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导致每年约160万人额外死亡，占全球疾病负担的很大一部分，主要是由于五岁以下儿童急性下呼吸道感染(ALRI)的风险增加。最近的证据还表明，怀孕期间暴露在烹饪烟雾中可能与新生儿体重减轻有关。这个问题在撒哈拉以南非洲尤其相关，那里用生物质燃料做饭很普遍。这项拟议研究的总体目标是测试商业上可获得的低成本改进厨灶在改善婴儿从出生到六个月大的健康结果方面的有效性。将检验两个假设：假设1。从怀孕晚期开始使用改进的厨灶将显著增加新生儿的平均出生体重。假设2：使用改进的厨灶将显著降低出生后前六个月严重ALRI的发生率。这些假设将在西非加纳农村地区金坦波地区的800对母婴随机干预试验中得到验证。家庭主厨的孕妇将在怀孕第三个三个月前确定。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。在早期干预村庄内，将向登记的孕妇分发改进的厨灶，以及医疗保险和经杀虫剂处理的蚊帐。晚期干预组将在入院时获得保险和蚊帐，并在完成产后随访时获得全面干预。怀孕年龄将在注册时通过超声波确定，并提供潜在受试者怀的是活的单胎胎儿的确认。我们将评估所有受试者在孕期和新生儿期对一氧化碳(CO)的实时暴露。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。实地工作人员将根据儿童疾病综合管理(IMCI)指导方针，在儿童生命的前六个月每周在家中监测严重肺炎，并对病例进行临床转介。这项拟议的研究建立在哥伦比亚大学和加纳中部的金坦波健康研究中心之间建立的合作基础上。

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.