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

Respiratory health is a major global health challenge. In urban areas of the developing world, air pollution from cars, burning of refuse and under-regulated industry pose significant health risks. In rural areas, open-fire cooking increases exposure to carbon monoxide and particulate matter, which can lead to serious long-term consequences. 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 their negative effects on human health, traditional cooking practices endanger biodiversity and contribute to global warming. Loss of trees represents lost habitats for various animal species, many of which are found only in Madagascar. The loss of ground cover also impacts the water cycle and other processes, leading to drying of the microclimate. As a result, traditional cooking practices can impact agricultural output while contributing to greenhouse gases and pollutants involved in climate change.

Working with the Duke Lemur Center’s SAVA Conservation Initiative, this Bass Connections project team investigated the health consequences of traditional cooking practices in Mandena, Madagascar.

The team traveled to Mandena in Summer 2016 to collect data on respiratory health, blood pressure, air quality and cooking practices, document sources of firewood and quantify the impact of wood extraction on nearby forests. In the fall the team analyzed data, identified focal areas of research and produced background documents with hypotheses, predictions and methods. In the spring the team focused on learning Malagasy and developing a cultural portfolio (supported by the Health Humanities Lab). The team shared findings to date at the Duke Lemur Center’s 50th Anniversary Symposium.

The team found that 93% of participants had lung capacity below healthy values. Based on the data, the team estimates that one in five community members has impaired lung function. The sleeping areas of homes had very high levels of particulate matter throughout the day, and the cooking areas of homes had extremely high levels of carbon monoxide around meal times. There were strong indications that traditional cooking practices are a culprit. In Summer 2017 the team will continue the data collection in Mandena. Further findings are expected to be shared in one or more published papers along with reports to local health authorities.


Summer 2016 – Summer 2017


Melissa Manus

Team Outputs

Marina B. Blanco, Lydia K. Greene, Libby J. Davis, Charles Welch. 2019. “Fuel use and cookstove preferences in the SAVA region,” Madagascar Conservation & Development 14(1):12-18.

Melissa B. Manus, Gerald S. Bloomfield, Ashley Sobel Leonard, Laura N. Guidera, David R. Samson, Charles L. Nunn. “High Prevalence of Hypertension in an Agricultural Village in Madagascar.” 2018. PLoS One 13(8).

Erin Litzow, Lydia K. Greene, Laura Guidera, Thomas Klug. 2017. “Cooking Practices, Human Health, and the Environment: The Case of Mandena, Madagascar.” Energy & Development (Global Energy Access Network Case Studies, Vol. 1).

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, 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, Erin Litzow)

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

Cookstoves, Respiratory Health and Conservation of Lemur Biodiversity in SAVA, Madagascar (presentation by Charlie Nunn, Duke Lemur Center 50th Anniversary Scientific Symposium, September 23, 2016)


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 student

Tommy Klug ’18

Laura Guidera ’18

Lydia Greene, PhD student in Ecology

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Multimedia Feature: Students Explore Human and Environmental Health in Madagascar

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And the Best Global Health Photos and Posters Are…

It Takes a Village: A Fieldwork Bystander’s Perspective

Missing Out Isn’t an Option

The Evolution of an Evolutionary Biologist

We’re not just collecting data. We’re really formulating new questions and identifying ways to tackle them. We’re immersed in this village. We’re getting to know the people. Ultimately, our goal is really to improve the health of this village. —Charles Nunn

We’re using different perspectives and students from different levels to address this global health issue. This is a very important component of global health—using teamwork to solve a problem. —Melissa Manus

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

Team Leaders

  • Gerald Bloomfield, School of Medicine-Medicine: Cardiology
  • Melissa Manus, Arts & Sciences-Evolutionary Anthropology
  • Charles Nunn, Arts & Sciences-Evolutionary Anthropology
  • Subhrendu Pattanayak, Sanford School of Public Policy
  • Charles Welch, Duke Lemur Center

/graduate Team Members

  • Lydia Greene, Ecology-PHD
  • Erin Litzow, Master of Environmental Management, Environmental Economics/Policy
  • Natalie Wickenkamp, Global Health - MSc

/undergraduate Team Members

  • Laura Guidera, Biology (BS)
  • Anna-Karin Hess, Program II (AB)
  • Thomas Klug, Environmental Sciences (BS), Public Policy Studies (AB2)
  • Kedest Mathewos, Economics (BS)
  • James Yu, Evolutionary Anthropology (BS)

/zcommunity Team Members

  • Brittany Carson, North Carolina Central University
  • Efe Fakir, Bahcesehir University
  • Henri Lahady, State Nurse, Madagascar
  • Prisca Raharimalala, Duke Lemur Center SAVA Conservation Initiative affiliate
  • Njaratiana Raharinoro, Graduate, Master of Biology of Animal Conservation, University of Antananarivo
  • Desire Razafimatratra, Duke Lemur Center SAVA Conservation Initiative affiliate