Prospective Cohort Study on the Effect of an Intervention to Reduce Household Air Pollution Among Sudanese Women and Children

BACKGROUND. Exposure to household air pollution through the burning of biomass fuels is a global health concern and can lead to negative health outcomes such as asthma and lung disease. OBJECTIVES. The goal of this four-year study was to determine whether an intervention to reduce household air pollution (HAP) which included health education and a new well-ventilated cooking location would reduce exposure to HAP, lower carbon monoxide (CO) levels and improve the health of women and children in Port Sudan, Sudan. METHODS. In 2016, 115 women of low socioeconomic status and their children were invited to participate in the study at two women's centers. One hundred and eleven women consented to participate and were divided into study and control groups on the basis of home ownership. Women who owned their homes learned about the adverse effects of HAP and a well-ventilated outside cooking location (rakoobah) was provided. Control women did not receive HAP education or a rakoobah. Questionnaires were used to assess the effect of education and a new well-ventilated cooking location for a group of Sudanese women who cook with biomass fuels. CO-oximetry was performed. Each year from 2017–2019, the questionnaires and CO-oximetry were repeated. RESULTS. Sixty-five women and 33 children were assigned to the study group and 46 women and 19 children were assigned to the control group in 2016. Women were enrolled in 2016 with CO levels of 17.8% and 17.4%, respectively. One year later some of the study group women had lower CO levels and others higher, while the CO levels of the controls were stable. An intensive HAP education program was started for the study group women. By 2019, the last study year, the CO levels of both the study and control group women had dropped to normal levels of 2.9% and 3.1%, respectively. Control group women may have benefited from the HAP education and modeled behavior of those in the study group. CONCLUSIONS. The health impact of the change in cooking location was unclear, yet both groups reported fewer health care visits in 2019. Education and an outside cooking location resulted in lower CO levels of Sudanese women and children. PARTICIPANT CONSENT. Obtained ETHICS APPROVAL. The study was approved by the Penn State Milton S. Hershey Medical Center Institutional Review Board and the Ethics Committee of the Red Sea University Faculty of Medicine located in Port Sudan, Sudan. COMPETING INTERESTS. The authors declare no competing financial interests.