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Thomas Clasen - One of the best experts on this subject based on the ideXlab platform.
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effects of a large scale distribution of Water Filters and natural draft rocket style cookstoves on diarrhea and acute respiratory infection a cluster randomized controlled trial in western province rwanda
PLOS Medicine, 2019Co-Authors: Corey L. Nagel, Miles A. Kirby, Thomas Clasen, Evan A. Thomas, Ghislaine Rosa, Laura Divens Zambrano, Sanctus Musafiri, Jean De Dieu NgirabegaAbstract:BACKGROUND: Unsafe drinking Water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household Water Filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve Water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS: In a large-scale program in Western Province, Rwanda, Water Filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking Water (piped, borehole, protected spring/well, or rainWater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking Water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have Water in their Filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking Water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS: Our findings indicate that the intervention improved household drinking Water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION: Clinical Trials.gov NCT02239250.
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behavioral reactivity associated with electronic monitoring of environmental health interventions a cluster randomized trial with Water Filters and cookstoves
Environmental Science & Technology, 2016Co-Authors: Evan A. Thomas, Miles A. Kirby, Thomas Clasen, Ghislaine Rosa, Sarita Tellezsanchez, Carson A Wick, Laura Divens Zambrano, Corey L. NagelAbstract:Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household Water Filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the Water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both f...
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assessing the impact of drinking Water and sanitation on diarrhoeal disease in low and middle income settings systematic review and meta regression
Tropical Medicine & International Health, 2014Co-Authors: Sandy Cairncross, Thomas Clasen, Jennyfer Wolf, Annette Prussustun, Oliver Cumming, Jamie Bartram, Sophie Bonjour, John M ColfordAbstract:Objective: To assess the impact of inadequate Water and sanitation on diarrhoeal disease in low- and middle-income settings. Methods: The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking Water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Results: Of 6819 records identified for drinking Water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking Water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of Water Filters, provision of high-quality piped Water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions: The results show that inadequate Water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved Water and sanitation implemented.
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designing and piloting a program to provide Water Filters and improved cookstoves in rwanda
PLOS ONE, 2014Co-Authors: Christina Barstow, Sophie Boisson, Thomas Clasen, Ghislaine Rosa, Fiona Majorin, Fidele Ngabo, Evan A. ThomasAbstract:Background In environmental health interventions addressing Water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. Methods and Findings This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household Water Filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage “pay for performance”. Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported Water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. Conclusion High uptake and sustained adoption of a Water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change.
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Thomas Clasen, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael JohnsonAbstract:Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Trial registration: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search
Miles A. Kirby - One of the best experts on this subject based on the ideXlab platform.
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effects of a large scale distribution of Water Filters and natural draft rocket style cookstoves on diarrhea and acute respiratory infection a cluster randomized controlled trial in western province rwanda
PLOS Medicine, 2019Co-Authors: Corey L. Nagel, Miles A. Kirby, Thomas Clasen, Evan A. Thomas, Ghislaine Rosa, Laura Divens Zambrano, Sanctus Musafiri, Jean De Dieu NgirabegaAbstract:BACKGROUND: Unsafe drinking Water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household Water Filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve Water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS: In a large-scale program in Western Province, Rwanda, Water Filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking Water (piped, borehole, protected spring/well, or rainWater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking Water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have Water in their Filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking Water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS: Our findings indicate that the intervention improved household drinking Water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION: Clinical Trials.gov NCT02239250.
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behavioral reactivity associated with electronic monitoring of environmental health interventions a cluster randomized trial with Water Filters and cookstoves
Environmental Science & Technology, 2016Co-Authors: Evan A. Thomas, Miles A. Kirby, Thomas Clasen, Ghislaine Rosa, Sarita Tellezsanchez, Carson A Wick, Laura Divens Zambrano, Corey L. NagelAbstract:Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household Water Filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the Water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both f...
