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