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Lung Health

    1. Clean Air
      • What is the health effect of air pollution on acute and chronic lung health in Malawi?
      • Which clean air interventions improve health in a cost effective way?
    2. Lung health across the lifespan
      • What is the burden, impact and determinants of chronic lung disease across the lifespan and how does this vary between urban and rural setting?
      • Which interventions will impact on developmental and childhood lung disease to mitigate their effects in adulthood
      • Acute Respiratory Illness
    3. How can improved acute care for respiratory illness reduce pneumonia morbidity and mortality?
      • Which aspects of care are amenable to low technology interventions?
    Which subset of patients would benefit from more intensive monitoring and treatment
    1. Household Air Pollution (HAP) causes 4 million deaths per year, predominantly through effects on respiratory & cardiovascular health including acute infections and chronic lung damage. It is the dominant environmental cause of death globally and in Malawi. Pneumonia is a leading cause of both child and adult death, particularly in vulnerable populations (the very young, elderly and HIV infected).
    2. A large proportion of adults in Blantyre have abnormal spirometry. This may reflect developmental lung disease (growth) or restrictive pathologies. Given the association of reduced lung volumes and increased morality, risk factors for poor lung growth offer an opportunity for intervention. The risk factors are unknown, but may include: high burdens of respiratory infections; dietary insufficiency; unclean air.
    3. Respiratory infection and sepsis has a high case mortality. Improvements in care in resource-rich settings have been driven by early recognition, and goal-driven treatments rather than expensive critical care interventions. In resource-limited settings, there is considerable uncertainty about how safe such protocols could be (see FEAST study of intravenous resuscitation in children). By investigating the relationship of treatment (oxygen, fluids, rational antimicrobial use) to physiological responses, appropriate and safe in-patient interventions will be designed and tested.
    1. a) Effect of cook stove intervention on child pneumonia;
      b) prevalence of chronic lung disease and association with HAP.
    2. As above
    3. a) Causes of adult pneumonia and risk factors for death;
      b) Susceptibility factors for pneumonia including HAP/HIV/poverty;
      c) effect of oxygen on outcome in pneumonia;
      d) role of pneumococcal vaccination in HIV.
  • Mortimer, K., et al. (2017). "A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial." Lancet 389(10065): 167-175.
    Rylance, J., et al., Household Air Pollution Causes Dose-dependent Inflammation and Altered Phagocytosis in Human Macrophages. Am J Respir Cell Mol Biol, 2014. 
    Piddock, K.C., et al., A cross-sectional study of household biomass fuel use among a periurban population in Malawi. Ann Am Thorac Soc, 2014. 11(6): p. 915-24. 
    Meghji, J., et al., Non-communicable Lung Disease in Sub Saharan Africa: a Community-based Cross-sectional Study of Adults in Urban Malawi. American Journal of Respiratory and Critical Care Medicine, 2016. 
    Gordon, S.B., et al., Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med, 2014. 2(10): p. 823-60.

    Grants supporting the work:
    DFID/MRC/Wellcome Joint Global Health Trials Development: Intravenous Fluids for Sepsis (£132,000: J Rylance 2017-)
    MRC GCRF Foundation Award: Lung health in Africa across the life course (£600,000: K Mortimer, 2017-)
    GSK: Burden of Lung Disease in Malawi (£110,000: K Mortimer, 2015 - )
    MRC Partnership Grant: BREATHE Africa (£380,000: S Gordon 2014 - )
    MRC NIRG: Lung Health and Exposure to Household Air Pollution in Malawi (£480,000: K Mortimer, 2013 - )
    Wellcome Trust Clinical PhD: (£350,000: H Jary, 2013 - )
    DFID/MRC/Wellcome Joint Global Health Trials: An advanced cookstove intervention to prevent pneumonia in children under 5 years old in Malawi: a cluster randomized controlled trial (£2,697,485: S Gordon, K Mortimer, 2012 – 2016)