Health and development effectiveness of integrated home-based interventions in rural Andean communities: a randomised trial

Plain English Summary

Background and study aims
Children and women in low- and middle-income countries are frequently exposed to accumulating health and developmental risks often rooted in unhealthy environments. Nearly 3 billion people worldwide use solid fuels, which are a major source of household air pollution (HAP). Exposure to HAP drastically increases the risk of acute respiratory infections and cognitive deficits in children. In addition, a considerable fraction of the world population lacks access to secure drinking water sources (11%) or adequate sanitation (36%). Exposure to unsafe drinking water, sanitation and inadequate personal hygiene (WASH) increases the risk of several negative health outcomes such as diarrhoea, malnutrition or trachoma. In 2011, HAP and WASH accounted for 1.3 million child deaths, more than AIDS, malaria and measles combined. Early child development (ECD) is one of the main social determinants of health – opportunities that are provided to young children are crucial in shaping their lifelong health and development status. However, today 200 million children worldwide are not developing their full cognitive potential. This disparity has lifetime adverse consequences and impacts the wellbeing of future generations. Poor cognitive stimulation has been identified as one of the key risk factors hampering ECD in low-income countries. Poor health and development require integrated approaches to address underlying the risks and structural determinants. Many investigations have demonstrated that low-cost interventions addressing common health risk factors at the same time have a powerful combined effect, leading to significant health and social improvements. Health and ECD interventions have demonstrated to be effective alone, so integrating environmental, health and ECD interventions can create safe, stimulating and responsive homes where children can play and eat without being exposed to factors that threaten their health and development. Furthermore, this approach can reduce the use of resources and provide a more holistic approach towards prevention. Although Peru is now classified as upper-middle income country economic growth it maintains large inequalities between urban and rural areas with poverty and extreme poverty, infant mortality, chronic malnutrition and illiteracy. The home-based interventions proposed in this study can alleviate the negative effects of poverty on child health and development and thereby prevent the widening gap between the rich and the poor. This includes health and non-health benefits such as better nutritional status, empowerment of women or the community, capacity building, increased security and time savings. The aim of this study is to assess the effectiveness of a package of home-environmental health and ECD interventions in rural Andean communities.

Who can participate?
Families with at least one child aged under 20 months, who use solid fuels as their main energy source for cooking/heating, have access to piped water in the yard or the community where the kitchen connections can be made, and do not plan to move within the next 24 months

What does the study involve?
Communities in two poor rural provinces of the Peruvian Andes are randomly allocated to one of four groups. Households in the three intervention groups receive either improved biomass cookstoves, kitchen sinks and hygiene education, the Peruvian national program on ECD, or both interventions combined. The control group do not receive any of the interventions during the study and follow-up period, but receive all the interventions (kitchen stove and sink) at the end of study. The researchers monitor the occurrence of acute respiratory infections, diarrhoea and changes in ECD in children under 36 months of age over one year through weekly visits and start and end of study comparisons. In addition, they study changes in exposure to air pollution in households and individuals in a small group of participants to assess cookstove efficiency, and also analyse the presence of E.coli (one of the main causes of diarrhoea) in drinking water of all the participants at the beginning and end of the study and regularly during the study in a small group of participants.

What are the possible benefits and risks of participating?
Households receive a cookstove, a kitchen sink and a piped water supply into the kitchen, which may improve health and development. The study will provide much needed evidence on health and non-health impacts and factors influencing the effectiveness of the interventions. There are no known risks of participating in this study. All study households receive all of the interventions at the end of the study.

Where is the study run from?
The study takes place in two Peruvian provinces (San Marcos and Cajabamba)

When is the study starting and how long is it expected to run for?
November 2014 to December 2017

Who is funding the study?
1. UBS Optimus Foundation (Switzerland)
2. Grand Challenges Canada (Canada)

Who is the main contact?
1. Stella Hartinger
2. Daniel Mausezahl

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• Peru

Study participating centre

Sponsor information

Funders

Funder type

Charity

Results and Publications

Study outputs

Editorial Notes

07/06/2022: Publication reference added.
23/04/2021: Internal review.
06/04/2020: The following changes have been made:
1. Publication reference added.
2. The total final enrolment number has been added from the reference.