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

社区动员以改善清洁炉灶的使用、减少家庭空气污染和预防高血压

• 批准号: 10448412
• 负责人: OLUGBENGA G. OGEDEGBE
• 金额: $ 67.67万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448412
• 关键词: Address; Adoption; Adult; Africa; Air; Annual Reports; Biomass; Blood Pressure; Chicago; Collaborations; Communities; Community Actions; Community Health; Cookstove; Country; Devices; Epidemic; Evidence based practice; Exploration Preparation Implementation and Sustainment; Government Officials; Health; Household; Household Air Pollution; Hypertension; Intervention; Kerosene; Leadership; Maintenance; Measures; Modeling; Monitor; Morbidity - disease rate; Needs Assessment; Nigeria; Outcome; Participant; Phase; Population; Preparation; Randomized; Readiness; Research; Resources; Saints; Self-Direction; System; Training; Universities; Urban Community; Woman; attributable mortality; base; behavior change; biomass fuel; blood pressure reduction; community barrier; community building; cooking; experience; follow-up; hybrid type 2 design; hypertension prevention; implementation framework; implementation strategy; improved; low and middle-income countries; medical schools; member; mortality; peri-urban; pilot test; post implementation; premature; primary outcome; research to practice; secondary outcome; solid fuel; sustainability framework; uptake

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.

项目摘要 每年有430万个过早死亡归因于使用的固体燃料的户外空气人口（HAP） 烹饪。在尼日利亚，有9000万户家庭用坚固的燃料做饭。使用清洁（即高效和低效率 排放）厨师可以减少HAP并改善健康结果。在我们在尼日利亚的271名妇女的RCT中，使用 “清洁燃油清洁炉”（CF-CS）与煤油基炉子导致大量血压（BP）降低 和80％的采用率。但是，它的宽度采用在非洲是最佳的，因为这些国家 通常缺乏协调系统更改以实施基于证据的实践所需的专业知识 协助。社区动员（CM）策略可能会克服这一障碍，因为它建立了社区 准备和支持正常变化。这是CM通过修改来增强对CF-CS使用的需求 通过其采用的社区障碍。与拉各斯州卫生部（MOH）合作，我们将开发 特定于上下文的CM策略，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 基于尼日利亚拉各斯的CF-CS使用。 CM策略包括：（1）社区顾问委员会（本地的 组织，政府官员和居民），将为领导和购买提供领导支持 CF-CS使用； （2）经过培训的社区卫生扩展工人[来自MOH]，他们将促进适当的 通过社区行动团队（CAT）将CF-CS的家庭使用； （3）社区对话 专注于对家庭中CF-CS使用的共同担忧。使用重点）实施研究 2型混合动力车中的框架，EPIS（探索，准备，实施和维持）模型 设计，我们将分为3个阶段进行这项研究：1）实现阶段，将探索障碍和 CF-CS使用的促进者，并制定CF CM使用策略； 2）比较的实施阶段 群集RCT CM与自我指导的条件的影响（即在没有CM的CF-C上的信息）对 采用CF-CS使用；和收缩压减少； 3）实施后阶段将比较效果 商业策略与在拉各斯郊区社区中使用CF-CS的可持续性的自我指导状况。 目的1：进行有关社区准备就绪的需求评估，以采用CF-CS 拉各斯的社区；开发和试点测试一种经过文化定制的商业策略。 AIM 2将在集群中进行比较 32个郊区社区的RCT，CM与自我指导状况对采用CF-CS的影响640 家庭； AIM 3将比较CM与自我指导条件对收缩压减少的影响；和目标4 将评估审判完成后一年使用CF-CS的可持续性。主要结果是 采用CF-CS的使用定义为使用CF-CS用于家庭中50％以上的烹饪活动的利用， 用ibuttons炉子使用监视器测量。次要结果是收缩BP的平均变化 基线至12个月； CF-CS使用的可持续性[在24个月时维持收养]，一年后 试验。