Dataset Information

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial.

ABSTRACT:

Background

Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove.

Methods

A cluster-randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within 1 year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population.

Results

A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89-1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline.

Conclusions

We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI.

Trial registration

The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

SUBMITTER: Adane MM

PROVIDER: S-EPMC7780395 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial.

Adane Mesafint Molla MM Alene Getu Degu GD Mereta Seid Tiku ST Wanyonyi Kristina L KL

BMC pediatrics 20210104 1

<h4>Background</h4>Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent ho ...[more]

PMID: 33397313

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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:BACKGROUND:Among the environmental risk factors, household air pollution exposure from traditional cooking practices is one of the biggest killers globally, which mainly impacts developing countries where many families rely on traditional cooking practices. Although improved cookstove adoption is central to tackle this public health issue, the efforts to disseminate cookstove technologies have faced challenges, and the adoption rates are reported to be very low in many developing countries including Ethiopia. Therefore, this study aimed to determine the magnitude and identify potential factors that may act as facilitators or barriers to adoption from users' point of view. METHODS:As part of the wider stove trial project, a cross-sectional study was conducted among a total of 5830 households under randomly selected clusters. The required data were collected through face-to-face interviews, and a backward stepwise logistic regression analysis technique was applied to evaluate the effect of potential predictor variables on adoption using adjusted odds ratio (AOR) as measures of effect. RESULTS:The prevalence of adoption was found to be 12.3% (95% CI 11.5-13.2), and households headed by females (AOR 1.96; 95% CI 1.24-3.10), private house ownership (AOR 4.58; 95% CI 3.89-6.19), separate cooking location (AOR 1.84; 95% CI 1.49-2.78), fuel purchasing (AOR 2.13; 95% CI 1.64-2.76), health benefit (AOR 1.76; 95% CI 1.15-2.70), optimistic social interaction (AOR 1.81; 95% CI 1.46-2.26), traditional suitability (AOR 1.58; 95% CI 1.28-1.95), stove use demonstration experience (AOR 2.47; 95% CI 1.98-3.07), cheap price (AOR 2.48; 95% CI 1.91-3.21), availability (AOR 1.81; 95% CI 1.5-1, 2.17), fuel-saving benefit (AOR 1.63; 95% CI 1.18-2.24), and more durable stove (AOR 1.71; 95% CI 1.30-2.26) of cookstove played a significant role as facilitators to adoption. In addition, lower educational level of head (AOR 0.31; 95% CI 0.23-0.42) and fuel processing requirement (AOR 0.55; 95% CI 0.44-0.70) of cookstove were found to be barriers for adoption. CONCLUSIONS:Extremely lower improved cookstove adoption was observed due to household- and setting-related, cookstove technology-related, user knowledge- and perception-related, and financial- and market development-related factors. Therefore, to gain successful adoption, implementers and policymakers should consider those important factors in the implementation of clean cooking solutions to the community.

Project description:BACKGROUND:Childhood acute lower respiratory infection in the form of pneumonia is recognized as the single largest cause of childhood death globally accounting for 16% of the overall deaths. Some studies also reported a higher prevalence of childhood acute respiratory infection in Ethiopia, which ranges from 16% up to 33.5%. Concerning the risk factors, there are limited community-based studies in Ethiopia in general, and in the current study region in particular. Therefore, the present study was conducted to investigate the prevalence of childhood acute respiratory infection and associated factors in Northwest Ethiopia. METHODS:As part of the wider stove trial project, a cross-sectional study was conducted in May 2018 among a total of 5830 children aged less than 4 years old in randomly selected clusters. Binary logistic regression was applied to identify factors linked with childhood acute lower respiratory infection and adjusted odds ratios were used as measures of effect with a 95% confidence interval. RESULTS:A total of 5830 children were included in the study within 100 clusters. Out of which 51.7% were male and 48.3% female. The prevalence of childhood lower acute respiratory infection was 19.2% (95% CI: 18.2-20.2) and found to decrease among children living in homes with chimney, eaves space and improved cookstove than children living in households with no chimney, eaves space and improved cookstove with estimated AOR of 0.60 (95% CI: 0.51-0.70), 0.70 (95% CI: 0.60-0.84) and 0.43 (95% CI: 0.28-0.67) respectively. It was also associated with other cooking-related factors such as cow dung fuel use [AOR = 1.54 (95% CI: 1.02-2.33)], child spending time near stove during cooking [AOR = 1.41 (95% CI: 1.06-1.88), presence of extra indoor burning events [AOR = 2.19 (95% CI: 1.41-3.40)] and with frequent cooking of meals [AOR = 1.55 (95% CI: 1.13-2.13)]. CONCLUSION:High prevalence of childhood acute lower respiratory infection was demonstrated by this study and it was found to be associated with household ventilation, cooking technology, and behavioral factors. Therefore, we recommend a transition in household ventilation, cooking technologies as well as in child handling and in the peculiar local extra indoor burning practices.

