Cookstove Replacement for Prevention of ARI and Low Birthweight in Nepal

尼泊尔更换炉灶以预防急性呼吸道感染和低出生体重

• 批准号: 8281596
• 负责人: JAMES M TIELSCH
• 金额: $ 79.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-17 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8281596
• 关键词: Acute; Address; Adult; Affect; Age; Age-Months; Air; Antibiotic Therapy; Area; Asthma; Biomass; Blood Pressure; Burn injury; Carbon Monoxide; Cause of Death; Child; Child Mortality; Chlorhexidine; Chronic Disease; Communicable Diseases; Communities; Consumption; Developing Countries; Effectiveness of Interventions; Environmental Exposure; Evaluation; Exposure to; Folate; Funding; Goals; Growth; Health; Home environment; Household; Immunization; Incidence; Infant; Infection; Intervention; Iron; Life; Live Birth; Low Birth Weight Infant; Measurement; Measures; Modeling; Morbidity - disease rate; National Institute of Environmental Health Sciences; Neonatal Mortality; Nepal; Newborn Infant; Outcome; Particulate; Personal Satisfaction; Policy Maker; Population; Pregnancy; Pregnant Women; Prevention; Preventive; Randomized; Relative (related person); Research; Research Personnel; Resistance; Resources; Respiratory Tract Infections; Respiratory physiology; Risk; Rural Population; Sampling; Severities; Site; Skin; Smoke; Source; Spirometry; Supplementation; Symptoms; Testing; Time; Umbilical cord structure; Vent; Woman; Work; Zinc; base; cohort; cooking; cost; cost effective; cost effectiveness; design; effective intervention; effective therapy; high risk; improved; interest; maternal cigarette smoking; member; micronutrient deficiency; mortality; neonatal morbidity; neurodevelopment; particle; population based; programs; pulmonary function; randomized trial; reproductive; respiratory; rural area; therapy design

DESCRIPTION (provided by applicant): The goals of our research program are to determine which interventions are most effective at reducing the burden of mortality and morbidity among women and children in high-risk populations in developing countries. At our field site in southern Nepal, acute respiratory illness (ARI) has been a leading cause of mortality among young children. Besides immunization there is little evidence for effective primary preventive approaches for ARI on a population basis. Low birth weight is highly prevalent in this population as well affecting approximately 30% of live born infants. Low birth weight is a key determinant of neonatal mortality and has also been resistant to cost-effective interventions in resource poor settings. Given the lack of appropriate interventions for poor, rural areas in developing countries and the strong observational association between open burning of biomass fuel sources and ARI in young children and low birth weight, we have designed a community-based randomized trial to determine if reductions in household indoor smoke exposure can reduce the incidence and duration of acute lower respiratory infections in children <36 months of age and low birthweight among newborn infants. Household indoor smoke reduction will be accomplished by replacing the current cook stove in the household with a locally appropriate, inexpensive model that is more efficient and vented to the exterior. In addition, we will assess the impact on respiratory function and symptoms among adults in the household, including women of reproductive age, and compare total fuel consumption and time spent collecting fuel for the household. The project is a cluster-randomized, community-based trial of cookstove replacement in a rural population of southern Nepal. Households will be randomized to receive replacement of their cook stove with an appropriately designed, efficient stove that is vented to the exterior at different time periods during the course of the study. An initial period of surveillance for ARI and low birth weight will establish a baseline rate for all clusters. This will be followed by the randomized, serial replacements of cook stoves over a 12 month period. Surveillance will continue throughout this period and for an additional 6 -18 months depending on when the stove was replaced. Two cohorts of sectors will enter the trial sequentially. Measurement of indoor air particulate concentration will be conducted in a sample of households before and after stove replacement. The analysis will focus on estimating the impact on incidence of ARI in children and low birth weight among live births as a result of stove replacement. We will also assess the relative efficiency of the new stoves by identifying fuel consumption in the household and time spent collecting fuel. Approximately 4200 children 1-35 months of age will be required to observe a minimum 10% reduction in risk of ARI with 90% power. Given the expected number of live births to occur in these clusters, we can detect a 50 gram difference in birthweight with over 90% power and a type I error of 5%. PUBLIC HEALTH RELEVANCE: Lower respiratory infections and low birthweight are leading causes of death among young children in developing countries. There are few preventative measures for these problems that are cost-effective in the context of severe resource constraints. We propose to test an inexpensive approach to reducing the risk of these infections and low birthweight by reducing the exposure to airborne fine particles and carbon monoxide caused by the open burning of biomass fuel sources in the home by replacing the cookstoves with an improved, more efficient, and vented stove. If the replacement of these stoves works to reduce respiratory infections and low birthweight, significant number of children's lives can be saved at very low cost.

