The International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA)

About half of the world's population, including 700 million people in Africa, depends on biomass fuel energy for everyday use. As these fuels are usually burnt indoors and in open fires that emit smoke into the household environment, they often lead to extreme levels of household air pollution. Photo: Morgana Wingard/Flickr

Women and children, moreso young children, are usually the most exposed to air pollution in the home. This has been linked to a range of adverse health outcomes including non-communicable lung diseases like chronic obstructive pulmonary disease (COPD) and lung cancer in adults and asthma in children. Photo: Teseum/Flickr

Biomass smoke is the third leading cause of global disability and death, accounting for up to 4 million deaths annually from exposure. This level of ill-health and loss of life is particularly burdensome for the poorest people and communities in the sub-Saharan Africa region, in particular. Photo: Carlos Fernandez/Flickr

Smoking has been shown to be a crucial current and future health risk to the African population, interfacing with other already prevalent environmental factors such as tuberculosis and workplace pollutants. Photo: Candace/Flickr

The health effects of smoking have been well-documented, especially with regards to its impact on life expectancy as a result of heart and lung conditions, and on birth outcomes, among other health factors. These effects have seen the prevalence rates of lung cancer and other diseases increase, putting additional stress on the capacity of Africa's health facilities. Photo: Jan Truter/Flickr

Shisha, which has become increasingly popular among the youth and women in Africa, contains tobacco. Therefore, like cigarettes it contains nicotine, tar, carbon monoxide and heavy metals, such as arsenic and lead. Photo: Carsten ten Brink/Flickr

Shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy. Photo: Marwa Morgan/Flickr

Overview Interventions Outcomes Partners

Globally, an estimated 1 billion people suffer from acute and chronic respiratory problems, contributing to 4 million deaths worldwide. Tuberculosis (TB) for example, is one of the leading causes of death with 1.5 million deaths recorded in 2018 alone, one-quarter of which were in Africa. Actually, Africa has a massive and growing burden of respiratory diseases, beyond just TB, including illnesses such as asthma, chronic obstructive pulmonary disease, acute respiratory infections, and lung cancer.

Despite this, lung health remains under-funded and under-researched. IMPALA seeks to change that narrative by generating scientific knowledge and implementable solutions for issues related to lung health in Africa. IMPALA involves multi-disciplinary collaborative work with scientists from Africa and the UK in clinical and public health, applied social science, health systems, health economics and modelling, and implementation science disciplines. The programme, spanning 10 African countries, built upon a critical mass of internationally excellent clinical and applied health scientists who are experts in lung health and strengthens the capacity of emerging interdisciplinary lung health researchers from Africa.

[Statistics from the WHO Global Tuberculosis Report 2019 and Global Impact of Respiratory Disease – Second Edition (2017)]

IMPALA included high-impact applied health research on non-communicable lung diseases, acute lung disease, tobacco-related diseases, air pollution and TB across 10 countries [Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Africa, Sudan Republic, Tanzania, Uganda] in Sub Saharan Africa. A large part of the research was conducted through eight multidisciplinary doctoral and postdoctoral research projects, whose summaries can be accessed on the IMPALA information sheet, while additional research was carried out by lung health experts within the IMPALA consortium (learn more).

AFIDEP co-led IMPALA’s Pathways to Impact component which aimed to ensure that IMPALA’s research was more than an academic exercise. Ultimately, we wanted the evidence generated to be translated into policy and practice for maximum impact. To achieve this, AFIDEP had the following interventions:

