Intervening to Improve Birth Weight and Infant Respiratory Health in Rural Ghana

描述（由申请人提供）：生物质燃烧产生的烟雾每年导致约160万人额外死亡，并在全球疾病负担中占很大份额，这在很大程度上是由于5岁以下儿童急性下呼吸道感染（ALRI）风险增加。最近的证据还表明，怀孕期间接触烹饪烟雾可能与出生体重下降有关。这个问题在撒哈拉以南非洲地区尤为重要，在那里用生物质燃料做饭是很普遍的。拟议研究的总体目标是测试市售的低成本改进炉灶在改善婴儿从出生到6个月大的健康结果方面的有效性。我们将测试两个假设：假设1。从妊娠晚期开始使用改进的炉灶将导致新生儿平均出生体重显著增加。假设2：使用改进的炉灶将导致在生命的头六个月内严重急性呼吸道感染的发生率显著降低。这些假设将在西非加纳农村Kintampo地区的800对母婴的随机干预试验中得到检验。在其家庭中担任主要厨师的孕妇将在妊娠晚期之前被确定。我们将随机将平均资产匹配的村庄分配到早期或晚期干预组。在早期干预村，将向登记的孕妇分发经改进的炉灶，以及医疗保险和驱虫蚊帐。后期干预组将在登记时获得保险和蚊帐，并在产后随访完成时进行全面干预。孕龄将在入组时通过超声检查确定，并提供潜在受试者携带活单胎胎儿的确认。我们将评估实时个人暴露于一氧化碳（CO）在所有受试者在怀孕期间和新生儿期间。在出生时，我们将测量出生体重并收集胎盘涂片用于疟疾评估。现场工作人员将根据儿童疾病综合管理（IMCI）指南，在儿童出生后的头六个月，每周在家中监测一次重症肺炎，并进行病例临床转诊。拟议的研究建立在哥伦比亚大学与加纳中部Kintampo卫生研究中心之间已建立的合作基础上。

DESCRIPTION (provided by applicant): Smoke from biomass combustion leads to approximately 1.6 million excess annual deaths and a substantial share of the global burden of disease, due in large part to increased risk of acute lower respiratory infections (ALRI) in children under age five. Recent evidence also suggests that exposures to cook smoke during pregnancy may be associated with reduced birth weight. This issue is particularly relevant in sub-Saharan Africa, where cooking with biomass fuels is widespread. The overall goal of the proposed research is to test the effectiveness of commercially available, low cost improved cook stoves in improving infant health outcomes from birth through six months of age. Two hypotheses will be tested: Hypothesis 1. Use of improved cook stoves starting by the third trimester pregnancy will lead to a significant increase in average birth weight in newborns. Hypothesis 2: Use of improved cook stoves will lead to a significant reduction in the rate of severe ALRI during the first six months of life. These hypotheses will be tested in a randomized intervention trial among 800 maternal- infant pairs in the Kintampo district of rural Ghana in West Africa. Pregnant women who are primary cooks in their families will be identified before the third trimester of pregnancy. We will randomly assign villages, matched on average assets, to early or late intervention groups. Within the early intervention villages, improved cook stoves will be distributed to enrolled pregnant women, along with health insurance and an insecticide-treated bed net. The late intervention group will receive insurance and a bed net at enrollment, and the full intervention at the completion of the postnatal follow-up. Gestational age will be determined by sonogram upon enrollment and provide confirmation that potential subjects are carrying live singleton fetuses. We will assess real-time personal exposure to carbon monoxide (CO) among all subjects during pregnancy and during the neonatal period. At birth we will measure birthweight and collect a placental smear for malaria assessment. Field workers will monitor for severe pneumonia at weekly intervals in the home for the first six months of the life of a child based on the Integrated Management of Childhood Illness (IMCI) guidelines, with clinical referral of cases. The proposed research builds on an established collaboration between Columbia University and the Kintampo Health Research Center in central Ghana. PUBLIC HEALTH RELEVANCE: Smoke from cooking with biomass fuels leads to almost one million deaths in children under age five around the world. However, we lack sufficient understanding of exposure-response, and of critical periods of exposure, to develop effective interventions for reducing these impacts. The proposed research will carefully examine the benefits of an intervention to improve infant birth weight and respiratory health in rural Ghana.