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Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

ABSTRACT: BACKGROUND:Despite their potential health and social benefits, adoption and use of improved cookstoves has been low throughout much of the world. Explanations for low adoption rates of these technologies include prices that are not affordable for the target populations, limited opportunities for households to learn about cookstoves through peers, and perceptions that these technologies are not appropriate for local cooking needs. The P3 project employs a novel experimental design to explore each of these factors and their interactive effects on cookstove demand, adoption, use and exposure outcomes. METHODS:The P3 study is being conducted in the Kassena-Nankana Districts of Northern Ghana. Leveraging an earlier improved cookstove study that was conducted in this area, the central design of the P3 biomass stove experiment involves offering stoves at randomly varying prices to peers and non-peers of households that had previously received stoves for free. Using household surveys, electronic stove use monitors, and low-cost, portable monitoring equipment, we measure how prices and peers' experience affect perceptions of stove quality, the decision to purchase a stove, use of improved and traditional stoves over time, and personal exposure to air pollutants from the stoves. DISCUSSION:The challenges that public health and development communities have faced in spreading adoption of potentially welfare-enhancing technologies, like improved cookstoves, have highlighted the need for interdisciplinary, multisectoral approaches. The design of the P3 project draws on economic theory, public health practice, engineering, and environmental sciences, to more fully grasp the drivers and barriers to expanding access to and uptake of cleaner stoves. Our partnership between academic institutions, in the US and Ghana, and a local environmental non-governmental organization creates unique opportunities to disseminate and scale up lessons learned. TRIAL REGISTRATION:ClinicalTrials.gov NCT03617952 7/31/18 (Retrospectively Registered).

SUBMITTER: Dickinson KL

PROVIDER: S-EPMC6206711 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

Dickinson Katherine L KL Dalaba Maxwell M Brown Zachary S ZS Alirigia Rex R Coffey Evan R ER Mesenbring Elise E Achazanaga Manies M Agao Desmond D Ali Moro M Kanyomse Ernest E Awaregya Julius J Adagenera Clifford Amoah CA Aburiya John Bosco A JBA Gubilla Bernard B Oduro Abraham Rexford AR Hannigan Michael P MP

BMC public health 20181029 1

<h4>Background</h4>Despite their potential health and social benefits, adoption and use of improved cookstoves has been low throughout much of the world. Explanations for low adoption rates of these technologies include prices that are not affordable for the target populations, limited opportunities for households to learn about cookstoves through peers, and perceptions that these technologies are not appropriate for local cooking needs. The P3 project employs a novel experimental design to expl ...[more]

PMID: 30373560

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Project description:BackgroundHousehold air pollution from biomass fuels burning in traditional cookstoves currently appeared as one of the most serious threats to public health with a recent burden estimate of 2.6 million premature deaths every year worldwide, ranking highest among environmental risk factors and one of the major risk factors of any type globally. Improved cookstove interventions have been widely practiced as potential solutions. However, studies on the effect of improved cookstove interventions are limited and heterogeneous which suggested the need for further research.MethodsA cluster randomized controlled trial study was conducted to assess the effect of biomass-fuelled improved cookstove intervention on the concentration of household air pollution compared with the continuation of an open burning traditional cookstove. A total of 36 clusters were randomly allocated to both arms at a 1:1 ratio, and improved cookstove intervention was delivered to all households allocated into the treatment arm. All households in the included clusters were biomass fuel users and relatively homogenous in terms of basic socio-demographic and cooking-related characteristics. Household air pollution was determined by measuring the concentration of indoor fine particulate, and the effect of the intervention was estimated using the Generalized Estimating Equation.ResultsA total of 2031 household was enrolled in the study across 36 randomly selected clusters in both arms, among which data were obtained from a total of 1977 households for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The improved cookstove intervention significantly reduces the concentration of household air pollution by about 343 μg/m3 (Ḃ = - 343, 95% CI - 350, - 336) compared to the traditional cookstove method. The overall reduction was found to be about 46% from the baseline value of 859 (95% CI 837-881) to 465 (95% CI 458-472) in the intervention arm compared to only about 5% reduction from 850 (95% CI 828-872) to 805 (95% CI 794-817) in the control arm.ConclusionsThe biomass-fuelled improved cookstove intervention significantly reduces the concentration of household air pollution compared to the traditional method. This suggests that the implementation of these cookstove technologies may be necessary to achieve household air pollution exposure reductions.Trial registrationThe trial project was retrospectively registered on August 2, 2018, at the clinical trials.gov registry database ( https://clinicaltrials.gov/ ) with the NCT03612362 registration identifier number.