Capacity strengthening for IMPALA researchers on effective research translation and policy engagement
- 5-day Policy Engagement and Evidence Uptake Training for IMPALA PhD students, January 2018, 23 total participants including 5 PhD students. Read more
- Technical support to PhD students on conducting policy analyses on their research topics
- 2-day Policy Engagement and Evidence Uptake for IMPALA post-doctoral students and country Principle Investigators, June 2019, 31 total participants including 5 IMPALA post-docs and 13 country Principle Investigators. Read more
- Technical support in national policy and communications strategies which project teams are now implementing and effectively generating support for their research to inform policy and programme interventions
Policy research to explore how to address policy barriers to promoting behaviours and environments that protect lung health in Africa
- Preliminary Regional Stakeholder and Policy Analysis – IMPALA
- Regional lung health policy analysis
- National chronic lung disease policy analyses for Kenya, Malawi, and Uganda
- Survey administered to IMPALA programme to identify key stakeholders, major lung health issues, lung health policy and programme gaps, and conditions needed to improve lung health in Africa

Facilitation of policy engagement at the national level as well as strategies to influence regional and global lung health policy

- IMPALA information sheet
- World TB Day outreach
- Regional engagements at key events, such as the United Nation’s High-Level |Tuberculosis Symposium in Stellenbosch, South Africa
- Post TB stakeholder workshop in Kenya

Strengthened capacity of the IMPALA project teams to effectively undertake policy engagement and evidence uptake activities at national and regional levels
Identified policy barriers to promoting behaviours and environments that protect lung health
Generated demand for and enabled the utilisation of IMPALA research in policy and programme decisions

In Kenya, AFIDEP convened the first stakeholder’s forum on Post TB Lung Disease in conjunction with the Division of National TB, Leprosy and Lung Disease Program (DNTLD) on 3^rd February 2020. The deliberations of this meeting have fed into the draft DNTLD integrated guidelines which for the first time include content on Post TB Lung Disease. The final guidelines will be available in late 2020.
IMPALA actively participated in the first ever United Nations High Level Meeting on TB 25^th September 2018 where heads of states made commitments to ensure the following targets are achieved in order to END TB: Treat 40 million people with TB between 2018 and 2022; 3.5 million children with TB, 1.5 million people with drug-resistant TB; and at-least 30 million put on TB Preventive Treatment.

The International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA), hosted and led by the Liverpool School of Tropical Medicine (LSTM), was a collaboration of 15 partner institutions which are conducting research across 10 African countries:

Cameroon: University of Douala
Ethiopia: Addis Ababa University
Sudan: Epidemiological Laboratory (Epi-Lab)
Kenya: AFIDEP, Kenya Medical Research Institute
Ghana: Kwame Nkrumah University of Science and Technology
Uganda: Makerere University
Malawi:
- AFIDEP
- Malawi Liverpool Wellcome Trust Clinical Tropical Research Programme
- REACH Trust
Tanzania:
- National Tuberculosis and Leprosy Programme
- National Institute for Medical Research
South Africa:
- Stellenbosch University
- University of Cape Town
- Pan African Thoracic Society
- Education for Health Africa
Nigeria:
- University of Ibadan

International respiratory societies, organisations and health policy research consortia, with strong representation from Low and Middle-Income Countries (LMICs), have been involved in prioritising relevant research topics and themes and will provide strategic guidance for IMPALA. These include:

Lung Health in Africa (LHIA)
Pan African Thoracic Society (PATS)
PATS Methods In Epidemiologic Clinical And Operations Research (MECOR)
Biomass Reduction and Environmental Air Towards Health Effects (BREATHE)-Africa
American Thoracic Society (ATS)
The International Union Against Tuberculosis and Lung Disease (IUATLD)
Vital Strategies
The Malawi-Liverpool Welcome Trust Clinical Research Programme (MLW)
Burden of Obstructive Lung Disease (BOLD) Initiative
The Global Asthma Network (GAN)
Spirometry Training Services Africa

Key Details

Dates:	June 2017 to April 2021
Aim:	The IMPALA project intended to expand the scientific knowledge and implementable solutions for issues related to lung health in Africa. More specifically, AFIDEP’s role on IMPALA was to have other lung health diseases and not just TB, on the regional health policy agenda.
Where:	Cameroon , Ethiopia , Ghana , Kenya , Malawi , Nigeria , South Africa , Sudan , Tanzania , Uganda
Project Manager:	Brenda Nyambura