Pneumonia remains the leading cause of death among children worldwide despite the availability of efficacious preventive and therapeutic interventions. Indoor air pollution (IAP) from biomass fuels is a risk factor for child pneumonia. The barriers to achieving high community effectiveness of IAP interventions have not been systematically examined in quantitative analyses. Further, it has not been analyzed how much the absolute benefits of IAP interventions depend on other childcare and healthcare pneumonia interventions. These analyses are needed to mitigate the policy-resistant problem of child pneumonia mortality. The objective of this developmental research is to develop, parameterize, and apply a model for the population level pneumonia effects of IAP interventions. The model will also incorporate how socioeconomic, behavioral, and infrastructure factors influence the coverage and effectiveness of interventions during implementation.
The specific aims for achieving this objective are (1) to identify interventions for reducing child IAP exposure in the study population;(2) to develop and implement a model of IAP interventions and child pneumonia;and (3) to estimate the impacts of interventions on child pneumonia in the study population in different implementation scenarios. The intervention model will be implemented as in an individual-based micro-simulation and will include multiple disease outcome states (susceptible, incident non-severe case, severe case, and death), and host and environmental characteristics that affect the transitions among disease states. The estimates of the absolute pneumonia disease and mortality benefits of IAP interventions will also take into account the presence of other childcare and healthcare interventions for pneumonia. The analysis population will be from the Upper River Division region of The Gambia. To estimate model parameters for the analysis population, we will re-analyze data from preliminary and ongoing studies on fuel use and IAP exposure, and on child pneumonia. We will also collect new data to assess the effects of socioeconomic, behavioral, and infrastructure factors on intervention coverage and effectiveness. The findings of this developmental research will be used to design a study on the community effectiveness of IAP interventions that complement other pneumonia interventions.

Public Health Relevance

Our ability to achieve the Millennium Development Goal 4 (to reduce child mortality) is severely constrained by the slow decline in child pneumonia mortality, especially in sub-Saharan Africa. The methods, models, and results of our proposed developmental research will enable researchers and health agencies to examine the potential effects of IAP interventions for child pneumonia at the population level, and to understand the socioeconomic, behavioral, and infrastructure barriers to intervention success.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-PSE-B (51))
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Dilworth, Caroline H
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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