An advanced cookstove intervention to prevent pneumonia in children under 5 years old in Malawi: a cluster randomised controlled trial

点击翻译按钮获取中文摘要

Malawi has one of the highest rates of death among infants and the under fives (69 and 110 per 1000 live births respectively in 2009) despite having made progress towards meeting the Millennium Development Goal of reducing child mortality. Pneumonia is the leading cause of death and one of the commonest causes of morbidity with around 298 per 1000 children under the age of 5 diagnosed with pneumonia every year and a case fatality rate between 2.7 and 13.2 per 1000. Exposure to smoke produced when biomass fuels (animal or plant material) are burned in open fires is a major avoidable risk factor for pneumonia. In Malawi, where at least 95% of households depend on biomass as their main source of fuel, biomass smoke exposure is likely to be responsible for a substantial burden of this disease. Effective strategies for reducing smoke exposure exist (e.g. ventilation, improved stoves, cleaner fuels, behaviour modification) but are out of reach for the majority due to a wide range of largely poverty-related factors. The Global Alliance for Clean Cookstoves was launched in 2010 to tackle this energy poverty issue through public private partnerships. A central aim of the alliance is for 100 million homes to adopt clean and efficient stoves and fuels by 2020. However, there is very limited evidence to assess the potential benefits of such an approach. We have conducted preparatory and pilot work in sub Saharan Africa to determine which of the currently available advanced cookstoves would be most suitable for use in a trial in Malawi in terms of improvements in combustion efficiency, reduced emissions and ability to cook local dishes. We have gone to considerable lengths to involve local communities in the development of this proposal. We are now in a position to be able to study an efficient and locally acceptable advanced cookstove that substantially reduces smoke emissions in a trial to address three principal research questions: 1) Can an advanced cookstove intervention that substantially reduces biomass smoke exposure relative to an open fire prevent pneumonia in children under 5 years old in Malawi?2) How affordable and cost effective is the intervention from household, healthcare system and societal perspectives?3) What can be learned from trial participants and non-participants about adoption of the intervention that could inform effective implementation of the trial findings in the future?High quality clinical trial evidence about the health and economic impacts seen when households adopt advanced cookstove technologies is needed to inform policy and decision makers across commercial, health, development and community sectors at local, regional and international levels. The results of this trial will be relevant to local policy makers in Malawi who will have new efficacy, economic and qualitative data to guide decisions about funding advanced cookstove programmes for improving child health; to regional commercial, non-governmental and governmental organisations in sub Saharan Africa manufacturing and distributing advanced cookstove solutions; and to international (e.g. World Health Organisation (WHO)) decision and policy makers by contributing new evidence about the health and economic impacts of an advanced cookstove intervention of broadly generalisable relevance to areas of the world where biomass fuel use is common. We have established local (e.g. community leaders), regional (e.g. commercial and non-governmental organisations and Malawi Ministry of Health) and international (e.g. WHO and Global Alliance for Clean Cookstoves) links that will allow us to disseminate the findings of the trial effectively at all levels to a wide range of stakeholders, policy and decision makers.