Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda, A FRESH AIR project.

Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives

Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study

The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6-12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5-126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5-39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7-40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.European Union’s Horizon 2020 programme under grant agreement no. 680997, TRIAL ID NTR5759, http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=23332. The devices, measuring the personal HAP, were funded by Netherlands Enterprise Agency (RVO

A novel lung health programme addressing awareness and behaviour-change aiming to prevent chronic lung diseases in rural Uganda

Chronic lung disease is a huge, growing, but under-reported problem in Africa. Following a survey in rural Uganda, which found 16% of the adult population had COPD, we developed a lung health programme aiming to raise awareness in the community of the risk factors for developing chronic lung disease and how to reduce the risks. A two-year train-the-trainer programme was conducted by healthcare workers (HCWs) in Masindi District, Uganda. Strategy and preliminary education materials were co-developed in a series of meetings with stakeholders including clinicians and community members. An initial group of HCWs were trained and further refined the education programme; they then taught other HCWs. Educational materials covered: "What is lung health?", "How lungs get damaged", "Smoking cessation" and "Preventing harm by reducing exposure to biomass smoke". These materials were approved by the Ministry of Health. Local radio messages were designed and broadcasted. We administered knowledge questionnaires before and after training for both HCWs and the community health workers (CHWs). We trained 12 HCWs who then trained 47 other HCWs, and over 100 community health workers (CHWs). After the programme, knowledge questionnaire scores improved: for HCWs, the percentage of correct answers were 74% before and 89% after training, and for CHWs from 74% to 91%. Over 15,000 people have beeneducated directly and thousands more through mass media messages. Knowledge questionnaires administered to 1261 people in the community confirmed awareness of lung health. This novel lung health programme illustrates how communities may be empowered to reduce their risks of developing chronic lung disease and is a model for addressing the rising tide of non-communicable diseases

A novel lung health programme addressing awareness and behaviour-change aiming to prevent chronic respiratory diseases in rural Uganda: a two-year train-the-trainer programme

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A novel lung health programme addressing awareness and behaviour-change aiming to prevent chronic lung diseases in rural Uganda

Chronic lung disease is a huge, growing, but under-reported problem in Africa. Following a survey in rural Uganda, which found 16% of the adult population had COPD, we developed a lung health programme aiming to raise awareness in the community of the risk factors for developing chronic lung disease and how to reduce the risks. A two-year train-the-trainer programme was conducted by healthcare workers (HCWs) in Masindi District, Uganda. Strategy and preliminary education materials were co-developed in a series of meetings with stakeholders including clinicians and community members. An initial group of HCWs were trained and further refined the education programme; they then taught other HCWs. Educational materials covered: "What is lung health?", "How lungs get damaged", "Smoking cessation" and "Preventing harm by reducing exposure to biomass smoke". These materials were approved by the Ministry of Health. Local radio messages were designed and broadcasted. We administered knowledge questionnaires before and after training for both HCWs and the community health workers (CHWs). We trained 12 HCWs who then trained 47 other HCWs, and over 100 community health workers (CHWs). After the programme, knowledge questionnaire scores improved: for HCWs, the percentage of correct answers were 74% before and 89% after training, and for CHWs from 74% to 91%. Over 15,000 people have beeneducated directly and thousands more through mass media messages. Knowledge questionnaires administered to 1261 people in the community confirmed awareness of lung health. This novel lung health programme illustrates how communities may be empowered to reduce their risks of developing chronic lung disease and is a model for addressing the rising tide of non-communicable diseases