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Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and Water Filters in Western Province, Rwanda
Contemporary Clinical Trials Communications, 2016Co-Authors: Corey L. Nagel, Christina K. Barstow, Miles A. Kirby, Ghislane Rosa, Laura D. Zambrano, Evan A. Thomas, Thomas F. ClasenAbstract:Background In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking Water is a primary cause of diarrheal disease. To date, there have been no large-scale effectiveness trials of programmatic efforts to provide either improved cookstoves or household Water Filters at scale in a low-income country. In this paper we describe the design of a cluster-randomized trial to evaluate the impact of a national-level program to distribute and promote the use of improved cookstoves and advanced Water Filters to the poorest quarter of households in Rwanda. Methods/Design We randomly allocated 72 sectors (administratively defined units) in Western Province to the intervention, with the remaining 24 sectors in the province serving as controls. In the intervention sectors, roughly 100,000 households received improved cookstoves and household Water Filters through a government-sponsored program targeting the poorest quarter of households nationally. The primary outcome measures are the incidence of acute respiratory infection (ARI) and diarrhea among children under five years of age. Over a one-year surveillance period, all cases of acute respiratory infection (ARI) and diarrhea identified by health workers in the study area will be extracted from records maintained at health facilities and by community health workers (CHW). In addition, we are conducting intensive, longitudinal data collection among a random sample of households in the study area for in-depth assessment of coverage, use, environmental exposures, and additional health measures. Discussion Although previous research has examined the impact of providing household Water treatment and improved cookstoves on child health, there have been no studies of national-level programs to deliver these interventions at scale in a developing country. The results of this study, the first RCT of a large-scale programmatic cookstove or household Water filter intervention, will inform global efforts to reduce childhood morbidity and mortality from diarrheal disease and pneumonia. Trial registration This trial is registered at Clinicaltrials.gov (NCT02239250).
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Thomas Clasen, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael JohnsonAbstract:Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Trial registration: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael Johnson, Thomas ClasenAbstract:UNLABELLED: Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. TRIAL REGISTRATION: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search.
Ghislaine Rosa - One of the best experts on this subject based on the ideXlab platform.
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effects of a large scale distribution of Water Filters and natural draft rocket style cookstoves on diarrhea and acute respiratory infection a cluster randomized controlled trial in western province rwanda
PLOS Medicine, 2019Co-Authors: Corey L. Nagel, Miles A. Kirby, Thomas Clasen, Evan A. Thomas, Ghislaine Rosa, Laura Divens Zambrano, Sanctus Musafiri, Jean De Dieu NgirabegaAbstract:BACKGROUND: Unsafe drinking Water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household Water Filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve Water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS: In a large-scale program in Western Province, Rwanda, Water Filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking Water (piped, borehole, protected spring/well, or rainWater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking Water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have Water in their Filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking Water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS: Our findings indicate that the intervention improved household drinking Water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION: Clinical Trials.gov NCT02239250.
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behavioral reactivity associated with electronic monitoring of environmental health interventions a cluster randomized trial with Water Filters and cookstoves
Environmental Science & Technology, 2016Co-Authors: Evan A. Thomas, Miles A. Kirby, Thomas Clasen, Ghislaine Rosa, Sarita Tellezsanchez, Carson A Wick, Laura Divens Zambrano, Corey L. NagelAbstract:Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household Water Filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the Water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both f...
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designing and piloting a program to provide Water Filters and improved cookstoves in rwanda
PLOS ONE, 2014Co-Authors: Christina Barstow, Sophie Boisson, Thomas Clasen, Ghislaine Rosa, Fiona Majorin, Fidele Ngabo, Evan A. ThomasAbstract:Background In environmental health interventions addressing Water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. Methods and Findings This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household Water Filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage “pay for performance”. Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported Water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. Conclusion High uptake and sustained adoption of a Water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change.
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Thomas Clasen, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael JohnsonAbstract:Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Trial registration: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael Johnson, Thomas ClasenAbstract:UNLABELLED: Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. TRIAL REGISTRATION: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search.
Evan A. Thomas - One of the best experts on this subject based on the ideXlab platform.
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effects of a large scale distribution of Water Filters and natural draft rocket style cookstoves on diarrhea and acute respiratory infection a cluster randomized controlled trial in western province rwanda
PLOS Medicine, 2019Co-Authors: Corey L. Nagel, Miles A. Kirby, Thomas Clasen, Evan A. Thomas, Ghislaine Rosa, Laura Divens Zambrano, Sanctus Musafiri, Jean De Dieu NgirabegaAbstract:BACKGROUND: Unsafe drinking Water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household Water Filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve Water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS: In a large-scale program in Western Province, Rwanda, Water Filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking Water (piped, borehole, protected spring/well, or rainWater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking Water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have Water in their Filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking Water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS: Our findings indicate that the intervention improved household drinking Water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION: Clinical Trials.gov NCT02239250.
