A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings

Hartinger, Stella M.; Martínez, Néstor Nuño; Hattendorf, Jan; Verástegui, Héctor; Ortiz, Mariela; Mäusezahl, Daniel

doi:10.1101/465856

Cited by 6 publications

(10 citation statements)

References 37 publications

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“…In brief, the IHIP-2 trial assessed the effectiveness of an integrated homeenvironmental intervention package comprising the installation of a kitchen sink with running water, ventilated improved cookstove and general kitchen, hand and food hygiene education, and early child development. 16 For the parent study, participant families were eligible if they met the following criteria: 1) have at least one child aged < 1.5 months living at home, 2) use solid fuels as main energy source for cooking/heating, 3) have access to non-treated piped water in the yard or the community (15 m maximum), 4) do not plan to move within the next 24 months, and 5) are not participating in another program or intervention. All data presented here are from the baseline phase of the IHIP-2 trial.…”

Section: Methodsmentioning

confidence: 99%

Antibiotic-Resistant Escherichia coli in Drinking Water Samples from Rural Andean Households in Cajamarca, Peru

Larson

Hartinger

Riveros

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Antibiotic resistance in pathogenic bacteria is a serious public health issue. The growing threat is a cause for concern and action to prevent the emergence of new resistant strains and the spread of existing ones to humans via the environment. This study aimed at identifying fecal pathogens in drinking water obtained from rural Andean households from Cajamarca, Peru, and measuring the antibiotic resistance profile of Escherichia coli. The study was embedded within a community-randomized controlled trial among 102 communities in the northern highlands of the Cajamarca region, Peru. Of 314 samples, 55.4% (95% CI [49.7, 61.0], n = 174) were identified as thermotolerant coliforms. Among the samples positive for thermotolerant coliform, E. coli was isolated in 37.3% (n = 117), Klebsiella spp. in 8.0% (n = 25), Enterobacter spp. in 5.1% (n = 16), and Citrobacter spp. in 2.5% (n = 8). Of the 117 E. coli samples, 48.7% (95% CI [39.4, 58.1], n = 57) showed resistance to any antibiotic. The E. coli antibiotic resistance profile showed highest resistance against tetracycline (37.6%), ampicillin (34.2%), sulfamethoxazole-trimethoprim (21.4%), and nalidixic acid (13%). Some 19.7% (95% CI [12.9, 28.0], n = 23) of the E. coli isolates displayed multidrug resistance, defined as resistance to at least three classes of antibiotics. The CTX-M-3 gene, which encodes extended-spectrum resistance to beta-lactamase antibiotics, was found in one isolate. The high prevalence of fecal contamination in drinking water highlights the importance of household water treatment methods. Likewise, the high levels of antibiotic resistance found indicate a need for further research to identify the origins of potential environmental contamination, misuse, or inadequate disposal of antibiotics.

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Section: Methodsmentioning

confidence: 99%

Antibiotic-Resistant Escherichia coli in Drinking Water Samples from Rural Andean Households in Cajamarca, Peru

Larson

Hartinger

Riveros

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…One limitation of this study was that both of the intervention groups were already established at the time of its implementation (33) 5 ) reduction for the improved cookstoves used in our study. However, emission reductions did not reach the limits stipulated in the WHO HAP guidelines (42).…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a quasi-experimental study with the mothers and the fathers of children who were previously participating in a community-randomised controlled trial (c-RCT, parent study) (33).The parent study used a covariate-base constrained randomisation (33).The aim of the parent study was to implement an integrated home-based intervention package (IHIP) in resource-limited Andean communities and assess the health impact on children under 36 months of age. The parent study intervened with two home-environmental improvements comprising (i) an ICS, a kitchen sink, tap water and a kitchen hygiene education, and, (ii) an early child development intervention (ECD).…”

Section: Methodsmentioning

confidence: 99%

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Improved cookstoves and the prevalence of metabolic syndrome in the rural Peruvian Andes: a quasi-experimental study

