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PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) HEALTH
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
Background: 
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.

Objectives: 
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. 

Methods:
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.