scholarly journals Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala

2021 ◽  
pp. 109019812199628
Author(s):  
Mayarí Hengstermann ◽  
Anaité Díaz-Artiga ◽  
Roberto Otzóy-Sucúc ◽  
Ana Laura Maria Ruiz-Aguilar ◽  
Lisa M. Thompson ◽  
...  
Keyword(s):  
Air Pollution ◽  
Focus Group ◽  
Controlled Trial ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Flip Chart ◽  
Cooking Fuels

Background Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method We conducted ethnographic research, including direct observation ( n = 36), in-depth ( n = 18), and semistructured ( n = 6) interviews, and 24 focus group discussions ( n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.

scholarly journals Promoting traditional foods for human and environmental health: lessons from agroecology and Indigenous communities in Ecuador

2020 ◽  
Author(s):  
Ana Laura Deaconu ◽  
Geneviève Mercille ◽  
Malek Batal
Keyword(s):  
Focus Group ◽  
Indigenous People ◽  
Agricultural Practices ◽  
Indigenous Communities ◽  
Traditional Food ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Dietary Practices ◽  
Production Diversity

Abstract Background: The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country’s agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors. Methods: Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n=61) and neighboring reference farmers (n=30) in Ecuador’s Imbabura province. Instruments include 24-hour dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers’ associations. Results: Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as likely drivers of stronger TF practices. Conclusions: Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only promotes the agricultural practices that are associated with TF production, but also appears to intensify affective sentiments toward TFs and inserts TFs in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.

scholarly journals Promoting traditional foods for human and environmental health: lessons from agroecology and Indigenous communities in Ecuador

2019 ◽  
Author(s):  
Ana Laura Deaconu ◽  
Geneviève Mercille ◽  
Malek Batal
Keyword(s):  
Focus Group ◽  
Indigenous People ◽  
Scale Up ◽  
Indigenous Communities ◽  
Traditional Food ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Dietary Practices ◽  
Production Diversity

Abstract Background: The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country’s agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors. Methods: Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n=61) and neighboring reference farmers (n=30) in Ecuador’s Imbabura province. Instruments include 24-hour dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers’ associations. Results: Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as drivers of stronger TF practices. Conclusions: Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only strengthens productive pathways toward TF promotion, but also intensifies affective sentiments toward TFs and inserts them in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.

scholarly journals Exposure contrasts of pregnant women during the Household Air Pollution Intervention Network randomized controlled trial

2021 ◽  
Author(s):  
Michael Johnson ◽  
Ajay Pillarisetti ◽  
Ricardo Piedrahita ◽  
Kalpana Balakrishnan ◽  
Jennifer L Peel ◽  
...  
Keyword(s):  
Air Pollution ◽  
Randomized Controlled Trial ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Mixed Effect ◽  
Randomized Controlled ◽  
Life Years ◽  
The Impact

Background: Exposure to PM2.5 arising from solid fuel combustion is estimated to result in approximately 2.3 million premature deaths and 90 million lost disability-adjusted life years annually. 'Clean' cooking interventions attempting to mitigate this burden have had limited success in reducing exposures to levels that may yield improved health outcomes. Objectives: This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial. Methods: The HAPIN trial included 3195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. 24-hour exposures to PM2.5, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (n=1605) and LPG arms (n=1590) and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels. Results: Median exposures of PM2.5, BC, and CO post-randomization in the intervention arm were lower by 66% (70.7 versus 24.0 µg/m3), 71% (9.6 versus 2.8 µg/m3), and 83% (1.2 versus 0.2 ppm), respectively, compared to the control arm. Exposure reductions were similar across research locations. Post-intervention PM2.5 exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of PM2.5 samples falling below the WHO Annual Interim Target 1 of 35 µg/m3. Discussion: This study indicates that an LPG intervention with high displacement of traditional cooking can reduce exposures to levels thought to be associated with health benefits. Success in reducing exposures was likely due to strong performance of, and high adherence to the intervention. Keywords (5-8): Liquefied petroleum gas, clean cooking, intervention, exposure assessment, PM2.5

scholarly journals Peer assessment to improve medical student’s contributions to team-based projects: randomised controlled trial and qualitative follow-up

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Regien Biesma ◽  
Mary-Claire Kennedy ◽  
Teresa Pawlikowska ◽  
Ruairi Brugha ◽  
Ronan Conroy ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Focus Group ◽  
Peer Assessment ◽  
Controlled Trial ◽  
Team Work ◽  
Assessment System ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Randomised Controlled