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behavioral reactivity associated with electronic monitoring of environmental health interventions a cluster randomized trial with Water Filters and cookstoves
Environmental Science & Technology, 2016Co-Authors: Evan A. Thomas, Miles A. Kirby, Thomas Clasen, Ghislaine Rosa, Sarita Tellezsanchez, Carson A Wick, Laura Divens Zambrano, Corey L. NagelAbstract:Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household Water Filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the Water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both f...
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Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and Water Filters in Western Province, Rwanda
Contemporary Clinical Trials Communications, 2016Co-Authors: Corey L. Nagel, Christina K. Barstow, Miles A. Kirby, Ghislane Rosa, Laura D. Zambrano, Evan A. Thomas, Thomas F. ClasenAbstract:Background In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking Water is a primary cause of diarrheal disease. To date, there have been no large-scale effectiveness trials of programmatic efforts to provide either improved cookstoves or household Water Filters at scale in a low-income country. In this paper we describe the design of a cluster-randomized trial to evaluate the impact of a national-level program to distribute and promote the use of improved cookstoves and advanced Water Filters to the poorest quarter of households in Rwanda. Methods/Design We randomly allocated 72 sectors (administratively defined units) in Western Province to the intervention, with the remaining 24 sectors in the province serving as controls. In the intervention sectors, roughly 100,000 households received improved cookstoves and household Water Filters through a government-sponsored program targeting the poorest quarter of households nationally. The primary outcome measures are the incidence of acute respiratory infection (ARI) and diarrhea among children under five years of age. Over a one-year surveillance period, all cases of acute respiratory infection (ARI) and diarrhea identified by health workers in the study area will be extracted from records maintained at health facilities and by community health workers (CHW). In addition, we are conducting intensive, longitudinal data collection among a random sample of households in the study area for in-depth assessment of coverage, use, environmental exposures, and additional health measures. Discussion Although previous research has examined the impact of providing household Water treatment and improved cookstoves on child health, there have been no studies of national-level programs to deliver these interventions at scale in a developing country. The results of this study, the first RCT of a large-scale programmatic cookstove or household Water filter intervention, will inform global efforts to reduce childhood morbidity and mortality from diarrheal disease and pneumonia. Trial registration This trial is registered at Clinicaltrials.gov (NCT02239250).
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designing and piloting a program to provide Water Filters and improved cookstoves in rwanda
PLOS ONE, 2014Co-Authors: Christina Barstow, Sophie Boisson, Thomas Clasen, Ghislaine Rosa, Fiona Majorin, Fidele Ngabo, Evan A. ThomasAbstract:Background In environmental health interventions addressing Water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. Methods and Findings This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household Water Filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage “pay for performance”. Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported Water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. Conclusion High uptake and sustained adoption of a Water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change.
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assessing the impact of Water Filters and improved cook stoves on drinking Water quality and household air pollution a randomised controlled trial in rwanda
PLOS ONE, 2014Co-Authors: Ghislaine Rosa, Christina K. Barstow, Miles A. Kirby, Sophie Boisson, Thomas Clasen, Evan A. Thomas, Fiona Majorin, Fidele Ngabo, Michael JohnsonAbstract:Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance Water Filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking Water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the Filters as their primary source of drinking Water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated Water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Trial registration: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search
Chicgoua Noubactep - One of the best experts on this subject based on the ideXlab platform.
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Editorial for the Special Issue: Filters in Drinking Water Treatment
MDPI AG, 2019Co-Authors: Chicgoua NoubactepAbstract:Slow sand Filters were first used for safe drinking Water provision during the 19th century. The technology has been gradually improved and utilized at several scales. Based on their intrinsic limitations other filtration systems have been developed, including membrane technologies. The universal applicability of filtration in drinking Water supply makes Filters a device of choice to facilitate the achievement of the UN Sustainable Development Goals (‘drinking Water for all by 2030’). Available strategies to rationally design efficient and sustainable Water Filters are scattered in the literature and are difficult to access and evaluate by starting researchers. The present Special Issue summarizes knowledge on two key filtration systems for drinking Water supply: (i) membrane technology and (ii) metallic iron based Filters. The five (5) accepted articles are being briefly presented herein
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discussing porosity loss of fe0 packed Water Filters at ground level
Chemical Engineering Journal, 2015Co-Authors: Richard Domga, Chicgoua Noubactep, Fulbert Toguekamga, J B TchatchuengAbstract:Abstract The use of granular metallic iron (Fe0) as filter material is gaining acceptance in the field of Water treatment. Few works have been directed at developing design guidance for efficient Fe0 Filters. This note consolidates earlier works and provides the scientific basis for the design and evaluation of Fe0 Filters for Water treatment at any scale. The approach assumes uniform corrosion of individual Fe0 particles and utilizes the radius loss (X = R0 − R) to asses the extent of porosity loss in the whole system. Results corroborate that, for R0 ⩽ 1.0 mm, sustainable Filters must content less than 53% Fe0 (v/v). A universal equation of Fe0 Filters is provided given X as a function of the initial radius R0, the initial volume of Fe0, the initial porosity of the filter and the coefficient of volumetric expansion (O2 availability). This equation should be routinely incorporated in simulations for modeling the hydraulic conductivity of Fe0 Filters. The model improves the discussion of published data on porosity loss.
