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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 Dates: October 2013 - February 2019

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. The 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.

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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

As of December 2017, the team continued data cleaning. Additionally, personal carbon monoxide (CO) exposure on children is being sampled in 83 children total. Of the 83 total, 53 live in a household that are biogas users HHs and 30 live in a household of biomass users HHS. Dr. Sharat C. Verma, Dr. Amod Pokhrel, and Dhiraj Pokhrel participated in the three-day (October 24-26, 2017) Clean Cooking Forum in New Delhi, India. The forum was organized by the Global Alliance for Clean Cookstove (GACC). Two presentations were made at the forum, one of which, "Household Contribution to Outdoor PM2.5: A Case-Study from Panchkhal" was based on the findings of the study conducted within the PEER study. In December, 30 students and four faculties of Kathmandu Medical College (KMC) visited Mahadevsthan area of PEER Health Nepal project site. The purpose of their visit was to learn how the community health volunteers have engaged in environmental health-related research and what role can medical students play in the environmental health-related research in Nepal. Mr. Arijit Basu, the GACC's Regional Director of Market Development for Clean Cookstoves for South East Asia and Africa, and the GACC's Nepal Coordinator visited PEER project site at Panchkhal. The primary purpose of the visit was to identify how viable and commercially suitable clean cooking energy market can be created in the Kavre district to move away from the current use of solid fuel-based cookstoves.

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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