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Free Content Feasibility of conducting a randomised controlled trial of a cookstove intervention in rural Malawi

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BACKGROUND: Exposure to household air pollution (HAP) causes 4 million deaths annually, and strategies to reduce HAP exposure are urgently required.

OBJECTIVE: To evaluate the acceptability and feasibility of conducting a trial of a cookstove intervention in rural Malawi.

DESIGN: Non-smoking women were randomised to continuing to use an open fire (control) or to using a wood-burning clay cookstove (intervention). Symptom burden, oxygen saturation and exhaled carbon monoxide (eCO) were assessed at baseline and 7-day follow-up. A subset of women underwent HAP exposure monitoring.

RESULTS: Of 51 women recruited, 50 (98%) completed the main study. The methodology was acceptable to participants. Headache, back pain and cough were the most commonly reported symptoms at baseline and follow-up. Median eCO was within normal limits, but with a difference of 0.5 parts per million (ppm) in median change of eCO from baseline to follow-up seen between the two groups (P = 0.035). The peak ambient CO concentration detected was 150 ppm.

CONCLUSION: This study suggests that a large cookstove intervention trial in Malawi would be feasible with careful community sensitisation. Monitoring exposure to HAP is challenging, and further studies evaluating potential biomarkers of exposure, including eCO, should be undertaken.
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Keywords: biomarker; carbon monoxide; pollution; respiratory symptoms; smoke

Document Type: Research Article

Affiliations: 1: Liverpool School of Tropical Medicine, Liverpool, UK; University of Liverpool, Liverpool, UK 2: Concern Universal, Blantyre, Malawi 3: Clioma Ltd, Lilongwe, Malawi 4: Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: 2014-02-01

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