Post on 19-Oct-2020
Deborah Havens, DO MPH
28 January 2017
Cooking And Pneumonia Study (CAPS)
*© The Liverpool School of Tropical Medicine
CAPS trial
• An advanced cookstove intervention to prevent pneumonia in children under 5 years old in Malawi: a cluster randomized controlled trial
• Five research themes:
Pneumonia in children under 5 years (primary)
Air pollution and personal exposures
Respiratory symptoms and lung function in adults
Health economics (affordability and cost-effectiveness)
Qualitative (societal perspectives/adoption)
*© The Liverpool School of Tropical Medicine
CAPS
• Summary of trial:
10,543 Malawian children under the age of 5 years in 150 village-level clusters in Chikhwawa and Chilumba
Intervention: Philips cookstove
Control: traditional cooking methods
The primary outcome was pneumonia (defined using the WHO Integrated Management of Childhood Illness pneumonia assessment protocol)
Secondary outcomes:
pneumonia not meeting IMCI criteria
burns
severe pneumonia
All households were followed for 24 months
Households were visited every 3 months
*© The Liverpool School of Tropical Medicine
CAPS Main trial design
*© The Liverpool School of Tropical Medicine
Stove Use Monitor System (SUMS)
• Used in 10% of intervention households
*© The Liverpool School of Tropical Medicine
Air Pollution Monitoring and Personal Exposures
Carbon monoxide in approximately 2000 children every 6 months including baseline
• Monitor for 48 hours
• Lascar CO Data Loggers
• Assess carboxyhemoglobin levels (RAD-57)
*© The Liverpool School of Tropical Medicine
Household Air Pollution
Black carbon, CO and PM 2.5 in approximately 250 adults, children and households
• microAeth
• ThermoScientific pDR 1500
Grouped samples: CO/PM by cooking source, black carbon/CO on mother, CO for child
*© The Liverpool School of Tropical Medicine
Air Pollution Monitoring-Black Carbon and Carbon
Monoxide
Emissions Concentration Exposure Intake Dose Health Effects
*© The Liverpool School of Tropical Medicine
Respiratory Symptoms and Lung Function in Adults
• Adult Lung Health Study-using BOLD protocol
• 2 years of follow up
• Approximately 2000 adults in Chikhwawa region
• Carbon Monoxide and PM2.5 measurements for 24 hours yearly during the study using Aprovecho IAP meter
• Spirometry baseline and every 12 months
*© The Liverpool School of Tropical Medicine
CAPS Participant/Household Characteristics
• 10543 children from 8470 households included in intention-to-treat analysis
Household level data at baseline Intervention Control
Number of households 4256 4214
Fuel used regularly for cooking
Wood 2494 (58.6%) 2390 (56.7%)
Crop residue 1339 (31.5%) 1320 (31.3%)
Charcoal 563 (13.2%) 723 (17.2%)
Gas 0 2 (0.0%)
Electricity 5 (0.1%) 13 (0.3%)
Tobacco smoker in household 746 (17.5%) 634 (15.0%)
Daily or almost daily exposure to smoke from:
Burning rubbish 1747 (41.0%) 1677(39.8%)
Cooking for business 554 (13.0%) 513 (12.2%)
Brick production 177 (4.2%) 214 (5.1%)
Paraffin/kerosene lamps 87 (2.0%) 105 (2.5%)
Mosquito coils 44 (1.0%) 82 (1.9%)
Beer production 54 (1.3%) 44 (1.0%)
Experienced a time within the past year when there was not
enough food for the household
2131 (50.1%) 2113 (50.1%)
Experienced a time in the past year when the household did
not have money to buy bathing soap
2608 (61.3%) 2597 (61.6%)
*© The Liverpool School of Tropical Medicine
CAPS Participant/Household Characteristics
Household level data at baseline Intervention Control
Cooking Characteristics (rainy season)
Outside with a separate structure with a
roof only
846 (16%) 754 (14%)
Outside in a separate structure with a roof
and walls
2156 (40%) 2044 (38%)
Outside in the open air 1120 (21%) 1185(22%)
Outside on the veranda 915 (17%) 1011(19%)
Inside in a separate room (kitchen) 218 (4%) 188 (4%)
Inside in a living room 165(3%) 169 (3%)
Symptom Characteristics
Cough 2987 (55%) 3272 (60%)
Wheeze 835 (15%) 935 (17%)
Burn 223 (4%) 293 (5%)
*© The Liverpool School of Tropical Medicine
. CAPS Results
Overall Intervention Control
IMCI Pneumonia 2506 1255 1251
Incidence Rate (per
100 child-years)
15.67 15.76 15.58 IRR:1.01 (95% CI
0.91-1.13; p=0.80)
Severe Pneumonia331 186 145
Incidence Rate (per
100 child-years)
2.07 2.33 1.80 IRR: 1.30 (95% CI
0.99-1.71;p=0.06)
Burns1505 549 956
Incidence Rate (per
100 child-years)
9.41 6.86 11.91 IRR: 0.58 (95% CI
0.51-0.65;p
*© The Liverpool School of Tropical Medicine
www.CAPStudy.org
A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in
children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster
randomised controlled trial.
Lancet. 2017 Jan 14;389(10065):167-175. Epub 2016 Dec 7.
https://www.ncbi.nlm.nih.gov/pubmed/27939058