Cooking And Pneumonia Study (CAPS)

Transcription

1 Cooking And Pneumonia Study (CAPS) Deborah Havens, DO MPH 28 January 2017

2 CAPS trial An advanced cookstove intervention to prevent pneumonia in children under 5 years old in Malawi: a cluster randomized controlled trial Five research themes: Pneumonia in children under 5 years (primary) Air pollution and personal exposures Respiratory symptoms and lung function in adults Health economics (affordability and cost-effectiveness) Qualitative (societal perspectives/adoption)

3 CAPS Summary of trial: 10,543 Malawian children under the age of 5 years in 150 village-level clusters in Chikhwawa and Chilumba Intervention: Philips cookstove Control: traditional cooking methods The primary outcome was pneumonia (defined using the WHO Integrated Management of Childhood Illness pneumonia assessment protocol) Secondary outcomes: pneumonia not meeting IMCI criteria burns severe pneumonia All households were followed for 24 months Households were visited every 3 months

4 CAPS Main trial design

5 Stove Use Monitor System (SUMS) Used in 10% of intervention households

6 Air Pollution Monitoring and Personal Exposures Carbon monoxide in approximately 2000 children every 6 months including baseline Monitor for 48 hours Lascar CO Data Loggers Assess carboxyhemoglobin levels (RAD-57)

7 Household Air Pollution Black carbon, CO and PM 2.5 in approximately 250 adults, children and households microaeth ThermoScientific pdr 1500 Grouped samples: CO/PM by cooking source, black carbon/co on mother, CO for child

8 Air Pollution Monitoring-Black Carbon and Carbon Monoxide Emissions Concentration Exposure Intake Dose Health Effects

9 Respiratory Symptoms and Lung Function in Adults Adult Lung Health Study-using BOLD protocol 2 years of follow up Approximately 2000 adults in Chikhwawa region Carbon Monoxide and PM2.5 measurements for 24 hours yearly during the study using Aprovecho IAP meter Spirometry baseline and every 12 months

10 CAPS Participant/Household Characteristics children from 8470 households included in intention-to-treat analysis Household level data at baseline Intervention Control Number of households Fuel used regularly for cooking Wood 2494 (58.6%) 2390 (56.7%) Crop residue 1339 (31.5%) 1320 (31.3%) Charcoal 563 (13.2%) 723 (17.2%) Gas 0 2 (0.0%) Electricity 5 (0.1%) 13 (0.3%) Tobacco smoker in household 746 (17.5%) 634 (15.0%) Daily or almost daily exposure to smoke from: Burning rubbish 1747 (41.0%) 1677(39.8%) Cooking for business 554 (13.0%) 513 (12.2%) Brick production 177 (4.2%) 214 (5.1%) Paraffin/kerosene lamps 87 (2.0%) 105 (2.5%) Mosquito coils 44 (1.0%) 82 (1.9%) Beer production 54 (1.3%) 44 (1.0%) Experienced a time within the past year when there was not enough food for the household 2131 (50.1%) 2113 (50.1%) Experienced a time in the past year when the household did not have money to buy bathing soap 2608 (61.3%) 2597 (61.6%)

11 CAPS Participant/Household Characteristics Household level data at baseline Intervention Control Cooking Characteristics (rainy season) Outside with a separate structure with a roof only Outside in a separate structure with a roof and walls 846 (16%) 754 (14%) 2156 (40%) 2044 (38%) Outside in the open air 1120 (21%) 1185(22%) Outside on the veranda 915 (17%) 1011(19%) Inside in a separate room (kitchen) 218 (4%) 188 (4%) Inside in a living room 165(3%) 169 (3%) Symptom Characteristics Cough 2987 (55%) 3272 (60%) Wheeze 835 (15%) 935 (17%) Burn 223 (4%) 293 (5%)

12 . CAPS Results Overall Intervention Control IMCI Pneumonia Incidence Rate (per 100 child-years) Severe Pneumonia Incidence Rate (per 100 child-years) Burns Incidence Rate (per 100 child-years) IRR:1.01 (95% CI ; p=0.80) IRR: 1.30 (95% CI ;p=0.06) IRR: 0.58 (95% CI ;p<0.0001)

13 A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial. Lancet Jan 14;389(10065): Epub 2016 Dec 7.