Bangor 201176.17 687109 715372 482524 387079.44 110590.46 69692.37 113509.49 69987.53 130964.66 92775 332887 82321 218897 181306 17998.66 32838.53 25084.54 27613.18 16461.6 14266.33 11435.05 14778.78 12232.78 21697.38 15994.76 96326.30 Dept of Health - NIHR 50000 Dept of Health - NIHR 54849.87 Dept of Health - NIHR 143397 Dept of Health - NIHR 117672 Dept of Health - NIHR 207960 Dept of Health - NIHR 76295 Dept of Health - NIHR 83904 Dept of Health - NIHR 222286.00 218080 Dept of Health - NIHR 9047.65 2445.57 5859.15 14406.93 18044.85 17333.85 18258.87 14523.51 27492.19 20546.36 23329.26 19323.37 23326.51 26274.13 24082.17 24258.17 92116.50 142567.41 150398.87 GB-COH-RC000660-NIHR200817 University Of Liverpool What are the aims of the project? Perinatal depression affects about one in five women in low- and middle-income countries and has huge human and economic costs. The condition can be treated effectively with ‘talking therapies’. However, the vast majority of women in low-income countries remain untreated because of serious lack of mental-health specialists to deliver such therapies. In our previous work, we have adapted talking therapies so these can be delivered by non-specialists in low-income settings. In order to make such interventions even more accessible to the larger population, we aim to develop and evaluate a digital Application (App) to facilitate delivery of a WHO-approved ‘talking therapy’, the Thinking Healthy Programme, through lay-women. The project will be conducted in Pakistan. We also aim to train researchers in Nepal, Bangladesh and Sri Lanka to conduct similar research in their settings. How will the project be carried out? Phase 1 - Development of the App: We have extensive knowledge of the content, methods of training, supervision and delivery of the Thinking Healthy Programme which was developed by our team. Building on this knowledge, we will develop the App by employing a Human-Centred Design, which places end-users at the heart of the process in 3 steps: a) identifying the requirements of lay-therapists and mothers; b) testing multiple prototypes on selected users, and; c) testing the final prototype in actual conditions. This phase will take about 18 months. Phase 2 - Evaluation of the App: We will then compare the effectiveness and ‘value-for-money’ of our new App-assisted Thinking Healthy Programme with routinely delivered programme in low socio-economic settings in Pakistan. All pregnant women from randomly picked villages, who score highly on a depression questionnaire, will receive one or the other intervention. We will then assess both groups at 3 and 6 months after childbirth for symptoms of depression and other health outcomes. We will interview some participants in more detail to understand the facilitators and barriers to the new way of intervention delivery. We will determine the costs associated with the programme to evaluate its ‘value-for-money’. This phase will take about 30 months. Phase 3 – Training of researchers in other countries of the region: In addition to Pakistan, junior or mid-career researchers from Nepal, Bangladesh, and Sri Lanka will be selected to undergo a specially-designed training programme in conducting research in perinatal mental health in their own settings. In total, 8 researchers will be trained. As part of their training, they will undertake research projects in areas which are thought to be critical for implementation of interventions for mental health. How will this project benefit the public? Ultimately, this project will lead to more women with perinatal depression in Pakistan and other low- and middle-income countries to receiving the treatment they need. In addition to developing innovative ways to deliver interventions, we plan to raise public awareness of perinatal depression and what can be done about it through our well-established South Asian Hub for Advocacy, Research, and Education in mental health, operating in all four countries since 2012. We will carry out community meetings where we will share the findings of our project. In Pakistan, we will incorporate our innovations into the ‘President’s Programme to Promote Mental Health of Pakistanis’. At the global level, we will work closely with the World Health Organization to incorporate our findings into the revised version of the Thinking Healthy Programme which will be disseminated to all member countries through the WHO’s flagship mental health gap action programme. University Of Liverpool Liverpool School of Tropical Medicine NIHR A) Formative Phase: App development: 01/06/2020 to 30/11/2021) The overarching aim of this work package is to develop a digital Application (App) to facilitate delivery of a WHO-approved ‘talking therapy’ for perinatal depression, the Thinking Healthy Programme, through lay-women. The activities are situated in Rawalpindi, Pakistan. Work is ongoing. B) Capacity Building: 01/06/2020 to 31/05/2024 The overarching aim of this Work Package is to build capacity in junior or mid-career researchers from Pakistan, Nepal, Bangladesh, and Sri Lanka by undergoing a specially-designed training programme in conducting research in perinatal mental health in their own settings. We committed to training 4 PhD-level and 4 mid-career level research fellows. As part of their training, they will undertake research projects in areas which are thought to be critical for implementation of interventions for mental health. Pakistan is the primary research site where the development of the innovation and its evaluation is being conducted. Nepal is a partner country where research capacity building is being conducted. Bangladesh is a partner country where research capacity building is being conducted. Sri Lanka is a partner country where research capacity building is being conducted. 