Sanchez-Samaniego

Mäusezahl

Cárcamo

et al. 2019

Preprint

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Background: Household air pollution increases the risk of non-communicable diseases, such as cardiovascular diseases and metabolic syndrome. This study hypothesised that the reduction of household air pollution through the installation of improved cookstoves is associated with the prevalence of metabolic syndrome. We compared the prevalence of metabolic syndrome between adults using open fire stoves and using improved cookstoves in high altitude provinces of Cajabamba and San Marcos in rural Peruvian Andes.Methods: This is a quasi experimental study nested within a randomised controlled trial (parent study) of 317 children randomised in four study arms. The parents study applied a 2x2 factorial design with three single intervention arms (improved cookstove (ICS), early child development (ECD) and Control) and one combined arm (ICS-ECD). This study was conducted 6-10 months after the ICS intervention was implemented and all parents of the 317 children in the parent study were eligible to participate. Ventilated improved cookstoves using biomass fuel were provided to intervention homes. All participants answered a 24-hour food recall and underwent a physical examination for metabolic syndrome diagnosis. Results: A total of 385 participants were allocated to two groups of improved cookstove users with 190 (112 women and 78 men) and open-fire stove users with 195 (123 women and 72 men). Metabolic syndrome was detected in 21% of all participants and more frequently in women than men (26% versus 13%). In women, the improved cookstove intervention was a protective factor for metabolic syndrome (Prevalence Ratio= 0.70 (0.46 to 1.08), p=0.11). In addition, PR increased with age in women. In both gender, significantly lower PR was found in participants living ≥2500 meters above sea level (PR=0.65 (0.42 to 1.00), p=0.051 in women; (PR=0.25 (0.07 to 0.71), p=0.009 in men).Conclusions: The improved cookstove intervention reducing household air pollution is associated with a lower prevalence of MetS in women users. In addition, residential altitude is an important risk factor for metabolic syndrome even in high altitude populations. Keywords: biomass fuel ventilated improved cookstove, household air pollution, metabolic syndrome, high altitude, Peru Trial registration: Trial registration number ISRCTN26548981 at www.srctn.com . Registered retrospectively, Jan. 15 2018.

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“…Our data collection was embedded within a randomised controlled trial by the Swiss-Peruvian Health Research Platform set in the Cajamarca region of the northern highlands of Peru, located in the provinces of San Marcos and Cajabamba. Our study harnessed the operational and logistical local setup of this trial, which assessed the efficacy of an Integrated Home-environmental Intervention Package (IHIP-2) to improve child respiratory, enteric, and early child development outcomes [22].…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

Moreo

Tüshaus

Zhang

et al. 2018

Preprint

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21Measuring peripheral oxygen saturation (SpO2) with pulse oximeters at the point of care is widely established. 22However, since SpO2 is dependent on ambient atmospheric pressure, the distribution of SpO2 values in populations 23 living above 2000 m a.s.l. is largely unknown. Here, we propose and evaluate a computer model to predict SpO2 24 values for pediatric permanent residents living between 0 and 4000 m a.s.l. Based on a sensitivity analysis of 25 oxygen transport parameters, we created an altitude-adaptive SpO2 model that takes physiological adaptation of 26 permanent residents into account. From this model, we derived an altitude-adaptive abnormal SpO2 threshold 27 using patient parameters from literature. We compared the obtained model and threshold against a previously 28 proposed threshold derived statistically from data and two empirical datasets independently recorded from 29 Peruvian children living at altitudes up to 4100 m a.s.l. Our model followed the trends of empirical data, with the 30 empirical data having a narrower healthy SpO2 range below 2000 m a.s.l., but the medians did never differ more 31 than 2.29% across all altitudes. Our threshold estimated abnormal SpO2 in only 17 out of 5981 (0.3%) healthy 32 recordings, whereas the statistical threshold returned 95 (1.6%) recordings outside the healthy range. The strength 33 of our parametrised model is that it is rooted in physiology-derived equations and enables customisation. 34 Furthermore, as it provides a reference SpO2, it could assist practitioners in interpreting SpO2 values for diagnosis, 35 prognosis, and oxygen administration at higher altitudes. 36 New & Noteworthy 37 Our model describes the altitude-dependent decrease of SpO2 in healthy pediatric residents based on physiological 38 equations and can be adapted based on measureable clinical parameters. The proposed altitude-specific abnormal 39 SpO2 threshold might be more appropriate than rigid guidelines for administering oxygen that currently are only 40 available for sea level patients. We see this as a starting point to discuss and adapt oxygen administration 41 guidelines. 42 65 abnormal SpO2 threshold. The physiology-backed altitude-adaptive model describes SpO2 values of healthy 66 children living permanently at altitudes up to 4000 m a.s.l. With this model, we aim to provide a better 67 understanding of healthy SpO2 values at altitudes above 2000 m a.s.l. for healthy children. The altitude-adaptive 68 abnormal SpO2 threshold is obtained by setting the model parameters to abnormal values found in hypoxemic 69 patients. We evaluate these results with a novel dataset obtained from healthy children living in the rural Andes 70 of Peru. 71 2011. 426 22.

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A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings

Cited by 6 publications

References 37 publications

Antibiotic-Resistant Escherichia coli in Drinking Water Samples from Rural Andean Households in Cajamarca, Peru

Antibiotic-Resistant Escherichia coli in Drinking Water Samples from Rural Andean Households in Cajamarca, Peru

Improved cookstoves and the prevalence of metabolic syndrome in the rural Peruvian Andes: a quasi-experimental study

Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

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