Feasibility intervention trial of two types of improved cookstoves in three resource-limited settings: study protocol for a randomized controlled trial

Elizabeth Klasen, J Jaime Miranda, Subarna Khatry, Diana Menya, Robert H Gilman, James M Tielsch, Caitlin Kennedy, Robert Dreibelbis, Neha Naithani, Sylvester Kimaiyo, Marilu Chiang, E Jane Carter, Charles B Sherman, Patrick N Breysse, William Checkley, COCINAS Trial Working Group, Angela Huaman, Mariela Levano, Delia Haustein, Evelyn Rhodes, Laura Grajeda, Stephanie Levy, Steven LeClerq, Robert Wise, Francis Ogaro, Cosmas Apaka, Joyce Baliddawa, Elizabeth Klasen, J Jaime Miranda, Subarna Khatry, Diana Menya, Robert H Gilman, James M Tielsch, Caitlin Kennedy, Robert Dreibelbis, Neha Naithani, Sylvester Kimaiyo, Marilu Chiang, E Jane Carter, Charles B Sherman, Patrick N Breysse, William Checkley, COCINAS Trial Working Group, Angela Huaman, Mariela Levano, Delia Haustein, Evelyn Rhodes, Laura Grajeda, Stephanie Levy, Steven LeClerq, Robert Wise, Francis Ogaro, Cosmas Apaka, Joyce Baliddawa

Abstract

Background: Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes.

Design: We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138).

Methods: At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period.

Discussion: Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide.

Trial registration: ClinicalTrials.gov NCT01686867.

Figures

Figure 1
Figure 1
Intervention study design by site. PEF = peak expiratory flow, FEV1 = forced expiratory volume at 1 second, CO = carbon monoxide.
Figure 2
Figure 2
Envirofit G-3300/3355 installed in Peru.
Figure 3
Figure 3
Locally constructed, improved cookstove installed in Peru.
Figure 4
Figure 4
Locally constructed, improved cookstove installed in Nepal.
Figure 5
Figure 5
Locally constructed, improved cookstove installed in Kenya.

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