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Determining the optimum Fe-o ratio for sustainable granular Fe-o/sand Water Filters
Chemical Engineering Journal, 2014Co-Authors: Brice Donald Btatkeu K., Sabine Caré, J B Tchatchueng, H. Olvera Vargas, Chicgoua NoubactepAbstract:Packed beds of metallic iron (Fe0) and sand are tested for their efficiency at discolouring an aqueous methylene blue (MB) solution (2.0 mg L-1) in gravity driven systems for up to 95 days. The aim was to determine the optimal Fe0/sand ration for sustainable Filters. Six different Fe0/sand volumetric ratios were explored: 0/100, 20/80, 30/70, 40/60, 60/40 and 100/0. The columns were characterized by (i) the time-dependant extent of MB discoloration and (ii) the evolution of the hydraulic conductivity (permeability). Results clearly showed increased permeability loss with increasing Fe0 ratio. The Fe0/sand ratio dependent extent of MB discoloration was not monotone. These observations corroborated the working hypothesis that properly designing a Fe0/sand Filters is finding a compromise between: (i) increased sustainability by lowering Fe0 ratios and (ii) decreased efficiency by lowering Fe0 ratios. This work provided the first experimental evidence for an optimal Fe0/sand volumetric ratio of 25/75. This result will accelerate efforts for non site-specific system design.
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metallic iron for safe drinking Water worldwide
Chemical Engineering Journal, 2010Co-Authors: Chicgoua NoubactepAbstract:Abstract A new concept for household and large-scale safe drinking Water production is presented. Raw Water is successively filtered through a series of sand and iron Filters. Sand Filters mostly remove suspended particles (media filtration) and iron Filters remove anions, cations, micro-pollutants, natural organic matter, and micro-organisms including pathogens (reactive filtration). Accordingly, treatment steps conventionally achieved with flocculation, sedimentation, rapid sand filtration, activated carbon filtration, and disinfection are achieved in the new concept in only two steps. To prevent bed clogging, Fe0 is mixed with inert materials, yielding Fe0/sand Filters. Efficient Water treatment in Fe0/sand Filters has been extensively investigated during the past two decades. Two different contexts are particularly important in this regard: (i) underground permeable reactive barriers and (ii) household Water Filters. In these studies, the process of aqueous iron corrosion in a packed bed was proven very efficient for unspecific aqueous contaminant removal. Been based on a chemical process (iron corrosion), efficient Water treatment in Fe0 beds is necessarily coupled with a slow flow rate. Therefore, for large communities several Filters should work in parallel to produce enough Water for storage and distribution. It appears that Water filtration through Fe0/sand Filters is an efficient, affordable, a flexible technology for the whole world.
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enhancing sustainability of household Water Filters by mixing metallic iron with porous materials
Chemical Engineering Journal, 2010Co-Authors: Chicgoua Noubactep, Sabine CaréAbstract:Abstract This study conceptually discusses the feasibility of enhancing the sustainability of conventional iron/sand filter (Fe0/sand filter) for safe drinking Water by partially or totally substituting sand (quartz) by porous materials. Relevant materials included activated carbon, dolomites, limestone, pumice, sandstone, and zeolites. The rational was to use the internal volume of porous additives as storage room for in situ generated iron oxyhydroxides (iron corrosion products) and thus delay time to filter clogging. Based on previous works a filter with a volumetric Fe0:quartz ratio of 51:49 was used as reference system. The reference system is clogged upon Fe0 depletion. Results showed that totally substituting quartz by pumice particles having a porosity of 80% yields to a residual porosity of 41%. This encouraging result suggested that the possibility of using Fe0/MnO2/pumice systems for a synergic promotion of Fe0 reactivity (by MnO2) and filter permeability (by pumice) should be investigated in more details.