Abstract Background Medical schools increasingly incorporate teamwork in their curricula but medical students often have a negative perception of team projects, in particular when there is unequal participation. The purpose of this study is to evaluate whether a novel peer evaluation system improves teamwork contributions and reduces the risk of students “free loading”. Methods A cluster randomised controlled trial (RCT) with qualitative follow up enrolled 37 teams (n = 223 students). Participating teams were randomised to intervention group (19 teams) or control group (18 teams). The validated Comprehensive Assessment Team Member Effectiveness (CATME) tool was used as the outcome measure, and was completed at baseline (week 2) and at the end of the project (week 10). The team contribution subscale was the primary outcome, with other subscales as secondary outcomes. Six focus group discussions were held with students to capture the team’s experiences and perceptions of peer assessment and its effects on team work. Results The results of the RCT showed that there was no difference in team contribution, and other forms of team effectiveness, between intervention and control teams. The focus group discussions highlighted students’ negative attitudes, and lack of implementation of this transparent, points-based peer assessment system, out of fear of future consequences for relationships with peers. The need to assess peers in a transparent way to stimulate open discussion was perceived as threatening by participants. Teams suggested that other peer assessment systems could work such as rewarding additional or floating marks to high performing team members. Conclusions Other models of peer assessment need to be developed and tested that are non-threatening and that facilitate early acceptance of this mode of assessment.

scholarly journals Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial

2020 ◽  
Vol 6 (1) ◽  
pp. 00308-2019
Author(s):  
Suzanne M. Simkovich ◽  
Lindsay J. Underhill ◽  
Miles A. Kirby ◽  
Dina Goodman ◽  
Mary E. Crocker ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cause Of Death ◽  
Controlled Trial ◽  
Severe Pneumonia ◽  
Clean Energy ◽  
Household Air Pollution ◽  
World Health ◽  
Liquefied Petroleum Gas ◽  
Preventable Risk Factor ◽  
Difficulty Breathing

Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.

scholarly journals Promoting traditional foods for human and environmental health: lessons from agroecology and Indigenous communities in Ecuador

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ana Deaconu ◽  
◽  
Geneviève Mercille ◽  
Malek Batal
Keyword(s):  
Focus Group ◽  
Indigenous People ◽  
Agricultural Practices ◽  
Indigenous Communities ◽  
Traditional Food ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Dietary Practices ◽  
Production Diversity

Abstract Background The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country’s agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors. Methods Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n = 61) and neighboring reference farmers (n = 30) in Ecuador’s Imbabura province. Instruments include 24-h dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers’ associations. Results Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as likely drivers of stronger TF practices. Conclusions Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only promotes the agricultural practices that are associated with TF production, but also appears to intensify affective sentiments toward TFs and inserts TFs in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.

scholarly journals Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

2021 ◽  
Vol 18 (23) ◽  
pp. 12592
Author(s):  
Ashlinn K. Quinn ◽  
Kendra N. Williams ◽  
Lisa M. Thompson ◽  
Steven A. Harvey ◽  
Ricardo Piedrahita ◽  
...  
Keyword(s):  
Air Pollution ◽  
Controlled Trial ◽  
Interquartile Range ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Randomized Controlled ◽  
Fuel Delivery ◽  
Adherence Intervention ◽  
Infant Birth

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and had a gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

scholarly journals Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention During Gestation: The Multi-country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

2021 ◽  
Author(s):  
Ashlinn K Quinn ◽  
Kendra N Williams ◽  
Lisa M Thompson ◽  
Steven Harvey ◽  
Ricardo Piedrahita ◽  
...  
Keyword(s):  
Air Pollution ◽  
Controlled Trial ◽  
Interquartile Range ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Randomized Controlled ◽  
Fuel Delivery ◽  
Adherence Intervention ◽  
Infant Birth

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of the stoves, with simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda either to a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention, at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of intervention households. 31.4% removed their traditional stoves upon receipt of the intervention, and among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: Fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

scholarly journals Promoting traditional foods for human and environmental health: lessons from agroecology and Indigenous communities in Ecuador

2020 ◽  
Author(s):  
Ana Laura Deaconu ◽  
Geneviève Mercille ◽  
Malek Batal
Keyword(s):  
Focus Group ◽  
Indigenous People ◽  
Agricultural Practices ◽  
Indigenous Communities ◽  
Traditional Food ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Dietary Practices ◽  
Production Diversity

Abstract Background: The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country’s agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors. Methods: Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n=61) and neighboring reference farmers (n=30) in Ecuador’s Imbabura province. Instruments include 24-hour dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers’ associations. Results: Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as likely drivers of stronger TF practices. Conclusions: Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only promotes the agricultural practices that are associated with TF production, but also appears to intensify affective sentiments toward TFs and inserts TFs in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.

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