Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda

Autor: Ghislaine Rosa, Sanctus Musafiri, Jean de Dieu Ngirabega, Thomas Clasen, Evan A. Thomas, Miles A. Kirby, Corey L. Nagel, Laura D. Zambrano
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Pulmonology
Physiology
030204 cardiovascular system & hematology
Pathology and Laboratory Medicine
Pediatrics
law.invention
0302 clinical medicine
Randomized controlled trial
law
Water Quality
Natural Resources
Medicine and Health Sciences
Cluster Analysis
Medicine
Public and Occupational Health
Cooking
030212 general & internal medicine
Household Articles
Respiratory Tract Infections
Materials
Respiration
Child Health
Respiratory infection
General Medicine
Diarrhea
Quartile
Breathing
Air Pollution
Indoor
Child
Preschool
Acute Disease
Physical Sciences
Water Resources
Engineering and Technology
Female
medicine.symptom
Research Article
Adult
Materials Science
Gastroenterology and Hepatology
Fuels
Water Purification
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
Environmental health
Humans
business.industry
Drinking Water
Ecology and Environmental Sciences
Rwanda
Biology and Life Sciences
Pneumonia
Confidence interval
Energy and Power
Water resources
Stove
Respiratory Infections
Water quality
Physiological Processes
business
Follow-Up Studies
Zdroj: PLoS Medicine, Vol 16, Iss 6, p e1002812 (2019)
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. Methods and findings In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children
Thomas Clasen and colleagues report their trial in which reduced levels of diarrhea in children under 5 result from the introduction of water filters and rocket-style cookstoves in Rwanda.
Author summary Why was this study done? Unsafe drinking water and household air pollution are leading health risks for young children in low-income countries and contribute to diarrhea and acute respiratory infections (ARIs), both of which are leading causes of child mortality and major burdens on healthcare systems. Systematic reviews have shown household-based water treatment to be effective in improving water quality and preventing diarrhea in low-income countries, while cooking indoors with solid fuels such as wood is associated with ARI in children. Intervention studies of household-based water treatment and higher-efficiency cookstoves have largely been short-term in duration, and there is limited evidence on intervention use, exposure, and health impacts when delivered programmatically at scale. What did the researchers do and find? In the context of a large-scale intervention program that delivered and promoted the use of an advanced water filter and portable biomass-burning “rocket” cookstove to over 101,000 low-income households in Rwanda, we conducted a cluster-randomized trial to assess intervention use, drinking water quality, and air quality (personal exposure to fine particulate matter, PM2.5) and diarrhea and ARI among children. A total of 1,582 households from 174 village-sized clusters were enrolled and visited approximately every 4 months for a year after receiving the intervention filter and stove. Among children under 5 years of age, the intervention reduced 7-day prevalence of diarrhea by 29% and ARI by 25%, although intervention use decreased throughout follow-up; drinking water quality improved, but adult and child personal exposures to PM2.5 remained unchanged and above WHO’s Air Quality Guideline (10 μg/m3) and Interim Target 1 (35 μg/m3) despite increased outdoor cooking. What do these findings mean? Our results suggest that this program was effective in reaching a vulnerable population, securing sustained use of the intervention, improving drinking water quality, and reducing risk of diarrhea and ARI among children under 5. While there was evidence of nonexclusive and diminished intervention use over time, our results suggest that the programmatic delivery and promotion of a combined household filter and cookstove intervention can provide a scalable interim solution among rural populations that currently lack access to safe piped-in drinking water, although cleaner cooking solutions are likely needed to optimize health benefits. Additional research is necessary to assess sustained benefits and identify effects, if any, on more serious cases of infection, as well as to explore the potential synergistic effects of combined household-level interventions.
Databáze: OpenAIRE
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