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

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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.