描述（由申请人提供）：我们的研究计划的目标是确定哪些干预措施最有效地减轻了发展中国家高风险人群中妇女和儿童的死亡率和发病率负担。在我们位于尼泊尔南部的野外现场，急性呼吸道疾病（ARI）一直是幼儿死亡的主要原因。除了免疫外，几乎没有证据表明在人群基础上采用有效的ARI预防方法。在这个人群中，低出生体重很普遍，影响了约30％的活生生婴儿。低出生体重是新生儿死亡率的关键决定因素，并且对资源不良设置的具有成本效益的干预措施也具有抵抗力。考虑到发展中国家贫困，农村地区缺乏适当的干预措施，以及在幼儿中开放燃烧生物质燃料来源和ARI之间的强烈观察性关联，我们设计了一项基于社区的随机试验，以确定家庭室内烟雾暴露的减少是否可以减少急性低呼吸症的急性下降和低生不动的急性呼吸道感染，而年龄较低的年龄少于年龄较低的生育量。家庭室内烟雾的减少将通过以当地合适，廉价的型号更有效且通向外部的当地库克炉来实现。此外，我们将评估家庭成年人（包括生殖年龄妇女）对呼吸功能和症状的影响，并比较总油耗和为家庭收集燃料所花费的时间。该项目是尼泊尔南部农村人口中的库克顿替换的集群，基于社区的试验。在研究过程中，家庭将随机分配使用适当设计的高效炉子，以适当设计的炉灶接收其库克炉的替换。 ARI和低出生体重的初始监视时期将为所有集群建立基线率。随后将在12个月内随机替换库克炉。监视将在此期间继续进行，并取决于何时更换炉子，再进行6-18个月。两个部门将依次进入试验。室内空气颗粒浓度的测量将在更换炉灶之前和之后的家庭样本中进行。该分析将着重于估计儿童对ARI发生率的影响，并且由于炉灶的替代而导致活产的低出生体重。我们还将通过确定家庭中的燃料消耗以及收集燃料的时间来评估新炉灶的相对效率。大约需要4200名儿童1-35个月大的孩子才能观察到90％功率的ARI风险至少降低10％。鉴于这些簇中预期的活产数量会发生，我们可以检测到超过90％的功率和I型错误5％的出生体重差异。公共卫生相关性：下呼吸道感染和低出生体重是发展中国家幼儿死亡的主要原因。在严重资源限制的背景下，几乎没有针对这些问题的预防措施。我们建议测试一种廉价的方法，通过减少暴露于空气中的细颗粒和碳一氧化碳，通过用改善，高效和发泄的stove替换烹饪炉，来降低这些感染的风险和低出生体重的风险。如果替换这些炉灶可减少呼吸道感染和低出生体重，则可以以非常低的成本来保存大量儿童的生活。

项目成果

Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials.

• DOI: 10.9745/ghsp-d-20-00011
• 发表时间: 2020-09-30
• 期刊: Global health, science and practice
• 作者: Katz J;Tielsch JM;Khatry SK;Shrestha L;Breysse P;Zeger SL;Kozuki N;Checkley W;LeClerq SC;Mullany LC
• 通讯作者: Mullany LC