Anisuddin Ahmed is the project lead of the “Simple inexpensive safety kitchen for low birth weight in resource-poor settings” project in Bangladesh, supported by Grand Challenges Canada’s Stars in Global Health program.
Imagine you’re making dinner.
Instead of a cookstove, you’re cooking on an open fire in the middle of a room. As you feed the fire with scraps of wood, clouds of smoke billow around you.
Your eyes water, your throat tingles, and with each breath you take, the thick, acrid smoke fills your lungs.
That’s what billions of women experience on a daily basis. In developing countries, cooking with biomass fuels like dung, straw and wood produces high levels of indoor air pollution and poses a serious threat to maternal, newborn and child health.
In many societies, women are in charge of cooking, and children are kept close to their mothers and the warm cooking fires.
This means that indoor air pollution has a disproportionate impact on women and children, according to the World Health Organization.
However, indoor air pollution can impact a child’s health before they’re even born.
That’s because women often continue cooking with biomass fuels even when pregnant – a practice that is highly associated with low-birth-weight and stillbirths.
Low-birth-weight, defined as a birth weight lighter than 5.5 pounds, is a major cause of newborn death in low- and middle-income countries, particularly in rural Bangladesh.
An innovative solution: the $100Kitchen
To address this issue, icddr,b designed and developed the $100Kitchen: a simple, low-cost, and prefabricated model kitchen with a reinforced concrete floor and a wooden roof and frame. It’s made from local, inexpensive materials like bamboo to provide ventilation and reduce indoor air pollution.
The $100Kitchen also includes an improved cookstove. There are three important pieces to the cookstove’s design:
First, biomass fuels are placed on a grate, allowing for the wood, dung, or other materials to be burned completely.
Second, the improved cookstove allows for smoke to be combusted in controlled conditions, replicating the minimal emissions of a gas cookstove.
Third, a chimney allows for polluted smoke to rise out of the kitchen, away the lungs of pregnant women and their children.
With the support of Grand Challenges Canada, funded by the Government of Canada, this project conducted a cluster randomized controlled trial to determine the kitchen’s effect among pregnant women and their newborns in the rural, Shahjadpur sub-district of Bangladesh between 2012 and 2014.
The study aimed to demonstrate that the $100Kitchen reduces pregnant women’s exposure to biomass fuels, ultimately reducing low-birth-weight prevalence among newborns in rural Bangladesh.
The study was conducted with 1267 pregnant women who were between 8 and 12 weeks of gestation, and followed up with visits until 42 days after birth. The intervention group was composed of 628 women and the control group was composed of 639 women.
Once a pregnant woman was confirmed, enrolled and the project gained the consent of her spouse and household head, the $100Kitchen and improved cookstove was installed in the courtyard of her household.
During a pregnant woman’s 2nd and 3rd trimesters, the project used a non-invasive analysis to test for carboxyhemoglobin, a byproduct of carbon monoxide exposure that can increase the risk of low-birth-weight. Birth outcomes were noted and newborns were weighed within 72 hours of being born, both at home and in the healthcare facilities.
The $100Kitchen and the improved cookstove resulted in a significant reduction of low-birth-weight prevalence (34.0%) among the rural newborns. Of the newborns who were born to mothers using traditional cookstoves, 35.9% were low-birth-weight. Of the newborns who were born to mothers using the $100Kitchen, 23.5% were low-birth-weight.
Adjusting for important factors like age, education level, body mass index (BMI), and husband’s smoking status, mothers using traditional cookstoves were about twice as likely to have low-birth-weight newborns compared to the mothers using the $100-Kitchen along with the improved cookstoves.
There was also a significant difference in the average level of carboxyhemoglobin in the blood of the pregnant women in the intervention group between their 2nd and 3rd trimesters (Figure 1). Surprisingly, this difference remained unchanged in the blood of the pregnant women in the control group between their 2nd and 3rd trimesters.
The pregnant women were satisfied with the sturdy structure and increased space of the $100Kitchen. The women were also happy with the smoke-free, improved cookstove, describing that smoke generated from the cookstove exited the $100Kitchen through the installed chimney.
In the words of the pregnant women using the $100Kitchen:
“The smoke generated from this cookstove goes upward of the kitchen through the pipe. That’s why I can breathe easily.”
“My baby inside me will born healthy if we cook food in the model kitchen using the improved cookstove. I felt good because we can cook fast and need less fuel and hence less costs and there is no spot under the cooking pots.”
“I cooked regularly in this kitchen using the improved cookstove. I believe that if I use this cookstove regularly my child health will be good as well as my health.”
“Build the model kitchen and use this cookstove, food will be delicious. It is smoke-free. There will be no tears and running nose while cooking. Our newborns will be healthy. Cooking will be quick as well.”
Implications and way forward
Together, the simple, $100Kitchen and improved cookstove significantly reduced the pregnant women’s exposure to biomass fuels and helped with the births of healthy newborns.
However, critical questions about how – and to what degree – the $100Kitchen reduces biomass fuel exposure need to be asked in order to reduce adverse pregnancy outcomes like low-birth-weight.
Therefore, the evidence and lessons learned from this pilot intervention study need to be further evaluated in more populations.
An exposure-response study design will help understand the effect of indoor air pollution on pregnant women – and ultimately, will help to save the lives of newborns through reducing the prevalence of low-birth-weight in rural Bangladesh.
This blog post is based on information presented by Anisuddin Ahmed at the Global Maternal Newborn Health Conference on October 20, 2015 in Mexico City.
To learn more about the $100Kitchen project, visit their project page on the Grand Challenges Canada website.