Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda

et al. 2020

Preprint

BackgroundHousehold 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. The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however not clear whether it is possible to prevent household air pollution-related disease burdens with locally made improved cookstoves, and the evidence regarding the health effect of improved cookstove interventions among children still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the customary open burning traditional baking stove.MethodsA 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 intervention was delivered to all households allocated into the intervention arm. A total of four follow-up visits were carried out within one year at approximately 3-month intervals immediately after the delivery of the intervention. The intervention effect was estimated using odds ratio as a measure of effect following a Generalized Estimating Equations modeling approach among the intention-to-treat population.ResultsA 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 for analysis. The intervention was not found to have a statistically significant effect on the outcome with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02) compared with the continuation of an open burning traditional baking stove method. Harms: There was no difference in the overall incidence rates of cooking-related burns between arms with an incidence rate ratio of 0.80 (95% CI: 0.53–1.21), and there were no grounds to stop the trial early for adverse events.ConclusionsWe found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood acute lower respiratory infection compared with the continuation of an open burning traditional baking stove method. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood acute lower respiratory infection.

Section: Discussioncontrasting

confidence: 99%

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: Cluster randomized controlled trial

et al. 2020

Preprint

“…Our findings do, however; contradict the findings of two previous biomass-burning stove intervention studies in Rwanda and Guatemala which found evidence of health effects among children following biomass-burning ICS interventions (10,48). The Rwanda large-scale stove trial reported that a natural draft rocket-style cookstove intervention effectively reduced acute respiratory infection (ARI) prevalence by 25% among children <5 years with a prevalence ratio of 0.75 (95% CI: 0.60-0.93) (48). Correspondingly, the field experiment carried out in rural Guatemala reported a 63.3% reduction in respiratory symptoms among children following woodburning ICS intervention (10).…”

Section: Statistical Analysis Methodscontrasting

confidence: 98%

“…The longitudinal childhood ALRI prevalence rate distribution by round was showed a steep reduction followed by a slight increase in similar fashion in both arms ( Figure 2) which might be explained by time variation of the data collection rounds undertaken which is linked with seasonal factors that have a major effect on the magnitude of both ALRI and HAP in Ethiopia (41). Our findings do, however; contradict the findings of two previous biomass-burning stove intervention studies in Rwanda and Guatemala which found evidence of health effects among children following biomass-burning ICS interventions (10,48). The Rwanda large-scale stove trial reported that a natural draft rocket-style cookstove intervention effectively reduced acute respiratory infection (ARI) prevalence by 25% among children <5 years with a prevalence ratio of 0.75 (95% CI: 0.60-0.93) (48).…”

Section: Statistical Analysis Methodscontrasting

confidence: 88%

Effect of Improved Cookstove Intervention on Childhood Acute Lower Respiratory Infection in Northwest Ethiopia: Cluster Randomized Controlled Trial

et al. 2020

Preprint

BackgroundHousehold 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. The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however not clear whether it is possible to prevent household air pollution-related disease burdens with locally made improved cookstoves, and the evidence regarding the health effect of improved cookstove interventions among children still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the customary open burning traditional baking stove.MethodsA 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 intervention was delivered to all households allocated into the intervention arm. A total of four follow-up visits were carried out within one year at approximately 3-month intervals immediately after the delivery of the intervention. The intervention effect was estimated using odds ratio as a measure of effect following a Generalized Estimating Equations modeling approach among the intention-to-treat population.ResultsA 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 for analysis. The intervention was not found to have a statistically significant effect on the outcome with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02) compared with the continuation of an open burning traditional baking stove method.Harms:There was no difference in the overall incidence rates of cooking-related burns between arms with an incidence rate ratio of 0.80 (95% CI: 0.53–1.21), and there were no grounds to stop the trial early for adverse events.ConclusionsWe found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood acute lower respiratory infection compared with the continuation of an open burning traditional baking stove method. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood acute lower respiratory infection.Trial registration: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

“…Our ndings do, however; contradict the ndings of two previous biomass-burning stove intervention studies in Rwanda and Guatemala which found evidence of health effects among children following biomass-burning ICS interventions (10,48). The Rwanda large-scale stove trial reported that a natural draft rocket-style cookstove intervention effectively reduced acute respiratory infection (ARI) prevalence by 25% among children < 5 years with a prevalence ratio of 0.75 (95% CI: 0.60-0.93) (48). Correspondingly, the eld experiment carried out in rural Guatemala reported a 63.3% reduction in respiratory symptoms among children following wood-burning ICS intervention (10).…”

Section: Numbers Analyzedcontrasting

confidence: 99%

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: Cluster randomized controlled trial

et al. 2020

Preprint

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 one 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).