Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and water filters in Western Province, Rwanda
Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and water filters in Western Province, Rwanda
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DOI：
10.1016/j.conctc.2016.07.003
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发表时间：
2016-12-15
影响因子：
1.5
通讯作者：
Clasen, Thomas F.
中科院分区：
文献类型：
--
作者：
Nagel, Corey L.;Kirby, Miles A.;Clasen, Thomas F.
背景：在卢旺达，肺炎和腹泻分别是五岁以下儿童死亡的第一和第二大原因。在室内用传统炉灶上的生物质燃料做饭造成的家庭空气污染是肺炎的一个重要风险因素，而饮用受污染的饮用水是腹泻疾病的主要原因。到目前为止，还没有对在低收入国家大规模提供改进的炉灶或家用滤水器的方案努力进行大规模有效性试验。在这篇文章中，我们描述了一项整群随机试验的设计，以评估一项国家级计划的影响，该计划旨在向卢旺达最贫穷的四分之一的家庭分发和推广使用改进的炉灶和先进的滤水器。方法/设计：我们随机分配西部省的72个区(行政定义的单位)进行干预，该省其余24个区作为对照。在干预部门，大约10万户家庭通过一个政府资助的项目获得了改进的炉灶和家用滤水器，该项目针对的是全国最贫穷的四分之一的家庭。主要的结果指标是5岁以下儿童的急性呼吸道感染(ARI)和腹泻的发生率。在一年的监测期内，研究地区卫生工作者确定的所有急性呼吸道感染和腹泻病例将从卫生机构和社区卫生工作者保存的记录中提取。此外，我们正在研究区域内随机抽样的家庭中进行密集、纵向的数据收集，以深入评估覆盖范围、使用情况、环境暴露和额外的健康措施。讨论：尽管先前的研究检查了提供家庭水处理和改进的炉灶对儿童健康的影响，但还没有关于在发展中国家大规模提供这些干预措施的国家级计划的研究。这项研究的结果是大规模计划炉灶或家庭滤水器干预的首次随机对照试验，将为减少腹泻疾病和肺炎的儿童发病率和死亡率的全球努力提供信息。(C)2016年提交人。由Elsevier Inc.出版。这是一篇CC BY-NC-ND许可下的开放获取文章。
Background: In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking water is a primary cause of diarrheal disease. To date, there have been no largescale effectiveness trials of programmatic efforts to provide either improved cookstoves or household water filters at scale in a low-income country. In this paper we describe the design of a clusterrandomized trial to evaluate the impact of a national-level program to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households in Rwanda.Methods/Design: We randomly allocated 72 sectors (administratively defined units) in Western Province to the intervention, with the remaining 24 sectors in the province serving as controls. In the intervention sectors, roughly 100,000 households received improved cookstoves and household water filters through a government-sponsored program targeting the poorest quarter of households nationally. The primary outcome measures are the incidence of acute respiratory infection (ARI) and diarrhea among children under five years of age. Over a one-year surveillance period, all cases of acute respiratory infection (ARI) and diarrhea identified by health workers in the study area will be extracted from records maintained at health facilities and by community health workers (CHW). In addition, we are conducting intensive, longitudinal data collection among a random sample of households in the study area for in-depth assessment of coverage, use, environmental exposures, and additional health measures.Discussion: Although previous research has examined the impact of providing household water treatment and improved cookstoves on child health, there have been no studies of national-level programs to deliver these interventions at scale in a developing country. The results of this study, the first RCT of a large-scale programmatic cookstove or household water filter intervention, will inform global efforts to reduce childhood morbidity and mortality from diarrheal disease and pneumonia. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.