421162 635842 GB-COH-RC000660-NIHR156365 University Of Liverpool Acute fever is a leading cause of child mortality in sub-Saharan Africa, responsible for 40% of child deaths (1.2 million fatalities) annually. Children presenting with acute fever are frequently assumed to have malaria or bacterial infections, leading to inappropriate treatments. A significant portion of these children likely suffer from zoonotic infections—diseases transmitted from animals to humans. Diagnosing these infections is challenging because healthcare professionals often lack training, and testing for zoonotic diseases is limited in much of Africa. Our Global Health Research Group aims to address this issue by: (1) Determining which zoonotic infections are most prevalent in the region; (2) Developing effective, new diagnostic tests for these infections; and (3) Establishing evidence-based guidelines to aid healthcare professionals in diagnosing and treating zoonotic infections. Our research group unites experts from the UK (University of Liverpool and Liverpool School of Tropical Medicine) and Africa (Kabale University and Makerere University in Uganda; University of Nairobi and the International Livestock Research Institute [ILRI] in Kenya; and Addis Ababa University and ILRI in Ethiopia). Our methodology includes: (i) Conducting studies in rural and urban areas of Uganda, Kenya, and Ethiopia to understand the symptoms, causes, and risk factors of fever in children; (ii) Developing and assessing new tests for zoonotic infections to determine their feasibility for use in clinical or research settings; and (iii) Engaging with communities and healthcare providers to understand their perceptions of the causes of fever and the challenges they face in treatment, as well as how healthcare is accessed by those who are sick. Through these studies we aim to develop tools and guidelines for diagnosing and treating acute fever in children in our target countries. Additionally, we will focus investment and training to enhance the capabilities of our partner institutions in detecting zoonotic infections and nurturing future leaders in zoonotic disease research. During the project lifespan (July 2024 - June 2028), our group will improve the local capacity to diagnose zoonotic infections and introduce new diagnostic tests. In the medium to long term, better detection and reporting of zoonotic infections will lead to more accurate treatment of fever, thereby reducing childhood mortality and curbing the misuse of antimalarial and antibiotic treatments. Our overarching goal is to improve the diagnosis and management of zoonotic causes of acute febrile illness in paediatric populations in sub-Saharan Africa. This will be achieved through four interlinked work packages, each with a specific aim and objectives. The specific aims are to: (1) Determine the common zoonotic causes of acute febrile illness and associated factors in paediatric patients living in urban and rural areas of Uganda, Kenya and Ethiopia; (2) Develop and test novel technologies and approaches for diagnosing zoonotic causes of acute febrile illness that are suitable for use in low- and middle-income countries and field settings; (3) Involve communities and the health sector in Uganda, Kenya and Ethiopia in defining improved approaches to diagnosis and management of zoonotic causes of acute febrile illness; and (4) Strengthen capacity and capability for research on diagnosis and management of zoonotic diseases in Uganda, Kenya and Ethiopia. University Of Liverpool NIHR 739442.54 824850.75 845764.49 388251.85 GB-COH-RC000660-NIHR134781 University Of Liverpool Most maternal deaths occur in Sub-Saharan Africa. Nearly all are preventable with good quality maternal healthcare. Both Malawi and Zambia are committed to improving maternal and neonatal health outcomes but are making limited progress. The aim of the NIHR DIPLOMATIC research group is to improve maternity outcomes in Malawi and Zambia by improving the quality of care. The senior leadership of the DIPLOMTIC research team are all based in Malawi and Zambia. The formal locus of control for research activity is the Malawi-Liverpool-Wellcome Trust in Blantyre, Malawi. The four-year (August 2022 – July 2026) programme of work described here builds upon previous DIPLOMATIC research in Zambia and Malawi to leverage its research strengths – strong social, political, and institutional networks in both countries – and to initiate new work to ensure meaningful impact on maternal and neonatal health outcomes. The NIHR group’s aim will be delivered through 4 themes, which operate alongside the cross-cutting domains of capacity building in institutions in both countries, communicating widely across professional and public settings for impact, and community engagement and involvement to ensure the sustainability of key changes implemented in systems of maternal care. Theme 1. Data-driven improvement High quality maternal and neonatal health data is essential for quality improvement. By implementing online dashboards in clinical settings, we will provide real-time digital reporting of maternal death, near-miss cases, and quality of care data. Data will identify critical improvement