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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Environmental Health Sciences (NIEHS)
Type
Research Project (R01)
Project #
5R01ES015558-04
Application #
8082695
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Gray, Kimberly A
Project Start
2008-09-17
Project End
2013-05-31
Budget Start
2011-06-01
Budget End
2012-05-31
Support Year
4
Fiscal Year
2011
Total Cost
$861,658
Indirect Cost
Name
Johns Hopkins University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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Chen, Chen; Zeger, Scott; Breysse, Patrick et al. (2016) Estimating Indoor PM2.5 and CO Concentrations in Households in Southern Nepal: The Nepal Cookstove Intervention Trials. PLoS One 11:e0157984
Soneja, Sutyajeet I; Tielsch, James M; Khatry, Subarna K et al. (2016) Highlighting Uncertainty and Recommendations for Improvement of Black Carbon Biomass Fuel-Based Emission Inventories in the Indo-Gangetic Plain Region. Curr Environ Health Rep 3:73-80
Soneja, Sutyajeet I; Tielsch, James M; Curriero, Frank C et al. (2015) Determining particulate matter and black carbon exfiltration estimates for traditional cookstove use in rural Nepalese village households. Environ Sci Technol 49:5555-62
Christian, Parul; Mullany, Luke C; Hurley, Kristen M et al. (2015) Nutrition and maternal, neonatal, and child health. Semin Perinatol 39:361-72
Ojo, Kristen D; Soneja, Sutyajeet I; Scrafford, Carolyn G et al. (2015) Indoor Particulate Matter Concentration, Water Boiling Time, and Fuel Use of Selected Alternative Cookstoves in a Home-Like Setting in Rural Nepal. Int J Environ Res Public Health 12:7558-81
Soneja, Sutyajeet; Chen, Chen; Tielsch, James M et al. (2014) Humidity and gravimetric equivalency adjustments for nephelometer-based particulate matter measurements of emissions from solid biomass fuel use in cookstoves. Int J Environ Res Public Health 11:6400-16
Tielsch, James M; Katz, Joanne; Zeger, Scott L et al. (2014) Designs of two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children and reproductive outcomes in rural Nepal. BMC Public Health 14:1271
Merritt, Maria W; Labrique, Alain B; Katz, Joanne et al. (2010) A field training guide for human subjects research ethics. PLoS Med 7: