Study protocol: Designs of Two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children and reproductive outcomes in rural Nepal. BMC Public Health, Dec 2014, 14:1271 doi:10.1186/1471-2458-14-1271
Authors: James M Tielsch, Joanne Katz, Scott L Zeger, Subarna K Khatry, Laxman Shrestha, Patrick Breysse, William Checkley, Luke C Mullany and Steven C LeClerq
Background – Acute lower respiratory infections (ALRI) are a leading cause of death among young children in low and middle income countries. Low birthweight is highly prevalent in South Asia and is associated with increased risks of mortality, morbidity, and poor motor and cognitive development. High levels of indoor household air pollution caused by open burning of biomass fuels such as wood, animal dung, and crop waste are common in these settings and are associated with high rates of ALRI and low birthweight. Alternative stove designs that burn biomass fuel more efficiently have been proposed as one method for reducing these high exposures and lowering the rates of these disorders. We designed two randomized trials to test this hypothesis.
Methods – We conducted a pair of community-based, randomized trials of alternative cookstove installation a rural district in southern Nepal. Phase one was a cluster randomized, modified step-wedge design using an alternative biomass stove with a chimney to vent smoke to the exterior. A pre-installation period of morbidity assessment and household environmental assessment was conducted for six months in all households. This was followed by a one year step-wedge phase with 12 monthly steps for clusters of households to receive the alternative stove. The timing of alternative stove introduction was randomized. This step-wedge phase was followed in all households by another six month follow-up phase. Eligibility criteria for phase one included household informed consent, the presence of a married woman of reproductive age (15-30 yrs) or a child < 36 months. Children were followed until 36 months of age or the end of the trial and then discharged. Pregnancies were identified and followed until completion or end of the trial.
Phase two was an individually randomized trial of the same alternative biomass stove versus liquid propane gas stove installation in a subset of households that participated in phase one. Follow-up for phase two was 12 months following stove installation. Eligibility criteria included the same components as phase one except children were only enrolled for morbidity follow-up if they were less than 24 months are the start.
The primary outcomes included: the incidence of ALRI in children and birthweight among newborn infants.
Conclusions – We have presented the design and methods of two randomized trials of alternative cookstoves on rates of acute lower respiratory infection and birthweight in a rural population in southern Nepal.
