Background
Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection. The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however not clear whether it is possible to prevent household air pollution-related disease burdens with locally made improved cookstoves, and the evidence regarding the health effect of improved cookstove interventions among children still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the customary open burning traditional baking stove.
Methods
A cluster randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and intervention was delivered to all households allocated into the intervention arm. A total of four follow-up visits were carried out within one year at approximately 3-month intervals immediately after the delivery of the intervention. The intervention effect was estimated using odds ratio as a measure of effect following a Generalized Estimating Equations modeling approach among the intention-to-treat population.
Results
A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The intervention was not found to have a statistically significant effect on the outcome with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02) compared with the continuation of an open burning traditional baking stove method.
Harms:
There was no difference in the overall incidence rates of cooking-related burns between arms with an incidence rate ratio of 0.80 (95% CI: 0.53–1.21), and there were no grounds to stop the trial early for adverse events.
Conclusions
We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood acute lower respiratory infection compared with the continuation of an open burning traditional baking stove method. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood acute lower respiratory infection.
Trial registration: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).