title: Feasibility of conducting a randomised controlled trial of a cookstove intervention in rural Malawi.
abstract: BACKGROUND
  Exposure to household air pollution (HAP) causes 4 million deaths annually, and strategies to reduce HAP exposure are urgently required.
  
  
  OBJECTIVE
  To evaluate the acceptability and feasibility of conducting a trial of a cookstove intervention in rural Malawi.
  
  
  METHODS
  Non-smoking women were randomised to continuing to use an open fire (control) or to using a wood-burning clay cookstove (intervention). Symptom burden, oxygen saturation and exhaled carbon monoxide (eCO) were assessed at baseline and 7-day follow-up. A subset of women underwent HAP exposure monitoring.
  
  
  RESULTS
  Of 51 women recruited, 50 (98%) completed the main study. The methodology was acceptable to participants. Headache, back pain and cough were the most commonly reported symptoms at baseline and follow-up. Median eCO was within normal limits, but with a difference of 0.5 parts per million (ppm) in median change of eCO from baseline to follow-up seen between the two groups (P = 0.035). The peak ambient CO concentration detected was 150 ppm.
  
  
  CONCLUSIONS
  This study suggests that a large cookstove intervention trial in Malawi would be feasible with careful community sensitisation. Monitoring exposure to HAP is challenging, and further studies evaluating potential biomarkers of exposure, including eCO, should be undertaken.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK; University of Liverpool, Liverpool, UK.
authors.forename: H R
authors.initials: HR
authors.lastname: Jary
authors.affiliation: Concern Universal, Blantyre, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Kachidiku
authors.affiliation: Concern Universal, Blantyre, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Banda
authors.affiliation: Concern Universal, Blantyre, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Kapanga
authors.affiliation: Concern Universal, Blantyre, Malawi.
authors.forename: J V
authors.initials: JV
authors.lastname: Doyle
authors.affiliation: Clioma Ltd, Lilongwe, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Banda
authors.affiliation: Clioma Ltd, Lilongwe, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Fox
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Gordon
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mortimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D016902:Air Pollution, Indoor / Q000517:prevention & control*; D001416:Back Pain / Q000139:chemically induced / Q000517:prevention & control; D001944:Breath Tests; D002248:Carbon Monoxide / Q000009:adverse effects* / Q000032:analysis; D003296:Cooking / Q000295:instrumentation*; D003371:Cough / Q000139:chemically induced / Q000517:prevention & control; D004784:Environmental Monitoring / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005390:Fires; D006261:Headache / Q000139:chemically induced / Q000517:prevention & control; D006794:Household Articles; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects / Q000517:prevention & control; D008295:Malawi; D008875:Middle Aged; D010865:Pilot Projects; D012107:Research Design; D012423:Rural Health; D013997:Time Factors; D014934:Wood / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D002248:Carbon Monoxide