A secondary data analysis of a cluster randomized controlled trial: improved cookstoves associated with reduction in incidence of low birthweight in rural Malawi.
A secondary data analysis of a cluster randomized controlled trial: improved cookstoves associated with reduction in incidence of low birthweight in rural Malawi.
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DOI：
10.1093/ije/dyac093
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发表时间：
2022-12-13
影响因子：
7.7
通讯作者：
McLean, Estelle
中科院分区：
文献类型：
--
作者：
Best, Rebecca;Mvala, Jullita;Dube, Albert;Katundu, Cynthia;Kalobekamo, Fredrick;Mortimer, Kevin;Gordon, Stephen B.;Nyirenda, Moffat;Crampin, Amelia;McLean, Estelle
在马拉维的北方农村，大多数家庭使用明火做饭，而且生育不良的负担也很重。使用明火或高污染炉灶与婴儿出生体重低有关。关于使用清洁燃烧的炉灶是否会减少出生体重不足的婴儿数量，有各种证据。这是对2014-17年在马拉维进行的一项群集随机对照试验的二次分析。家庭被随机分配到接受改进的炉灶或继续目前的做法。对于这项分析，主要结局是在试验时间范围内发生的出生（N = 4010）中，在常规人口统计学监测下的家庭中的低出生体重。还分析了关于原始随机分配的具有更严格暴露定义的数据子集（N = 1050）。使用因果关系的前向建模方法。主要数据集显示了干预对低出生体重影响的证据[校正比值比（aOR）0.69; 95% CI 0.48-0.99，n = 2788）。亚组分析缺乏提供更严格暴露定义中改良炉灶与低出生体重之间相关性的证据的能力（aOR 0.62; 95%CI 0.35-1.09，n = 932）。这项研究提供了一些证据，表明在马拉维农村改进炉灶的干预措施使低出生体重婴儿的数量减少了30%。在子集分析中也观察到了这种影响方向。分析表明，干预措施减少了早产儿或宫内生长受限婴儿的数量，表明改进炉灶可能是一种有用的孕产妇健康干预措施。
In northern rural Malawi, the majority of households cook using open fires and there is also a high burden of adverse birth outcomes. The use of open fires or highly polluting cookstoves is associated with low birthweight in babies. There is mixed evidence on whether implementation of cleaner burning cookstoves reduces the number of babies born with low birthweight. This is a secondary analysis of a cluster randomized control trial in Malawi, conducted over 2014–17. Households were randomized to receive improved cookstoves or to continue current practices. For this analysis, the primary outcome was low birthweight in households under routine demographic surveillance, among births occurring within the trial time frame (N = 4010). A subset of data with stricter exposure definitions respecting the original randomized allocation was also analysed (N = 1050). A causal, forwards modelling approach was used. The main dataset showed evidence of effect of the intervention on low birthweight [adjusted odds ratio (aOR) 0.69; 95% CI 0.48–0.99, n = 2788). The subset analysis lacked power to provide evidence of association between improved cookstoves and low birthweight in the stricter exposure definition (aOR 0.62; 95% CI 0.35–1.09, n = 932). This study provides some evidence that an improved cookstove intervention in rural Malawi reduced the number of babies born with low birthweight by 30%. This direction of the effect was also seen in the subset analysis. The analysis suggests that the intervention reduced the number of infants born prematurely or with intra-uterine growth restriction, indicating that improved cookstoves could be a useful maternal health intervention.
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