Feasibility intervention trial of two types of improved cookstoves in three resource-limited settings: study protocol for a randomized controlled trial

Trials

William Checkley⁴  Patrick N Breysse⁷  Charles B Sherman¹  E Jane Carter¹  Marilu Chiang²  Sylvester Kimaiyo⁵  Neha Naithani⁴  Robert Dreibelbis⁴  Caitlin Kennedy⁴  James M Tielsch⁴  Robert H Gilman²  Diana Menya⁵  Subarna Khatry⁴  J Jaime Miranda³  Elizabeth Klasen⁶ 

[1] The Warren Alpert Medical School, Brown University, Providence, RI, USA;Biomedical Research Unit, Asociacion Benefica PRISMA, Lima, Peru;CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru;Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;School of Public Health, Moi University, Eldoret, Kenya;Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave, Suite 9121, Baltimore, MD 21205, USA;Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

关键词: Biomass fuel;    Spirometry;    DLCO;    Indoor air pollution;    Adoption;    Behavior change;    Ventilated cookstove;    Improved cookstove;   

Others  :  1092936
DOI  :  10.1186/1745-6215-14-327

 received in 2013-06-05, accepted in 2013-10-01,  发布年份 2013

【 摘 要 】

Background

Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes.

Design

We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138).

Methods

At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period.

Discussion

Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide.

