Cookstoves and Air Pollution in Madagascar: Finding Winning Solutions for Human Health and Biodiversity (2016-2017)


Respiratory health is a major global health challenge, especially in low- and middle-income countries. In urban areas of the developing world, air pollution from automobiles, burning of refuse and under-regulated industry pose significant health risks. In rural areas, open-fire cooking increases exposure to carbon monoxide and small and large particulate matter. This can lead to serious long-term health consequences. These health effects can asymmetrically impact those who cook and spend time near the cooking fires—women and their young children. The World Health Organization estimates that more than two million people die annually from the effects of indoor air pollution originating from household cooking fires (more deaths than are attributed to malaria).

In addition to negative effects on human health, traditional cooking practices endanger biodiversity and contribute to global warming. It is estimated that a typical family utilizing traditional cooking practices uses around two tons of firewood per year. Loss of trees reflects the loss of habitat for biodiversity. The loss of ground cover also impacts evapotranspiration and other processes, consequently drying the microclimate. Traditional cooking practices can impact agricultural output in rural communities, while contributing to greenhouse gases and pollutants involved in climate change globally.

Project Description

Working with the Duke Lemur Center’s SAVA Conservation Initiative, this project team will investigate the health consequences of traditional cooking practices in Mandena, Madagascar. Team members will quantify the consequences of current cooking practices on human respiratory health and air quality, assess the impact of wood extraction for cooking on nearby forests and wildlife and quantify human effort needed to obtain sufficient firewood and investigate whether cooking practices account for the high rates of cardiopulmonary disease observed in this population. Through this highly interdisciplinary project, we aim to produce a winning solution for the harmful impact of open-fire cooking that will benefit the health of humans, their environment and biodiversity.

The team will travel to Madagascar over two summers to investigate current cooking methods, human health and environmental degradation. The second summer the team will travel to Madagascar to help implement changes that will shift current practices to cleaner-burning cookstove technology. Students will receive training in measuring carbon monoxide and particulate matter in the air, assessing respiratory and cardiovascular health, evaluating ecological impacts of firewood extraction and running statistical tests.

Anticipated Outcomes

We anticipate that the research will result in 1-3 published papers, along with reports to local health authorities. We ultimately hope that a major deliverable will be improved cookstoves for a substantial number of households in Mandena and nearby villages.

Related Course

Seminar, Spring 2017


Spring 2016 – Summer 2017

We anticipate a six-person team in Summer 2016, with those individuals who participate effectively in 2016 invited to return in 2017. We will first recruit a team starting in January 2016. This team will be tasked with collecting key data on respiratory health, blood pressure, air quality, cooking practices, documenting sources of firewood, and quantifying the impact of wood extraction on nearby forests. This team will also conduct surveys to assess attitudes toward current cooking practices and interest in alternative options for cooking. We will hold six planning sessions at Duke prior to departing for Madagascar in July 2016. Upon return, we will hold 2-3 meetings to organize results and analyses, and present findings via two posters in the Fall 2016 Global Health Showcase. Around that time, we will recruit the second team, which will be somewhat larger. Undergraduates in this larger team will be expected to enroll in the seminar in Spring 2017, along with Ph.D. and other students who are interested in receiving credit. This team will continue the data collection in Mandena in Summer 2017, develop a plan to deliver new stoves to households during the field season and assess fuel wood usage, health impacts and attitudes toward improved stoves when in actual households.

Team Outcomes to Date

The Effects of Cooking Practices on Human and Environmental Health in Rural Madagascar (poster by Tommy Klug, Laura Guidera, Anna-Karin Hess, Lydia Greene, Melissa Manus and Brittany Carson; winner of Duke Global Health Institute Poster Award, Second Place)

Cardiovascular and Respiratory Health in Rural Madagascar (poster by Laura Guidera, Anna-Karin Hess, Tommy Klug, Lydia Greene and Erin Litzow)

Duke Global Health Institute Student Fieldwork Photo Contest, Third Place Award for “Carrying Rice” (photo by Lydia Greene)


Students Explore the Environmental Costs of Open-Fire Cooking in Madagascar

Students Explore Health Hazards of Open-Fire Cooking in Madagascar

Cookstoves, Respiratory Health and Conservation


Anna-Karin Hess '19

Erin Litzow, MEM

Tommy Klug '18

Laura Guidera '18

Lydia Greene, PhD in Ecology

This Team in the News

When Traditions Take a Toll

Multimedia Feature: Students Explore Human and Environmental Health in Madagascar

Alumna Spotlight: Melissa Manus ’16 Explores Links between Evolution and Medicine

New Projects Invigorate Bass Connections Program

Graduate Fellowship Winners Describe Their Research

Exploring Human and Environmental Health in the SAVA Region

Blue Devil of the Week: Supporting Madagascar and Its People

Bass Connections Team Members Share Their Global Health Research and Win Awards

And the Best Global Health Photos and Posters Are…

It Takes a Village: A Fieldwork Bystander’s Perspective

Missing Out Isn't an Option

See earlier related team, Shining Evolutionary Light on Global Health Challenges (2014-2015).


Faculty/Staff Team Members

Gerald Bloomfield, School of Medicine - Medicine - Cardiology*
Melissa Manus, Trinity - Evolutionary Anthropology*
Charles Nunn, Trinity - Evolutionary Anthropology*
Subhrendu Pattanayak, Sanford School of Public Policy*
Charles Welch, Duke Lemur Center*
James Yu, Trinity - Evolutionary Anthropology

Graduate Team Members

Lydia Greene, PhD in Ecology
Erin Litzow, Nicholas School - Master of Environmental Management
Melissa Manus, Master of Science in Global Health

Undergraduate Team Members

Laura Guidera, Biology (BS)
Anna-Karin Hess, Program II (BS)
Thomas Klug, Public Policy Studies (AB), Environmental Sciences (BS2)
James Yu, Evolutionary Anthropology (AB)

Community Team Members

Brittany Carson, North Carolina Central University
Henri Lahady, State Nurse, Madagascar

* denotes team leader