needs and measure progress following interventions. A well-established community Demographic Health Surveillance System sites will give information beyond the clinic, to understand longer term outcomes and critical gaps in facility-based data such as loss to follow-up. Theme 2. Placing users at the centre of change We will use qualitative methods to represent the experience of vulnerable service users, in particular pregnant adolescents, and pregnant women with mental health problems. Their personal narratives will identify how services can better target their needs and inform priority setting for both health systems change and future health research. User experience is an important outcome alone, but it often also drives other health behaviours. Few data represent users’ experience of maternity care in Malawi and Zambia. We will optimise a tool to gather maternity users’ feedback and evaluate its use in clinical practice. Theme 3. Prioritisation and co-design Many changes to improve maternal health target the health facility, and yet the root causes of poor maternal health span the whole health system. We will conduct an annual maternal health needs prioritisation meeting to galvanise broad stakeholder engagement to identify and champion complex issues to establish a sector-wide focus for change. To ensure sustainable implementation of the priority interventions, we will train health managers and providers in rational intervention design using the Behaviour Change Wheel methodology We will also ensure wide participation of diverse stakeholders in the co-design process for implementation. Theme 4. Implementing and evaluating change We will support sites across Malawi and Zambia to implement carefully designed behaviour change interventions and then robustly evaluate the implementation process. One intervention has already been prioritised and is ready to implement at the start of the new DIPLOMATIC programme. Alongside implementation, we will evaluate this package of “Enhanced Antenatal Care,” which aims to improve local compliance with WHO guidance and ensure consistent delivery of evidence-based practice. A second priority is to improve antenatal identification of sexually transmitted infections in pregnant women. We will explore how the existing approach of syndromic management can be improved. Following staff training and co-design of a behavioural change intervention, local development teams will test the intervention. We will then select the most effective pilot interventions for a multi-site implementation study across Malawi and Zambia. Capacity building Plans for developing local researchers include 3 PhD studentships and support for integrated MSc student projects. Ongoing research skills, policy engagement and management training will be provided for all levels of the research team. Communicating for impact In addition to high quality scientific outputs, we are superbly positioned with national and international partners to communicate the group’s work to social, political, and institutional networks to maximise impact of changes in the practice of antenatal care. We will further support the impact of our research findings by forming “policy and impact committees” and by distributing policy briefs. NIHR University Of Liverpool Malawi Liverpool Wellcome Trust Malawi Epidemiology and Intervention Research Unit University of Glasgow University of Edinburgh Lusaka Apex Medical University University College Dublin Kamuzu University of Health Sciences MLW, MEIRU LAMU U Liverpool, U Glasgow, U Edinburgh UCD 720696.00 721037 760037 790829 GB-COH-RC000660-NIHR300808 University Of Liverpool The NIHR Professorship was awarded to Prof David Lissauer, a scientist and maternal and fetal medicine specialist, recently appointed as Professor of Global Maternal and Fetal Health at the University of Liverpool. Prof Lissauer describes the proposed work: My programme of work aims to reduce mortality and morbidity from maternal sepsis in Africa. Over the next 5 years I will undertake a broad programme of research, in 3 workstreams: Workstream 1: Understanding maternal infection in Malawi. There is the urgent need for better information on maternal infections and morbidity outcomes in Malawi. I will lead the development of a maternal infection and severe maternal outcome surveillance system, that will be piloted in Blantyre district, Malawi. We will also co-design clinician and public facing dashboards, to enable the surveillance data to be used for quality improvement. It is well recognised that care delays often contribute to adverse outcomes, and we will develop and pilot a novel geospatial location approach to explore these care delays and map infection and delay hotspots. We will link surveillance data to laboratory data to understand the aetiology of these infections and the antimicrobial resistance profiles. Workstream 2: Preventing infections; focussing on caesarean section and miscarriage surgeryInfection is 20 times more likely after caesarean birth. We will conduct a research priority setting exercise, following a modified James Lind Alliance approach, with a broad stakeholder group to prioritise 10 uncertainties in the prevention of infection after caesarean section. One of the priority topics will be selected for a pilot study in preparation for a full trial. The WHO has highlighted evidence based recommendations to reduce infections after caesarean section yet surveys of practice show these are not performed reliably. We will utilise