Project description:ObjectiveAdherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding.DesignThis was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach.SettingA multisite study conducted in four rural communities in two regions of northern Ghana.ParticipantsWe conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively.ResultsThree major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty.ConclusionThere is a substantial mismatch between communities' perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.

Project description:BackgroundPrescription drug misuse is an escalating public health problem that is prevalent among college students. Various factors, such as sex, age, race, mental health conditions, and fraternity and sorority membership, increase the risk for prescription drug misuse. Peer influences may also pose significant risks for starting prescription drug misuse, because peers are the primary source of misused prescription drugs among college students.ObjectivesTo examine college students' beliefs about prescription drug misuse among their peers and to understand their beliefs about the available and potential intervention efforts to reduce prescription drug misuse.MethodWe conducted a cross-sectional survey of 312 college students aged 18 to 30 years who were enrolled in a large midwestern US university. The survey included questions about the responders' demographic characteristics, beliefs, and perceptions regarding prescription drug misuse among their peers and potential reduction programs for prescription drug misuse.ResultsThe respondents' mean age was 21 years, and most (65%) respondents were women. A majority (90%) of the respondents were enrolled in the university as full-time students. More than 60% of the respondents reported knowing someone with prescription drug misuse in the past 12 months. Fraternity or sorority members were more likely to report peer prescription drug misuse than nonmembers (83% vs 60%, respectively; P = .017). Stimulants were the most misused drug class, accounting for 75% of all reported peer prescription drug misuse. Approximately 60% of the misused prescription drugs were sourced from peers, which included friends, roommates, and classmates. A total of 73% of respondents said that prescription drug misuse was a problem among college students and 67% agreed that interventions were needed to reduce prescription drug misuse. The perceived need for interventions varied by peer prescription drug misuse. A total of 90% of students whose peers did not misuse prescription drugs said that interventions were needed, but only 67% of those with peer prescription drug misuse thought that interventions were needed.ConclusionOur findings indicate that peer prescription drug misuse is very common among college students, and the most misused drug class is stimulants. Survey respondents perceived that the current interventions used to address prescription drug misuse are not very effective or may not be targeting the right population. Peer prescription drug misuse influences college students' perceptions about the risks and harms of prescription drug misuse, as well as the need for interventions.

Project description:BackgroundHousehold air pollution (HAP) from combustion of biomass fuel, such as wood and animal dung, is among the leading environmental risk factors for preventable disease. Close to half of the world's population relies on biomass cookstoves for their daily cooking needs. Understanding factors that affect HAP can inform measures to maximize the effectiveness of cookstove interventions in a cost-effective manner. However, the impact of kitchen and household characteristics, as well as the presence of secondary stoves, on HAP concentrations is poorly understood in Puno, Peru.ObjectiveTo explore how household characteristics explain variability of kitchen area concentrations and personal exposures to CO, PM2.5 and BC from biomass cookstoves among women in rural Peru.MethodsHousehold characteristics (including kitchen materials and layout, wealth, and cooking behaviors) and HAP measurements were collected from 180 households in Puno, Peru, from baseline measurements of a randomized trial. Kitchen area concentrations and personal exposures to carbon monoxide (CO), fine particulate matter (PM2.5) and black carbon (BC) were sampled for 48 h. We implemented simple and multivariable linear regression models to determine the associations between household characteristics and both kitchen area concentration and personal exposure to each pollutant.ResultsMean daily kitchen area concentrations and personal exposures to HAP were, on average, 48 times above World Health Organization indoor guidelines for PM2.5. We found that roof type explained the most variability in HAP and was strongly associated with both kitchen area concentrations and personal exposures for all pollutants after adjusting for other household variables. Personal exposures were 27%-36% lower for PM2.5, CO and BC, in households with corrugated metal roofs, compared to roofs made of natural materials (straw, totora or reed) after adjusting for other factors. Higher kitchen area concentrations were also associated with less wealth, owning more animals, or sampling during the dry season in multivariable models. Having a liquefied petroleum gas (LPG) stove and having a chimney were associated with lower personal exposures, but were not associated with kitchen area concentrations. Personal exposures were lower by 21% for PM2.5 and 28% for CO and BC concentrations among participants who had both LPG and biomass stoves compared to those with only biomass cookstoves adjusting for other household factors.ConclusionsCharacterizing HAP within different settings can help identify effective and culturally-relevant solutions to reduce HAP exposures. We found that housing roof type is strongly related to kitchen area concentrations and personal exposures to HAP, perhaps because of greater ventilation in kitchens with metal roofs compared to those with thatch roofs. Although HAP concentrations remained above guidelines for all households, promoting use of metal roof materials and LPG stoves may be actionable interventions that can help reduce exposures to HAP in high-altitude rural Peru and similar settings.

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Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

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Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

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