PEER Health Project

Acute Respiratory Infection (ARI) is the leading cause of childhood morbidity and mortality in Nepal. The Ministry of Health and Population (MoHP) 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 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 Global Alliance for Clean Cookstove 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 (with flue) cookstove–ICS and 131596 biogas systems throughout the country. However, there has been no study conducted to assess their effectiveness in either reducing HAP or health burden in the community. LEADERS Nepal is implementing Investigation of the effectiveness of national clean cookstove program in Nepal in reducing Acute Respiratory Infection in ≤ 5 children project with the support of PEER Health Project of National Academic of Science, USA and USAID. This prospective cohort study in Kavre district seeks to evaluate the effectiveness of national clean cookstove technologies—biogas and ICS on the incidence of ARI, including pneumonia in ≤3 year’s old children. The study will follow ~520 severe ALRI free children at the baseline on a weekly basis for two years and assess episodes of ARI on them by their stove use pattern and exposure to HAP such as PM2.5 and carbon monoxide in their homes. These children will be randomly recruited from households using biogas, ICS and traditional cookstove (biomass cookstove without chimney). The study plan to document stove use pattern by administrating the questionnaire and by putting stove use monitors (SUMS) on the stove, and measure kitchen and child’s bedroom level PM2.5 and CO in all households, and personal level of CO and PM2.5 in a sub-sample of children on bi-monthly basis. The episodes of ARI in this study will be documented by Female Community Health Volunteer (FCHV), and the episodes of pneumonia including severe pneumonia will be further confirmed by the pediatrician. In summary, the findings of this study will help answer following policy relevant questions:
i) Could clean cook stove technologies complement Nepal Government’s (MoHP) effort of lowering the incidence of ARI (including pneumonia) and under-five mortality in the country?
ii) Which levels of air pollution reduction is necessary to protect or meaningfully improve children’s health?