Trial registration

ClinicalTrials.gov NCT01686867

【 授权许可】

   
2013 Klasen et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Torres-Duque C, Maldonado D, Pérez-Padilla R, Ezzati M, Viegi G: Forum of International Respiratory Studies (FIRS) Task Force on Health Effects of Biomass Exposure. Biomass fuels and respiratory diseases: a review of the evidence. Proc Am Thorac Soc 2008, 5:577-590.
• [2]Bruce N, Perez-Padilla R, Albalak R: Indoor air pollution in developing countries: a major environmental and public health challenge. Bull World Health Organ 2000, 78:1078-1092.
• [3]Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, et al.: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380:2224-2260.
• [4]Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, Orduz C, Guevara DP, Maldonado D: Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest 2008, 133:343-349.
• [5]Bautista LE, Correa A, Baumgartner J, Breysse P, Matanoski GM: indoor charcoal smoke exposure and acute respiratory tract infections in young children in the Dominican Republic. Am J Epidmiol 2009, 169:572-580.
• [6]Liu Q, Sasco AJ, Riboli E, Hu MX: Indoor air pollution and lung cancer in Guangzhou, People’s Republic of China. Am J Epidemiol 1993, 137:145-154.
• [7]Ko YC, Lee CH, Chen MJ, Huang CC, Chang WY, Lin HJ, Wang HZ, Chang PY: Risk factors for primary lung cancer among non-smoking women in Taiwan. Int J Epidemiol 1997, 26:24-31.
• [8]Bruce N, Neufeld L, Boy E, West C: Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala. Int J Epidemiol 1998, 27:454-458.
• [9]Dennis RJ, Maldonado D, Norman S, Baena E, Martinez G: Woodsmoke exposure and risk for obstructive airways disease among women. Chest 1996, 109:115-119.
• [10]Menezes AM, Victora CG, Rigatto M: Prevalence and risk factors for chronic bronchitis in Pelotas, RS, Brazil: a population-based study. Thorax 1994, 49:1217-1221.
• [11]Orozco-Levi M, Garcia-Aymerich J, Villar J, Ramírez-Sarmiento A, Antó JM, Gea J: Wood smoke exposure and risk of chronic obstructive pulmonary disease. Eur Respir J 2006, 27:542-546.
• [12]Shrestha IL, Shresta SL: Indoor air pollution from biomass fuels and respiratory health of the exposed population in Nepalese households. Int J Occup Environ Health 2005, 11:150-160.
• [13]Rinne ST, Rodas EJ, Bender BS, Rinne ML, Simpson JM, Galer-Unti R, Glickman LT: Relationship of pulmonary function among women and children to indoor air pollution from biomass use in rural Ecuador. Respir Med 2006, 100:1208-1215.
• [14]Ramırez-Venegas A, Sansores RH, Perez-Padilla R, Regalado J, Velázquez A, Sánchez C, Mayar ME: Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco. Am J Respir Crit Care Med 2006, 173:393-397.
• [15]Akhtar T, Ullah Z, Khan MH, Nazli R: Chronic bronchitis in women using solid biomass fuel in rural Peshawar, Pakistan. Chest 2007, 132:1472-1475.
• [16]Liu S, Zhou Y, Wang X, Wang D, Lu J, Zheng J, Zhong N, Ran P: Biomass fuels are the probable risk factor for chronic obstructive pulmonary disease in rural South China. Thorax 2007, 62:889-897.
• [17]Perez-Padilla R, Regalado J, Vedal S: Exposure to biomass smoke and chronic airway disease in Mexican women. A case–control study. Am J Respir Crit Care Med 1996, 154:701-706.
• [18]Fullerton DG, Bruce N: Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg 2008, 102:843-851.
• [19]Smith-Sivertsen T, Díaz E, Pope D, Lie RT, Díaz A, McCracken J, Bakke P, Arana B, Smith KR, Bruce N: Effect of reducing indoor air pollution on women’s respiratory symptoms and lung function: the RESPIRE Randomized Trial, Guatemala. Am J Epidemiol 2009, 170:211-220.
• [20]Mannino DM, Braman S: The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007, 4:502-506.
• [21]Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006, 367:1747-1757.
• [22]Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380:2095-2128.
• [23]Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380:2197-2223.
• [24]Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997, 349:1498-1504.
• [25]Lin HH, Murray M, Cohen T, Colijn C, Ezzati M: Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study. Lancet 2008, 372:1473-1483.
• [26]Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, Menezes AM, Sullivan SD, Lee TA, Weiss KB, Jensen RL, Marks GB, Gulsvik A, Nizankowska-Mogilnicka E: BOLD Collaborative Research Group: International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007, 370:741-750.
• [27]Buist AS, Vollmer WM, McBurnie MA: Worldwide burden of COPD in high- and low-income countries. Part I. The burden of obstructive lung disease (BOLD) initiative. Int J Tuberc Lung Dis 2008, 12:703-708.
• [28]Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA: BOLD Collaborative Research Group: COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 2011, 139:752-763.
• [29]Wise RA: The value of forced expiratory volume in 1 second decline in the assessment of chronic obstructive pulmonary disease progression. Am J Med 2006, 119:4-11.
• [30]Pederson OF: The Peak Flow Working Group: physiological determinants of peak expiratory flow. Eur Respir J 1997, 10(Suppl 24):11-16.
• [31]Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF: Peak expiratory flow: conclusions and recommendations of a Working Party of the European Respiratory Society. Eur Respir J 1997, 10(Suppl 24):2-8.
• [32]Paoletti P, Paggiaro PL, Lebowitz M: Environmental factors in PEF variability. Eur Respir J 1997, 10(Suppl 24):64-66.
• [33]Gannon PF, Burge PS: Serial peak expiratory flow measurement in the diagnosis of occupational asthma. Eur Respir J 1997, 10(Suppl 24):57-83.
• [34]Smith KR: Indoor air pollution in developing countries: recommendations for research. Indoor Air 2002, 12:198-207.
• [35]Smith KR, McCracken JP, Weber MW, Hubbard A, Jenny A, Thompson LM, Balmes J, Diaz A, Arana B, Bruce N: Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomised controlled trial. Lancet 2011, 378:1717-1726.
• [36]Fitzgerald C, Aguilar-Villalobos M, Eppler AR, Dorner SC, Rathbun SL, Naeher LP: Testing the effectiveness of two improved cookstove interventions in the Santiago de Chuco Province of Peru. Sci Total Environ 2012, 15:54-64.
• [37]Edwards RD, Liu Y, He G, Yin Z, Sinton J, Peabody J, Smith KR: Household CO and PM measured as part of a review of China’s National Improved Stove Program. Indoor Air 2007, 17:189-203.
• [38]Dutta K, Shields K, Edwards R, Smith KR: Impact of improved biomass cookstoves on indoor air quality near Pune. India Energ Sustain Dev 2007, 11:19-32.
• [39]Mukhopadhyay R, Sambandam S, Pillarisetti A, Jack D, Mukhopadhyay K, Balakrishnan K, Vaswani M, Bates MN, Kinney PL, Arora N, Smith KR: Cooking practices, air quality, and the acceptability of advanced cookstoves in Haryana, India: an exploratory study to inform large-scale interventions. Glob Health Action 2012, 5:1-13.
• [40]Gall ET, Carter EM, Earnest CM, Stephens B: Indoor air pollution in developing countries: research and implementation needs for improvements in global public health. Am J Public Health 2013, 103:e67-e72.
• [41]Barnes B: Interventions to reduce child exposure to indoor air pollution in developing countries: behavioral opportunities and research needs. Children, Youth and Environments 2005, 15:67-82.
• [42]Liu LJ, Slaughter JC, Larson TV: Comparison of light scattering devices and impactors for particulate measurements in indoor, outdoor, and personal environments. Environ Sci Technol 2002, 36:2977-2986.
• [43]Howard-Reed C, Rea AW, Zufall MJ, Burke JM, Williams RW, Suggs JC, Sheldon LS, Walsh D, Kwok R: Use of a continuous nephelometer to measure personal exposure to particles during the U.S. Environmental Protection Agency Baltimore and Fresno panel studies. J Air Waste Manage Assoc 2000, 50:1125-1132.
• [44]Quintana PJ, Samimi BS, Kleinman MT, Liu LJ, Soto K, Warner GY, Bufalino C, Valencia J, Francis D, Hovell MH, Delfino RJ: Evaluation of a real-time passive personal particle monitor in fixed site residential indoor and ambient measurements. J Expo Anal Environ Epidemiol 2000, 10:437-445.
• [45]Chakrabarti B, Fine PM, Delfino R, Sioutas C: Performance evaluation of the active-flow personal DataRAM PM2.5 mass monitor (Thermo Anderson pDR-1200) designed for continuous personal exposure measurements. Atmos Environ 2004, 38:3329-3340.
• [46]Lohman TG, Roche AF, Martorell R: Anthropometric Standardization Reference Manual. Champaign: Human Kinetics Books; 1988.
• [47]Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force: Standardisation of spirometry. Eur Respir J 2005, 26:319-338.
• [48]Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller MR, Navajas D, Pedersen OF, Pellegrino R, Wanger J: Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 2005, 26:720-735.
• [49]Hanna R, Duflo E, Greenstone M: Up in smoke: the influence of household behavior on the long-run impact of improved cooking stoves. SSRN Electronic J 2012. http://www.ssrn.com/abstract=2039004 webcite
• [50]Ezzati M: Indoor air pollution and health in developing countries. Lancet 2005, 366:104-106.