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A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial
Kevin Mortimer, Chifundo B Ndamala, Andrew W Naunje and 12 more
The Lancet · 2017 · Randomised trial · CC BY
doi:10.1016/s0140-6736(16)32507-7
Abstract
Background. WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children.
Methods. We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623.
Findings. We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89–16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72–16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91–1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37–2·23]; p=0·83).
Interpretation. We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed.
Funding. Medical Research Council, UK Department for International Development, and Wellcome Trust.
References 21
- 1.
Gordon SB, Bruce NG, Grigg J, et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med. 2014;2:823-60.
Not in our library10.1016/s2213-2600(14)70168-7
- 2.
Mortimer K, Gordon SB, Jindal SK, Accinelli RA, Balmes J, Martin WJ. Household air pollution is a major avoidable risk factor for cardio-respiratory disease. Chest. 2012;142:1308-15.
Not in our library10.1378/chest.12-1596
- 3.
Indoor air quality guildelines: household fuel combustion. 2014.
Not in our library
- 4.
Africa energy outlook.
Not in our library
- 5.
Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60.
Not in our library10.1016/s0140-6736(12)61766-8
- 6.
Health management information bulletin. 2005.
Not in our library
- 7.
Chihana M, Price A, Floyd S, et al. The effect of maternal HIV status on under-five mortality in rural northern Malawi:a prospective cohort study. J AIDS. 2015;68:81-90.
Not in our library10.1097/qai.0000000000000405
- 8.
Meghji J, Nadeau G, Davis K, et al. Non-communicable lung disease in sub-Saharan Africa: a community-based cross-sectional study of adults in urban Malawi. Am J Respir Crit Care Med. 2016;194:67-76.
Not in our library10.1164/rccm.201509-1807oc
- 9.
Fullerton DG, Semple S, Kalambo F, et al. Biomass fuel use and indoor air pollution in homes in Malawi. Occup Environ Med. 2009;66:777-83.
Not in our library10.1136/oem.2008.045013
- 10.
Romieu I, Riojas-Rodríguez H, Marrón-Mares AT, Schilmann A, Perez-Padilla R, Masera O. Improved biomass stove intervention in rural Mexico: impact on the respiratory health of women. Am J Respir Crit Care Med. 2009;180:649-56.
Not in our library10.1164/rccm.200810-1556oc
- 11.
Smith KR, McCracken JP, Weber MW, et al. Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomised controlled trial. Lancet. 2011;378:1717-26.
Not in our library10.1016/s0140-6736(11)60921-5
- 12.
Jetter JJ, Kariher P. Solid-fuel household cook stoves: characterization of performance and emissions. Biomass Bioenergy. 2009;33:294-305.
Not in our library
- 13.
Puzzolo E, Pope D, Stanistreet D, Rehfuess EA, Bruce NG. Clean fuels for resource-poor settings: a systematic review of barriers and enablers to adoption and sustained use. Environ Res. 2016;146:218-34.
Not in our library10.1016/j.envres.2016.01.002
- 14.
This reference’s wording can’t be shown under the paper’s licence.
Not in our library
- 15.
Mortimer K, Gordon SB. Protocol 13PRT/4689: an advanced cookstove intervention to prevent pneumonia in children younger than 5 years in Malawi: a cluster randomised controlled trial (ISRCTN59448623). The Lancet.
Not in our library
- 16.
Handbook IMCI: integrated management of childhood illness. 2005.
Not in our library
- 17.
Kalu N, Lufesi N, Havens D, Mortimer K. Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for the assessment of pneumonia in the under 5s in rural Malawi. PLoS One. 2016;11:e0155830.
Not in our library10.1371/journal.pone.0155830
- 18.
Weston W, Smedley J, Bennett A, Mortimer K. The Cooking and Pneumonia Study (CAPS) in Malawi: implementation of remote source data verification. PLoS One. 2016;11:e0155966.
Not in our library10.1371/journal.pone.0155966
- 19.
- 20.
Bruce N, Smith KR, Balmes J, et al. WHO indoor air quality guidelines: household fuel combustion. Review 4: health effects of household air pollution (HAP) exposure.
Not in our library
- 21.
Health and sustainable development. Breathlife. Clean air. Healthy future.
Not in our library
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