Practicum Studying Impact of Cookstoves in Mozambique Leads to Publication

Environmental and Occupation Health MPH Student Ans Irfan is the kind of person who makes things happen. His experience of doing his practicum project working with the World Bank is no exception.

Ans initially learned about the opportunity to do this practice experience project through the Environmental Health Science & Policy Program's Practicum Director, Associate Professor Peter LaPuma.  He put Ans in touch with Professorial Lecturer Susan Anenberg, co-founder of Environmental Health Analytics and an expert in assessing the health benefits of mitigating air pollution and climate change.  When he contacted her, Ans expressed a preference for applied-research work with the potential to catalyze a policy change.  “I am trained as a medical doctor, and I wanted to do something public health practice-oriented that could make a bigger difference at the population level,” he explains. 

Anenberg assigned Ans to work on a project for the World Bank intended to inform decisions about public health in Mozambique, where 95% of households burn solid fuels—mainly wood and charcoal—for cooking.  The project appealed to Ans because it included assessing both household air pollution exposure and strategies to mitigate the exposure’s impacts.  Each year, more than 4 million people, mainly women and children in the developing world, die prematurely from exposure to smoke from cooking with solid fuels, according to the World Health Organization (WHO). 

As Assistant Professor Amanda Northcross, who Ans credits for furthering his interest in air pollution and cookstoves, explains:  “Cooking with solid fuels like wood, charcoal, and coal is inefficient and creates a lot of smoke.  Inhaling that smoke on a daily basis creates significant health impacts.  To reduce these health impacts, a key primary goal is to provide clean cooking solutions to ensure that everyone can have access to clean air within their home.” 

Burning solid fuels can expose people to small particles that can travel deep into the lungs.  These particles are technically known as particulate matter and grouped into two sizes:  less than 10 micrometers (PM10) and smaller than 2.5 micrometers (PM2.5).  Exposure to PM has been linked to respiratory symptoms, the aggravation of asthma, and an increase in hospital admissions, as well as increased mortality from cardiovascular and respiratory diseases and from lung cancer. 

Ans grew up in a rural part of Pakistan where rudimentary cookstoves were the norm, and he went back to Pakistan to practice medicine at a community health center for a year as part of his medical education at the Xinjiang Medical University in China.  (Ans is fluent in Mandarin and four other languages in addition to English.)  He credits his public health studies for broadening his perspective of human health, and he now recognizes that medical practitioners should be asking patients, particularly women, about potential exposures including cooking practices because of the impacts on human health.  “At present, this isn’t happening, especially in developing countries, and that’s a fundamental flaw in clinical medicine” Ans says.

“Like a kid in a candy shop.”

After finishing his medical education in China, Ans joined GW in Fall ’15 to study public health. “I fell head over heels in love with public health.  I am like a kid in a candy shop.  Every single one of these classes makes me very happy,” he says.

Ans began his practicum last summer with a group of collaborators including Anenberg, whose expertise includes understanding the impact of different household cooking fuels on the health of both individual families and the climate.  The team also included researchers from Boston University, the University of California at Berkeley, and the University of Colorado.  The project was coordinated by Gary Kleiman, a senior environmental specialist at the World Bank Group focused on air quality and climate planning for state and national governments. The group used state-of-the-science methods to estimate the potential air quality, health, and climate co-benefits of expanding Mozambique's use of cleaner woodstoves in rural areas and modern charcoal and liquefied petroleum gas (LPG) stoves in urban areas.

The research team concluded that cleaner cooking stoves could help achieve both health and climate benefits. However, Anenberg noted that a key challenge in estimating the potential health benefits from clean cookstove interventions is that very little information exists about real-world population exposure levels before and after the intervention. Ans developed a sensitivity analysis calculating public health benefits given different levels of baseline and intervention exposures. “The sensitivity analysis that Ans developed is critical," Anenberg explains. "As exposure measurements in Mozambique become available, the sensitivity analysis can be used to update the expected health benefits from cleaner cookstoves.”

Before the practicum started, Ans had a goal of publishing the research to highlight not only the existing challenges faced by citizens in Mozambique, as well as the many other countries where cooking with solid fuels remains the norm, but also the many workable solutions. Ans credits Anenberg for her mentorship and “teaching me so much more than I expected” in the process of conducting the analysis and developing the publication. 

To produce the paper, Ans devoted “many hours” to writing the background, completing sensitivity analyses, and using the Household Air Pollution Intervention Tool (HAPIT) to estimate and compare health benefits attributable to stove and/or fuel programs that reduce exposure to household air pollution (HAP) resulting from solid fuel use in traditional stoves in developing countries.  “It was a very hard and grueling process,” Ans says.  The paper, “Air pollution-related health and climate benefits of clean cookstove programs in Mozambique,” was recently published in Environmental Research Letters, an open access journal. 

Ans will be graduating in May ’17 from both GW and Georgetown University where he is concurrently studying international migration. From there, he intends to “pursue my passion for public health, which is also the pursuit of happiness for me.  The only thing I love more than public health is the most important man in my life, my dog, Buster” (pictured above). The many areas where he is interested in bringing his not inconsiderable talents to bear include public health practice, environmental justice, climate change and its impacts on human health and migration, health equity, and occupational health. 

Ans eventually sees himself in roles involving public health practice and “building on existing progress and actively applying, in the field, the excellent research being conducted” in addition to international development in the health sector.  This could encompass being in a leadership capacity in a public health organization, ideally in a public service role. But no matter what the specifics of his future role may be, Ans says his love of education ensures that he “will continue teaching regardless of the day job.”  He thanks all his professors and mentors at GW for supporting him well beyond the classroom setting.   “I look forward to their advice and working with them for years to come,” he says confidently.