Community Mobilization for Improved Clean Cookstove Uptake, Household Air Pollution Reduction, and Hypertension Prevention

项目摘要 每年有430万人因使用固体燃料造成的家庭空气污染（HAP）而过早死亡 做饭用的在尼日利亚，9000万家庭用固体燃料做饭。使用清洁（即高效率和低成本） 因此，使用清洁炉灶（即清洁炉灶排放）可以减少HAP并改善健康结果。在我们对尼日利亚271名妇女的随机对照试验中，使用 与基于煤油的炉灶相比，“清洁燃料-清洁炉灶”（CF-CS）的使用可显着降低血压（BP） 80%的采用率。然而，它的广泛采用在非洲是次优的，因为这些国家 通常缺乏协调系统变化所需的专业知识，以实施循证实践， 援助.社区动员（CM）战略可以克服这一障碍，因为它建立了社区 为规范性变革做好准备并提供支持。因此，CM可以通过修改 社区的障碍，以通过。在与拉各斯州卫生部（MoH）的合作下，我们将开发 一个具体的CM战略，并评估其对负担得起的生物乙醇的采用和可持续性的影响- 在尼日利亚的拉各斯使用CF-CS。社区管理战略包括：（1）社区咨询委员会（当地 组织，政府官员和居民），这将提供领导支持和购买的采用 （2）经过培训的社区卫生推广工作者[来自卫生部]，他们将促进适当的 通过社区行动小组（CAT）家庭使用CF-CS;（3）社区对话， 重点是对家庭中使用CF-CS的共同关切。使用有针对性的）实施研究 框架，EPIS（勘探，准备，实施和维持）模型，在类型2混合 设计，我们将分3个阶段进行这项研究：1）实施前阶段，将探讨障碍， CF-CS使用的促进者，并为CF-CS的使用制定CM策略; 2）实施阶段， 一项群集RCT，CM与自我导向条件（即，接收到关于CF-CS的信息，但未使用CM）对 采用CF-CS;收缩压降低; 3）实施后阶段，将比较 CM战略与自我导向条件的可持续性的CF-CS使用在拉各斯城郊社区。 目标1：对城郊社区采用CF-CS的准备情况进行需求评估 在拉各斯的社区;制定和试点测试文化定制的CM战略。AIM 2将在群集中进行比较 32个城郊社区的随机对照试验，CM与自我导向条件对640例采用CF-CS的影响 家庭; AIM 3将比较CM与自我导向条件对收缩压降低的影响; AIM 4 将在试验完成一年后评估CF-CS使用的可持续性。主要结局是 采用CF-CS使用定义为在家庭烹饪活动中使用CF-CS超过50%， 使用iPhone5炉灶使用监测器测量。次要结果是收缩压的平均变化 基线至12个月;以及CF-CS使用的可持续性[在24个月时保持采用]，一年后 庭审

PROJECT SUMMARY Annually 4.3 million premature deaths are attributable to household air population (HAP) from solid fuels used for cooking. In Nigeria, 90 million households cook with solid fuels. The use of clean (i.e. high-efficiency and low emission) cookstoves can reduce HAP and improve health outcomes. In our RCT of 271 women in Nigeria, use of “clean fuel-clean-stove” (CF-CS) vs. kerosene-based stoves led to significant blood pressure (BP) reduction and an 80% adoption rate. However, its widespread adoption is sub-optimal in Africa because these countries often lack expertise needed to coordinate system changes to implement evidence-based practices without assistance. Community mobilization (CM) strategy may overcome this barrier because it builds community readiness and support for normative changes. Thus, CM may enhance the demand for CF-CS use by modifying community barriers to its adoption. In collaboration with the Lagos State ministry of health (MoH), we will develop a context-specific CM strategy, and evaluate its effects on adoption and sustainability of affordable bioethanol- based CF-CS use in Lagos, Nigeria. The CM strategy includes: (1) Community advisory board (of local organizations, government officials, and residents), that will provide leadership support and buy-in for adoption of CF-CS use; (2) Trained community health extension workers [from the MoH], who will facilitate proper household use of CF-CS through community action teams (CATs); and (3) Community dialogues that are focused on shared concerns regarding CF-CS use in households. Using a focused) implementation research framework, the EPIS (Exploration, Preparation, Implementation and Sustainment) model, in a type-2 hybrid design, we will conduct this study in 3 phases: 1) A pre-implementation phase that will explore barriers and facilitators of CF-CS use, and develop a CM strategy for CF-CS use; 2) An Implementation phase to compare in a cluster RCT the effect of CM vs. a self-directed condition (i.e. receipt of information on CF-CS without CM) on adoption of CF-CS use; and systolic BP reduction; 3) A post-implementation phase that will compare the effect of CM strategy vs. self-directed condition on sustainability of the CF-CS use in periurban communities in Lagos. AIM 1: To conduct a needs assessment on community readiness for the adoption of CF-CS use in periurban communities in Lagos; develop and pilot test a culturally-tailored CM strategy. AIM 2 will compare in a cluster RCT of 32 periurban communities, the effect of CM vs. self-directed condition on adoption of CF-CS use in 640 households; AIM 3 will compare the effect of CM vs. self-directed condition on systolic BP reduction; and AIM 4 will evaluate the sustainability of CF-CS use one year after completion of the trial. The primary outcome is adoption of CF-CS use defined as utilization of CF-CS for more than 50% of cooking activities in the household, measured with iButtons stove usage monitors. The secondary outcomes are mean change in systolic BP from baseline to 12 months; and sustainability of CF-CS use [maintenance of adoption at 24 months], one year after the trial.