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• 1. [Article] Study Design of a Cluster-Randomized Controlled Trial to Evaluate a Large-scale Distribution of Cook Stoves and Water Filters in Western Province, Rwanda

  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 ...

  Citation × Citation Citation Abstract Copy Title: Study Design of a Cluster-Randomized Controlled Trial to Evaluate a Large-scale Distribution of Cook Stoves and Water Filters in Western Province, Rwanda Author: Nagel, Corey L., Kirby, Miles, Zambrano, Laura D., Rosa, Ghislaine, Barstow, Christina K., Thomas, Evan A., Clasen, Thomas Year: 2016 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 largescale 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 clusterrandomized 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. Title: Study Design of a Cluster-Randomized Controlled Trial to Evaluate a Large-scale Distribution of Cook Stoves and Water Filters in Western Province, Rwanda Author: Nagel, Corey L., Kirby, Miles, Zambrano, Laura D., Rosa, Ghislaine, Barstow, Christina K., Thomas, Evan A., Clasen, Thomas Year: 2016 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 largescale 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 clusterrandomized 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. Close

• 2. [Article] Remotely Accessible Instrumented Monitoring of Global Development Programs: Technology Development and Validation

  Many global development agencies self-report their project outcomes, often relying on subjective data that is collected sporadically and communicated months later. These reports often highlight successes ...

  Citation × Citation Citation Abstract Copy Title: Remotely Accessible Instrumented Monitoring of Global Development Programs: Technology Development and Validation Author: Thomas, Evan A., Zumr, Zdenek, Graf, Jodi, Wick, Carson A., McCellan, James H., Imam, Zachary, Barstow, Christina, Spiller, Kelly, Fleming, Michael Year: 2013 Many global development agencies self-report their project outcomes, often relying on subjective data that is collected sporadically and communicated months later. These reports often highlight successes and downplay challenges. Instrumented monitoring via distributed data collection platforms may provide crucial evidence to help inform the sector and public on the effectiveness of aid, and the on-going challenges. This paper presents the process of designing and validating an integrated sensor platform with cellular-to-internet reporting purposely targeted at global development programs. The integrated hardware platform has been applied to water, sanitation, energy and infrastructure interventions and validated through laboratory calibration and field observations. Presented here are two examples: a water pump and a household water filter, wherein field observations agreed with the data algorithm with a linear fit slope of between 0.91 and 1, and an r-squared of between 0.36 and 0.39, indicating a wide confidence interval but with low overall error (i.e., less than 0.5% in the case of structured field observations of water volume added to a household water filter) and few false negatives or false positives. Title: Remotely Accessible Instrumented Monitoring of Global Development Programs: Technology Development and Validation Author: Thomas, Evan A., Zumr, Zdenek, Graf, Jodi, Wick, Carson A., McCellan, James H., Imam, Zachary, Barstow, Christina, Spiller, Kelly, Fleming, Michael Year: 2013 Many global development agencies self-report their project outcomes, often relying on subjective data that is collected sporadically and communicated months later. These reports often highlight successes and downplay challenges. Instrumented monitoring via distributed data collection platforms may provide crucial evidence to help inform the sector and public on the effectiveness of aid, and the on-going challenges. This paper presents the process of designing and validating an integrated sensor platform with cellular-to-internet reporting purposely targeted at global development programs. The integrated hardware platform has been applied to water, sanitation, energy and infrastructure interventions and validated through laboratory calibration and field observations. Presented here are two examples: a water pump and a household water filter, wherein field observations agreed with the data algorithm with a linear fit slope of between 0.91 and 1, and an r-squared of between 0.36 and 0.39, indicating a wide confidence interval but with low overall error (i.e., less than 0.5% in the case of structured field observations of water volume added to a household water filter) and few false negatives or false positives. Close