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Cycle 1

Principal Investigator:  Sharat Verma, National Tuberculosis Center
NIH-Supported Collaborator: Kirk Smith, University of California, Berkeley
Title of NIH Award: Investigation of indoor solid fuel and kerosene use as Tuberculosis risk factors

Project Overview

Acute Respiratory Infection (ARI) is the leading cause of childhood morbidity and mortality in Nepal. The Ministry of Health and Population has recognized ARI as one of the major public health problems. It has given due importance to improve medical case management strategies to lower the incidence of ARI. In spite of such strategies, incidence of ARI is still prevalent. Household air pollution (HAP) from solid-fuel-burning stoves has been causally linked to ARI in children. In Nepal, about 83% of households use solid fuel for cooking and heating. A study conducted in Dhading district has attributed 50% of ARI, mainly ALRI or pneumonia to HAP. While we apply antibiotics to improve medical case management to lower the incidence of ARI, it is prudent also to more thoroughly explore the roles of clean cookstoves in lowering the incidence of ARI and under-five mortality in the country. For example, WHO and GACC have identified reduction of HAP as one of the potential intervention areas to prevent ARI related morbidity and mortality in children. In Nepal, government has installed around 450,000 biomass improved cookstove and 132,000 biogas systems throughout the country. However, there has been no survey conducted to assess their effectiveness in either reducing HAP or health burden in the community. This prospective cohort study, seeks to assess whether clean cookstove technologies complement Nepal Government’s effort of lowering the incidence of ARI in the country. It also seeks to assess, which levels of air pollution reduction is necessary to meaningfully improve children’s health.

The specific objectives are: a) To investigate the effectiveness of biogas cookstove technologies being promoted by the government of Nepal in a) household smoke reduction, and b) reduction of ARI, mainly the acute lower respiratory tract infection (ALRI) or pneumonia in children under-5-years of age. 

This will be an exposure based prospective cohort study. The study team will longitudinally monitor the fuel/stove use pattern and levels of particulate matters in the home, and the incidence of ALRI—mainly pneumonia in children ≤3 years of age living in households using traditional and biogas stoves over the course of 2 years.

Public Health Outcome:
The proposed study will help evaluate the benefits, and the effectiveness of national cookstove programs in reduction of HAP and occurrences of pneumonia among children ≤5 years of age in Nepal. This study will also help identify behavior change interventions among cookstove users that could be applied at a large, e.g. national, scale.
The findings of this study will help develop a plan to scale-up the best cookstove interventions.

NIH Collaborator:
Dr. Smith runs the oldest and largest research group in the world on household energy, health, and climate impacts. He has conducted pollution measurements related to heath and climate impacts, developed new monitoring technologies, and conducted epidemiological investigations of the relation between household air pollution and child pneumonia, COPD, heart disease risk factors, low birth weight, cataracts, cognitive deficit, and several biomarkers. Many of these studies have been done in India and Nepal, where he has worked since 1980.

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Awareness rally on air pollution and pneumonia organized by Female Community Health Volunteers (FCHV). (photo courtesy of PI Verma S)Evaluation of weekly morbidity assessments in HH level and health posts by PI Verma S and Investigators. (photo courtesy of PI Verma S)

Summary of Recent Activities

During the period of January to March 2016, the team continued to conduct morbidity assessments, stove usage data, data entry, air pollution monitoring, and particulate matter 2.5 data collection. Weekly morbidity assessment of 547 children study participants is ongoing as well as air pollution monitoring activities in 547 households. Twenty-eight (28) health volunteers are conducting weekly surveillance of acute respiratory tract infection (ARI) morbidity in children. They are also collecting a fuel use data on a weekly basis. Health volunteers are also collecting weekly morbidity, energy consumption, and nutrition data through survey forms. The health volunteers of Mahadevsthan VDC of Kavre organized an awareness rally on effects of air pollution on children’s health. In February 2016, Parshu Nepal, Director of the International Development Institute (USA), visited PEER project site. The discussion was held to draft a proposal for additional research activities within the PEER project. PEER Nepal project staff made donation from their salary to rebuild the health post of Patalekhet VDC. The health post was severely damaged by April 25th, 2015 earthquake. Project vehicle was used to bring some materials for the rebuilding work.

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Weekly morbidity assessment performed by FCHV. (photo courtesy of PI Verma S)Installation of SUMS on biomass and Biogas stoves. (photo courtesy of PI Verma S)

Health Cycle 1 Recipients