RFA 12-1: COOKSTOVES AND CHILD SURVIVAL | Source: Alliance website, June 16, 2013 |
A total of 20 applications were received in response to RFA 12-1. The Alliance’s External Review Panel, which included clinicians, epidemiologists, public health practitioners, and experts in exposure assessment, reviewed and ranked these applications. The Alliance has awarded grants to the three highest ranked applicants.
GRANT 1 – MOLECULAR METHODS FOR ETIOLOGIES OF PNEUMONIA IN THE GHANA BIOMASS STOVE STUDY
Principal Investigator: Dr. Darby Jack
Institution: The Trustees of Columbia University in the City of New York
We will investigate the potential relationship between household air pollution and respiratory tract infection in a cluster-randomized controlled cookstove environment in Ghana through pursuit of two objectives. First we will add standardized physician diagnosis of all pneumonia and severe pneumonia to our current primary outcome (fieldworker assessed probable pneumonia). Second, we will use MassTag PCR, a state-of-the-art multiplex molecular tool for pathogen identification developed by researchers at Columbia University, to determine respiratory pathogens responsible for pneumonia infections in a sample of physican diagnosed severe pneumonia cases. The proposed work will enhance the scientific relevance of the parent study, and will shed new light on which respiratory pathogens are most responsive to household energy interventions. It may also implicate specific pathogens that can be addressed through use of vaccines or other interventions. The proposal has been developed through collaboration between the Kintampo Health Research Centre in Ghana, the Center for Infection and Immunity, and the Department of Environmental Health Sciences at Columbia University.
GRANT 2 – NEPAL COOKSTOVE INTERVENTION TRIAL
Principal Investigator: Dr. James Tielsch
Institution: Johns Hopkins Bloomberg School of Public Health
Acute lower respiratory infections remain the leading cause of death among children under 5 in the world. The observational epidemiologic data strongly support an association of open burning of biomass fuel sources in the home and ALRI. As a result of strong international interest in programs for reducing indoor air pollution there is a need for randomized trials to generate data on the potential health impacts. The Nepal Cookstove Replacement Trial is a large, cluster-randomized, step-wedge designed trial to assess the impact of replacing traditional open burning stoves with an “improved” stove on the incidence of ALRI and adverse reproductive outcomes in a rural population in southern Nepal.
Enrollment and follow-up of over 3600 households will be completed by the summer of 2012, but the “improved” stove used in this project (Envirofit G3355 with chimney) only reduces PM concentrations by approximately 50-70%. Despite this reduction, the exposure concentrations remain much higher than current WHO and EPA indoor air standards. Data from observational studies of outdoor PM concentrations and chronic disease outcomes suggest that the shape of the dose-response function can vary significantly by the disease of concern.
Very few data exist to estimate the dose-response function for ALRI in low-income countries. As a result, it is unclear how well in terms of PM reduction improved stoves need to perform in order to see important reductions in risk of ALRI. Results of our main step-wedge trial are not yet available, but it is clear that a point of higher PM reduction on the dose-response curve will provide important information for stove designers and program managers in estimating the magnitude of health effects that can be attributed to stove intervention programs.
This application proposes an extension to the current trial by appending a randomized trial comparing the Envirofit stove to a LPG stove on ALRI incidence in young children. A total of 1600 of the households in the current trial who have children.
GRANT 3 – HOUSEHOLD AIR POLLUTION FROM BURNING BIOMASS: IMPLICATIONS FOR MATERNAL HEALTH AND PREGNANCY OUTCOME (NIGERIA)
Principal Investigator: Dr. Christopher Olusola (Sola) Olopade
Institution: University of Chicago
In Nigeria, 90 million people and 70% of the rural population uses solid fuels for household energy, exposing them to large concentrations of toxins emitted from fuel combustion. The use of biomass fuels for cooking and the subsequent exposures have been shown to be associated with adverse pregnancy outcomes such as low birth weight (weighing less than 2,500 g), stillbirth and premature delivery. Babies born pre-term (earlier than 37 weeks of gestation) and/or with low birth weight are at an increased risk for postnatal morbidity and mortality. Up to 17% of infants born in Nigerian hospitals are reported as being born with low birth weight and as many as 20% are born preterm. Despite the magnitude of the problem, there is no evidence linking exposure to smoke from biomass fuels with adverse pregnancy outcomes; and given that smoke from burning biomass for cooking produces many of the same pollutants found in tobacco smoke and ambient air, there is a good reason to expect a relationship between smoke exposure and adverse pregnancy outcomes among vulnerable rural women.
In a multidisciplinary effort, we have brought together an international group of experts who will use rigorous research methodology to tackle the health challenges posed by exposure to household air pollution from biomass burning in southwest Nigeria. Although wood-fueled cookstoves have been developed that use less wood and reduce emissions of health damaging smoke, reductions of personal exposures, which are most important to improving health, are varied and remain 4 to 6 fold higher than WHO guideline limits. Nigeria, as an implementing national partner of the Global Cookstove Alliance, has launched the Clean Cookstove Alliance for Nigeria aimed at reducing adverse health effects caused by exposure to smoke from household air pollution. This policy change and commitment by the government provides a unique opportunity to investigate the impact of the use of cleaner fuel for cooking on pregnancy outcome. Project Gaia, a US-based NGO will distribute 150 ethanol stoves using bioethanol that is produced sustainably in Nigeria and has achieved reductions in personal exposures that meet suggested WHO guidelines.
The specific objectives of this study are to establish an exposure response relationship for measured pollutants (CO, PM2.5, PAH) and health outcomes for 300 pregnant women in Ibadan, Nigeria, to investigate the ability of ethanol stoves to reduce personal exposures to PM2.5, CO, and PAH, to compare exposure by stove/fuel type with health outcomes and to evaluate stove use/likability of the ethanol stoves by temperature based monitoring and compare with health outcomes. The overall hypothesis of the proposed study is that the Ethanol stove will reduce pregnant women’s exposures to PM2.5, PAH, and CO and reduce adverse pregnancy outcomes. Our long-term goal is that knowledge gained from this study will provide empiric data that can be used to expand the study population to include additional types of stoves and fuels, and influence policy that supports the scale-up and adoption of clean stoves and clean fuels such as bioethanol in the most affected and vulnerable populations.
