Feasibility study of a community-based intervention to reduce air pollution exposure.
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Date
2020-11-11
Authors
Journal Title
Journal ISSN
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Publisher
Kamuzu university of Health Sciences
Abstract
Study Type
A before-after study to test the feasibility of a community-wide cooking intervention
Problem to be studied
Air pollution is a leading environmental health risk globally, particularly in low- and middle-income countries, contributing
to pathology in the major organ systems and poor pregnancy outcomes (Schraufnagel et al., 2019a, 2019b; World Health
Organization, 2018). Whilst evidence exists for health improvement from air pollution reduction interventions, the
interventional research in low income settings has to date largely relied on the introduction of single devices (improved
cookstoves) in attempts to tackle the problem, and these have not reached their theoretical potential, in terms of achieving
particulate exposure reductions seen in laboratory conditions, due at least in part to insufficient uptake (also incorporating
exclusive use), and continued use (Hanna, Duflo, & Greenstone, 2016).
The overall PAMODZI study (“P.02/19/2600 - Participatory Approaches in Mpemba for Developing Clean Air
interventions (PAMODZI) version 2.0”) has sought to understand the cultural and social context in which smoke exists,
describe the patterns of smoke exposure within a village in rural Malawi, and top co-develop a context-appropriate,
feasible cleaner air intervention together with the community on the village. Following the initial ethnographic and
participatory phase, we now seek to implement this intervention, in an engaged and receptive way, within the same village.
Such an evaluation with community at the centre throughout, will optimise the chances of success in achieving its goals
and reap meaningful conclusions in terms of how we do Global Health research.
Overall aim
1 To assess feasibility of a community-based intervention in Makanjira village to reduce smoke exposure and to
determine the effects of the intervention on particulate exposures in this setting
Objectives
1 To assess how the study population (in the village) engage with the research intervention, in terms of uptake
and continuing use of the intervention (qualitative and quantitative outcomes)
2 To assess whether the proposed approach for air quality monitoring is informative and acceptable (see
protocol section vi] Data collection)
3 To quantify any changes in ambient and personal PM2.5 and carbon monoxide (CO) exposures from baseline to
selected follow-up timepoints (as described in methodology section)
Methodology
The study will involve two phases:
1 ‘Before’ (baseline phase) - Baseline ambient particulate monitoring using stationary PM2.5 and CO monitors at
three public points within the village; additional baseline monitoring of individual exposures as required given
previously collected data (2x24 hour periods per participant); community preparation for intervention
introduction.
2 ‘After’ (post-intervention phase) – Initial month of in-depth observation (realist process evalution) postintervention
introduction; similar qualitative evaluation approximately 3 selected timepoints post-evaluation.
Ambient air quality monitoring (3 points) at one month post-intervention and at the final follow-up timepoint;
personal air quality monitoring (2x24 hour periods per participant) at the same two timepoints.
Intervention will incorporate two elements:
1 Local wood burning cookstove for each household
2 Request to cook outdoors or on a well-ventilated khonde where possible
Data Management and analysis
Qualitative and quantitative data will be collected and analysed separately as appropriate. Qualitative data will be
entered into NVIVO for management and analysis, which will be thematic, done iteratively throughout and beyond the
period of fieldwork, in discussion with the research assistant and fieldworker. Quantitative data will be input into excel
and the programme ‘R’ will assist in statistical analysis. Comparisons will be made between baseline CO and PM2.5
levels at baseline and post-intervention. Decisions on appropriate analyses and specific statistical tests will be
informed by discussions with staff from the statistical support unit at MLW.
Expected findings and dissemination
An in-depth account of uptake and continued use of the cooking intervention and complex implementation factors. In
addition, a qualitative indication of any changes to personal and ambient particulate exposures in the village throughout
the time of the trial. These will be disseminated through a number of pathways, both locally within the community itself,
regionally and nationally in Malawi, including to COMREC, and through wider scientific networks through publication and
presentation. This will be supported by the MLW Science Communications team.