1. Acute Respiratory Infections Control Manager
Norman Lufesi
Acute Respiratory Infections Control Manager
Ministry of Health

2. Introduction
Almost half of the world’s population, including 700 million Africans, rely on biomass fuels for cooking
Animal dung
Crop residues
Wood
Charcoal
Biomass fuel is typically burned in open fires, often indoors, leading to high levels of household air pollution from smoke
Women and children experience high exposures
WHO attributes over 4 million deaths annually
No good evidence is available on how exposure is linked to pneumonia

3. What was known before this study
Two trials, one in Guatamala
Both tested stoves that reduce exposure mainly by venting emissions to the outdoor environment via a chimney rather than by improving combustion efficiency.
Objective of the study
Was determine whether a cleaner burning biomass-fuelled cookstove intervention would reduce pneumonia incidence in children under 5 years of age living in rural Malawi compared with continuation of traditional open fi re cooking

4. Setting Rural areas of Karonga and Chikhwawa districts in Malawi
Involved 8,626 households (4256 intervention, 5246 control)
Involved 10,750 children (5297 intervention, 5246 control)

5. Outcomes 2,506 WHO IMCI defined pneumonia were reported
1,255 in the intervention and 1,251 in the control
Incidence rate 15.67/ 100 child years
Incidence rate in intervention and in the control
Incidence ratio = 1.01

6. Conclusion
NO evidence of a reduction in pneumonia in young Malawian children in a rigorously conducted clinical trial of a cleaner burning biomass fuelled cookstove intervention
May be explained by exposure to other sources of air pollution, including rubbish burning and tobacco smoke, that could have overwhelmed any potential effects of the cookstoves

7. Possible reasons for these findings
Most households did not use the stoves consistently due to malfunctions and battery failure
The trial was done in hot districts where cooking is mostly done in outdoors
Study had assumed that children stay with their mother while cooking

8. What are the benefits from these type of studies?
Reduction in burns in Malawi
Reduction in respiratory symptoms, and decline in lung function in adults in a per-protocol analysis of intervention adopters in Mexico
Reduction in severe acute lower respiratory tract infections in Guatemala

9. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140- 6736(16)32507-7.pdf