Project description:BackgroundPoor air quality of the household is likely to be the largest public health concern in resource-constrained countries. Exposure to household air pollution, poor working environment, and fuel type used at household level have been associated with respiratory symptoms. This study aimed to assess acute respiratory symptoms and its associated factors among mothers who have under five-years-old children in Gondar city, northwest Ethiopia.MethodA cross-sectional study was carried out from February 15, 2019 to June 20, 2019. Study participants were selected using simple random sampling, and data were collected via face-to-face interviews. Binary logistic regression analysis was used to test the association of explanatory and outcome variables. Variables with p < 0.05 were considered as significantly associated with the outcome variable.ResultsThe prevalence of respiratory symptoms among mothers of under-five years-old children in this study was 46.1%. Education (vocational training compared to cannot read and write) (adjusted odd ratio (AOR) = 0.26 at 95% confidence interval (CI): 0.08-0.82), working in dusty environment (AOR = 2.90 at 95% CI: 1.39-6.08), wood fire use (AOR = 0.37 at 95% CI: 0.16-0.85), living in mud- and wood-walled houses (AOR = 0.53 at CI: 0.32-0.89), recent house painting (AOR = 1.95 at 95% CI: 1.03-3.69), new carpet (AOR = 2.02 at 95% CI: 1.08-3.77), pesticide use (AOR = 1.71 at 95% CI: 1.03-2.84), damp stain (AOR = 2.45 at 95% CI: 1.04-5.75), spending longer time in house for 6 to 11 h (AOR = 2.59 at 95% CI: 1.53-4.37) and 11 to 15 h (AOR = 3.47 at 95% CI: 1.87-6.43), and living less than 100 m from unpaved roads/streets (AOR = 4.35 at 95% CI: 2.64-7.18) were significantly associated with respiratory symptoms among mothers of under-five years-old children.ConclusionRespiratory symptoms were common among mothers who have under five-years-old children. Air quality improvement, fuel selection, and residential planning will help to reduce respiratory symptoms.

Project description:BackgroundChildhood diarrhea continues to be a public health problem in developing countries, including Ethiopia. Detecting clusters and trends of childhood diarrhea is important to designing effective interventions. Therefore, this study aimed to investigate spatiotemporal clustering and seasonal variability of childhood diarrhea in northwest Ethiopia.MethodsRetrospective record review of childhood diarrhea was conducted using quarterly reported data to the district health office for the seven years period beginning July 1, 2007. Thirty three districts were included and geo-coded in this study. Spatial, temporal and space-time scan spatial statistics were employed to identify clusters of childhood diarrhea. Smoothing using a moving average was applied to visualize the trends and seasonal pattern of childhood diarrhea. Statistical analyses were performed using Excel® and SaTScan programs. The maps were plotted using ArcGIS 10.0.ResultsChildhood diarrhea in northwest Ethiopia exhibits statistical evidence of spatial, temporal, and spatiotemporal clustering, with seasonal patterns and decreasing temporal trends observed in the study area. A most likely purely spatial cluster was found in the East Gojjam administrative zone of Gozamin district (LLR = 7123.89, p <0.001). The most likely spatiotemporal cluster was detected in all districts of East Gojjam zone and a few districts of the West Gojjam zone (LLR = 24929.90, p<0.001), appearing from July 1, 2009 to June 30, 2011. One high risk period from July 1, 2008 to June 30, 2010 (LLR = 9655.86, p = 0.001) was observed in all districts. Peak childhood diarrhea cases showed a seasonal trend, occurring more frequently from January to March and April to June.ConclusionChildhood diarrhea did not occur at random. It has spatiotemporal variation and seasonal patterns with a decreasing temporal trend. Accounting for the spatiotemporal variation identified in the study areas is advised for the prevention and control of diarrhea.

Project description:BackgroundVisceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia.MethodsA hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05.ResultsAmong 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI.ConclusionAKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.

Project description:INTRODUCTION:Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3. METHODS:Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed. RESULTS:Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%-10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2-3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit. CONCLUSIONS:An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.

Project description:IntroductionAlthough hypertension is highly prevalent in Ethiopia, it is poorly diagnosed, treated and controlled. Poor access to care and a shortage of healthcare providers are major barriers. This study aims to evaluate the effects of health extension workers' led home-based intervention on hypertension management in patients with hypertension in rural districts of northwest Ethiopia.Methods and analysisA two-arm cluster randomised controlled trial will be conducted among 456 hypertensive patients. Adults aged ≥25 years who have a diagnosis of hypertension both in the home-based hypertension screening study and at another measurement prior to recruitment will be eligible for the study. Randomisation will be done at the kebele level. In the intervention clusters, trained health extension workers will provide home-based intervention for hypertensive patients every 2 months for 9 months. The primary outcomes of the trial will be clinical linkage and blood pressure changes, whereas the secondary outcomes will be lifestyle modification, medication adherence and blood pressure control. Intention-to-treat analysis will be used for all primary analyses. A linear mixed-effect regression model will be used to model the change in blood pressure, while a mixed effect logistic regression model will be used to evaluate the intervention's effect on the binary outcomes. Effect sizes such as mean difference for the continuous outcomes and relative risk, attributable risk and population attributable risk for binary outcomes will be used. All statistical analyses are two sided and a p<0.05 will be used.Ethics and disseminationThis study has been approved by institutional review board of the University of Gondar (Ref. No: V/P/RCS/05/2293/2020). The district's health office will grant permission for cluster randomisation, and each participant will provide written informed consent for participation. The findings will be presented at scientific conferences and published in peer-reviewed scientific journals.Trial registration numberPACTR202102729454417.

Project description:BackgroundThe period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization.MethodsA double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model.ResultOf 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4-24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31-8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15-2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71-7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18-0.59) less likely to attend three postnatal care visit.ConclusionsThe implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother's decision.Trial registrationClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030 .

Dataset Information

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial.

Background

Methods

Results

Conclusions

Trial registration

Publications

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial.

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