a behavioural change perspective to co-design an intervention to improve compliance with these practices at caesarean section and miscarriage surgery. Workstream 3: Improving the management of maternal sepsis. We will investigate if lactate measurement, available as a point-of-care test, has incremental benefit over conventional maternal vital sign assessment in the diagnosis of sepsis and identification of women at risk of severe morbidity and mortality. We will also aim to test at scale if a maternal sepsis bundle based approach (FAST-M) is clinically effective in reducing maternal infection related mortality and severe morbidity and if it is cost effective. A robust mixed methods implementation evaluation will also be conducted to understand the way the intervention functions in practice.These 3 work streams will be accompanied by 2 cross cutting themes: Training and capacity building: We will support Malawian researchers and clinicians to develop their research careers and become the next generation of leading scientists. Communication with the public, practitioners and policy makers: We will throughout be communicating about the research we are doing with the public to raise the profile of women's health issues and the importance of maternal infections and sepsis. NIHR University Of Liverpool Malawi Liverpool Wellcome Trust 57540.00 357109.00 371206.00 407531.00 370289.00 312452.00 GB-COH-RC000660-GB-GOV-10-GHRG_4_155559 University Of Liverpool Across three African countries (Malawi, South Africa and Tanzania) we plan to: (1) develop the ability to research the careof people with broken bones, (2) determine the number of people affected by broken bones, (3) describe the healthcareresources available for the treatment of broken bones and work out what is important for the best delivery of services, (4)measure how a broken bone impacts the lives and livelihoods of patients and their carers, and (5) improve the recovery of patients with broken bones.Injuries are the leading cause of death in people aged 10-49 years. More people die from injuries than from HIV, malaria,and tuberculosis combined. For every person who dies, up to 50 people survive but become disabled. Broken bonesaccount for most of these injuries, and these happen more often to people living in poor regions, including some countriesin Africa. Across Africa, little is known about how many people break a bone, what healthcare services are available totreat them, how a broken bone affects patients/families, and how to improve recovery.Our project has four parts:(1)RESEARCH TRAINING AND RESOURCES: Doctors, nurses and healthcare workers involved in the care of patients withbroken bones have limited training in how to conduct research, and have poor access to the resources to do research.This makes it more difficult to improve the care for their patients. We will look at the current levels of research training andorganization. We will design educational resources to fill gaps in the current understanding and ability to do research. (2)COUNTING BROKEN BONES: We will create a network of hospitals in our partner countries to study how often differenttypes of broken bones occur. We will describe the resources (people and equipment) available to treat these injuries andhow patients use these services. We collect this information for five broken bones that the World Health Organization(WHO) have identified to cause the most disability. (3) UNDERSTANDING RECOVERY: We will find out how patients inour partner countries recover from their broken bones, and how this impacts on their livelihoods and those who care forthem. (4) STUDY FOR FUTURE RESEARCH: We want to understand how to do large-scale research for patients withbroken bones throughout Africa. To do this we will run a small study in our network of hospitals to see what works welland what is challenging. This project will help us understand the number of broken bones that happen in Africa and whattreatments are available to patients. It will develop research teams and guide us for future research studies. This workstowards our vision that the care for broken bones in poor countries can be safe, accessible, and appropriate to theresources of local health systems. Community engagement and involvement: We have engaged with local patients andhealthcare workers, whose opinions have informed our work so far. We will continue to integrate patients and communityleaders to co-produce our research.Dissemination: Patients, clinicians and methodologists will co-develop publications,social media, and events. We will work alongside policy makers in national government ministries and strengthen ourrelationship with leaders within the WHO to ensure that we disseminate our findings effectively and influence policy todrive improved patient care. University Of Liverpool The start and planned date are the same date, the project started on time. The project is currently active. GB-COH-RC000660-MILK-CENTRE University Of Liverpool Exclusive breastfeeding is recommended by the World Health Organisation for the first six months of life, because of benefits to mother and child. However, worldwide around half of all women require treatment with some form of medication during breastfeeding. For all mothers, their first concern will be about potential consequences to the infant. For decades, there has been recognition that everybody deserves access to the information they need to make an informed choice about their healthcare. But frequently, when a