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

项目总结 每年有430万人过早死亡可归因于使用固体燃料造成的家庭空气污染 做饭用的。在尼日利亚，9000万家庭用固体燃料做饭。清洁(即高效低耗)的使用 (排放)炉灶可以减少羟基磷灰石，改善健康状况。在我们对尼日利亚271名妇女进行的随机对照试验中，使用 使用“清洁燃料-清洁炉灶”(CF-CS)与使用煤油炉灶相比，可显著降低血压(BP 以及80%的领养率。然而，它在非洲的广泛采用并不是最好的，因为这些国家 通常缺乏协调系统更改以实施循证实践所需的专业知识 援助。社区动员(CM)战略可以克服这一障碍，因为它建立了社区 为规范变革做好准备并提供支持。因此，CM可以通过修改来提高对CF-CS的使用需求 社区对它的采用设置了障碍。与拉各斯国家卫生部合作，我们将制定 针对具体情况的CM战略，并评估其对可负担得起的生物乙醇的采用和可持续性的影响- 尼日利亚拉各斯的基于CF-CS的使用。社区管理战略包括：(1)社区咨询委员会(地方) 组织、政府官员和居民)，将为采用提供领导支持和支持 (2)[卫生部]训练有素的社区卫生推广工作者，他们将促进适当的 通过社区行动小组(CATS)家庭使用CF-CS；和(3)符合以下条件的社区对话 重点关注家庭中使用氯氟化碳的共同关切。使用有重点的)实施研究 第二类混合体中的EPIS(探索、准备、实施和维持)模式 设计，我们将分3个阶段进行此研究：1)实施前阶段，将探索障碍和 CF-CS的促进者使用，并为CF-CS的使用制定CM策略；2)在实施阶段进行比较 群集RCT CM与自我导向条件(即，在没有CM的情况下接收关于CF-CS的信息)对 采用CF-CS；和降低收缩压；3)实施后阶段，将比较效果 在拉各斯郊区社区中使用CF-CS的可持续性的CM策略与自我导向条件的比较。 目标1：对社区在郊区采用CF-CS的准备情况进行需求评估 拉各斯的社区；开发和试点根据文化量身定做的CM战略。目标2将在一组中进行比较 32个城市周边社区随机对照研究--640名社区居民社区管理与自我指导条件对社区居民使用CF-CS的影响 家庭；目的3将比较CM和自我指导条件对收缩压降低的影响；以及目的4 将在试验结束一年后评估CF-CS使用的可持续性。主要结果是 采用CF-CS的使用定义为将CF-CS用于50%以上的家庭烹饪活动， 使用iButton炉具使用情况监视器进行测量。次要结果是平均收缩压从 基线为12个月；一年后，CF-CS使用的可持续性[采用维持在24个月] 审判。

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.