Abstract
BackgroundExposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes.DesignWe plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138).MethodsAt baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period.DiscussionFindings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide.Trial registrationClinicalTrials.gov NCT01686867
Highlights
Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide
If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide
We aim to fill this gap in knowledge by conducting a comprehensive study that encompasses evaluation of environmental, respiratory and cardiovascular health outcomes, and behavioral changes before and after an intervention with improved cookstoves with a chimney vent to the exterior, and analyze the influences on the primary cookstove user that determine her preferences for specific stove designs, motivators and barriers to adoption, and contextual data on the key behaviors associated with cooking
Summary
Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. Global burden of disease attributed to biomass fuel smoke More than half of the world population burns solid fuels, including wood, dung, crop waste, coal and charcoal, indoors for cooking. Incomplete combustion of these materials results in the production of hazardous byproducts that directly affect health [1,2]. The World Health Organization has identified indoor combustion of biomass solid fuels as one of the leading risk factors for disease burden worldwide. Biomass fuel exposure has been associated with an increased risk of respiratory infections including pneumonia [5], lung cancer [6,7], chronic obstructive pulmonary disease (COPD) [8,9,10,11,12,13,14,15,16,17], cardiovascular events, low birth weight and allcause mortality in both adults and children [18]
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