breastfeeding mother requires treatment with amedicine, that evidence simply does not exist.Studying drug safety and effectiveness in breastfeeding, so-called ‘lactation pharmacology’, requires breastfeeding mothers to trust the research team, and for the research team to have the skills andequipment to perform research that keeps the number of participants and biological sampling points to a minimum whilst maximising the information gained. Once the research is complete, the research team must also engage with policy makers to make sure that the results change healthcare practice.AimsWe aim to meet the critical need for better understanding of which drugs are safe for mother and infant duringbreastfeeding by establishing of a centre of excellence for lactation pharmacology at the Infectious DiseasesInstitute in Uganda.1. To work with communities and decision-makers to understand which drugs we should study first2. To determine how to safely and fairly include in research breastfeeding mothers who have complexsituations, such as age 14-17, mental health conditions and breastfeeding during a virus outbreak3. To measure whether antidepressants and antibiotics pass to the infant through breastmilk4. To build mathematical prediction models to predict how likely it is that particular drugs will pass throughbreastmilk5. To be ready to explore safety and breastmilk transfer of new drugs during a virus outbreakIn parallel with this, we will:A. Work with local communitiesB. Train researchers in our methodsC. Work with policy makers to make sure our research changes healthcare Makerere University NIHR University Of Liverpool NIHR304266 started 1 December 2024. The planned end date for NIHR304266 is 30 November 2029. 394352 434131 438991 369464 343436 GB-COH-RC000660-NIHR134530 University Of Liverpool Globally 3.8 billion people rely on polluting fuels (e.g. wood, charcoal, kerosene) for cooking. Household air pollution (HAP) from burning these fuels caused 2.3 million premature deaths in 2019 (more than HIV/AIDS, malaria and tuberculosis). With 695,000 premature deaths and 38 million Disability-Adjusted-Life-Years (DALYs) in 2019, Sub-Saharan Africa (SSA) bears a disproportionate fraction (30%) of the global HAP-related disease burden. The NIHR CLEAN-Air(Africa) Unit will accelerate the understanding of HAP-related disease burden through a unique set of studies that will (i) strengthen national health systems for community health prevention of HAP-related disease and (ii) provide evidence-based recommendations for population transition to clean household and institutional energy. The Unit will leverage the expertise of community health workers (CHWs), an overlooked frontline health promotion workforce, via implementation of a national Ministry of Health (MoH) led training of CHWs in HAP, health and prevention. This will include (i) development of curricula/ job aids in Cameroon, Rwanda and Uganda, (ii) creation of a digital platform for CHW training and health surveillance to maximise reach of training and (iii) effective rollout of training in Kenya to 140,000 CHWs. To inform national strategies to achieve UN Sustainable Development Goal (SDG) 7 (ensuring universal access to clean, modern household energy by 2030) and address the associated negative health, gender, and climate impacts of reliance on polluting cooking fuels, the Unit will collaborate with several international organisations (e.g. WHO, World Food Programme) to investigate innovations that have potential for rapid scale in SSA. We will run 5 randomised controlled trials to test technological (pay-as-you-cook LPG smart meters and pressure cookers), nutritional (pre-cooked, vitamin enhanced beans) and behavioural (cooking classes) innovations for addressing barriers to adoption and exclusive use of clean cooking fuel for households (n=620) and schools (3,600 pupils) in East Africa. A focus on institutional cooking in schools is particularly novel, with a high degree of HAP exposure to school cooks and pupils offering high value for money in terms of population-level reductions in polluting fuel use. An in-depth mixed-methods evaluation (n=400) will be conducted of a successful social entrepreneur company in Kenya providing LPG access to rural women (20,000 current users) to understand their ability to facilitate microfinance for clean cooking. Through Africa's first Air Pollution Centre of Excellence at KEMRI, we will use state-of-the-art air monitoring equipment to elucidate relationships between exposure to HAP and respiratory disease (spirometry study; n=500) and cardiovascular health (heart rate variability study using wearable technology; n=100) in Cameroon. The Unit will also quantify hidden burdens related to gender inequity (time poverty from fetching firewood) and burns/ scalds (establishment of clinical/ primary care surveillance). Research activities will begin by Year 2 after Unit launch and start of the capacity building program in Year 1. The Unit's academic trainee programme will run from Years 1-4. Our dissemination foci on (i) population awareness raising and (ii) rapid knowledge translation of research evidence to policy will be enabled through close engagement with ministerial stakeholders steering national energy strategy. University Of Liverpool NIHR Makerere Lung Institute Kenya Medical Research Institute (KEMRI) Douala General Hospital Moi University Rwanda Biomedical Research Centre University of Dar es Salaam 1380390.18 954948.64 1499189.43 1323933.19 1143257.28