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WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children. We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623. We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89–16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72–16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91–1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37–2·23]; p=0·83). We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed. Medical Research Council, UK Department for International Development, and Wellcome Trust.

Hypertension is a leading risk factor for cardiovascular disease, and its association with household air pollution (HAP) in sub-Saharan Africa is understudied. To investigate the association between blood pressure (BP) and HAP exposure in a population-based cohort in rural Malawi. In the Chikwawa district, the site of a previous randomized controlled trial of a cleaner-burning cookstove intervention (the Cooking and Pneumonia Study or CAPS), we recruited 1,481 randomly selected adults. A subset (∼21%) were from participating households in CAPS. This cross-sectional analysis investigates associations of BP with stove type and, in a sample of participants, with particulate matter ≤ 2.5 μm diameter (PM2.5) and carbon monoxide (CO), both measured using 48-hour personal monitoring. Two main types of analysis were conducted: a) assessment of differences in mean systolic BP (SPB) and diastolic BP (DBP) among three groups based on stove use/type and b) assessment of the associations between PM2.5 and CO with mean SBP and DBP; both analyses using multivariable linear regression. Of the 1481 participants, 910 provided BP data. There was no difference for either mean SBP or DBP between the CAPS intervention and control groups. However, when comparing all CAPS participants (i.e., those provided cleaner-burning cookstoves by study's end) to the non-CAPS group, mean SBP was reduced (-3.53 mmHg, 95% CI:-6.54,-0.52), but not DBP (-0.73 mmHg, 95% CI:-2.36,0.90). Of these, 599 participants also had ≥24 hours personal exposure monitoring data. Neither the log mean PM2.5 concentration nor the log mean CO concentration was associated with either SBP or DBP. In this cross-sectional study in non-pregnant adults to measure both exposure to HAP and blood pressure in sub-Saharan Africa, we found evidence for an association between receiving a cleaner-burning cookstove and reduced SBP, but no evidence for an association between BP and personal exposure to PM2.5 or CO.

Household air pollution from solid fuel burning kills over 4 million people every year including half a million children from acute lower respiratory infections. Although biologically plausible, it is not clear whether household air pollution is also associated with acute lower respiratory infections in adults. We systematically reviewed the literature on household air pollution and acute lower respiratory infection in adults to identify knowledge gaps and research opportunities. Ten bibliographic databases were searched to identify studies of household air pollution and adult acute lower respiratory infection. Data were extracted from eligible studies using standardised forms. From 4617 titles, 513 abstracts and 72 full-text articles were reviewed. Eight studies met the inclusion criteria of which 2 found a significant adjusted increased risk of acute lower respiratory infection, 2 identified a univariate association whilst 4 found no significant association. Study quality was generally limited. Heterogeneity in methods and findings precluded meta-analysis. A systematic review of the literature found limited evidence for an association between household air pollution and risk of acute lower respiratory infection in adults. Additional research, with carefully defined exposure and outcome measures, is required to complete the risk profile caused by household air pollution in adults. CRD42015028042.

The Cooking and Pneumonia Study (CAPS) is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s) in Malawi (www.capstudy.org). The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO) integrated management of childhood illnesses (IMCI) pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7) out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%). Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13) out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings.

Background. Battery recycling facilities in developing countries can cause community lead exposure. Objective. To evaluate child lead exposure in a Vietnam battery recycling craft village after efforts to shift home-based recycling outside the village. Methods. This cross-sectional study evaluated 109 children in Dong Mai village, using blood lead level (BLL) measurement, parent interview, and household observation. Blood samples were analyzed with a LeadCare II field instrument; highest BLLs (≥45 μg/dL) were retested by laboratory analysis. Surface and soil lead were measured at 11 households and a school with X-ray fluorescence analyzer. Results. All children had high BLLs; 28% had BLL ≥45 μg/dL. Younger age, family recycling, and outside brick surfaces were associated with higher BLL. Surface and soil lead levels were high at all tested homes, even with no recycling history. Laboratory BLLs were lower than LeadCare BLLs, in 24 retested children. Discussion. In spite of improvements, lead exposure was still substantial and probably associated with continued home-based recycling, legacy contamination, and workplace take-home exposure pathways. There is a need for effective strategies to manage lead exposure from battery recycling in craft villages. These reported BLL values should be interpreted cautiously, although the observed field-laboratory discordance may reflect bias in laboratory results.

Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.

Although lead recycling activities are a known risk factor for elevated blood levels in South East Asia, little is known regarding the prevalence of and risk factors for elevated blood lead levels (BLL) among the general pediatric population in Vietnam. This study is a cross-sectional evaluation of 311 children from Children’s Hospital #2 in Ho Chi Minh City, Vietnam. Capillary blood lead testing was performed using the LeadCare II. Mean BLLs were 4.97 μg/dL (Standard Deviation (SD) 5.50), with 7% of the participants having levels greater than 10 μg/dL. Living in Bing Duong province (OR 2.7, 95% CI 1.4–5.6.1) or the Dong Nai province (OR 2.3, 95% CI 1.0–5.1) and having an age greater than 12 months (OR 6.0, 95% CI 3.1–11.8) were associated with higher BLLs. The prevalence of elevated BLLs in Vietnam is consistent with other SE Asian countries. Mean BLLs in Ho Chi Minh City are markedly less than those seen in a separate study of children living near lead recycling activities. Additional evaluation is necessary to better detail potential risk factors if screening is to be implemented within Vietnam.

Childhood lead poisoning is one of the most carefully studied and documented environmental exposures worldwide. However, despite increased awareness that lead exposure can compromise health and that lead exposure is completely preventable, lead continues to contribute significantly to the global burden of disease. Even though elevated blood lead levels have been found throughout Southeast Asia, often in association with various environmental lead exposures such as lead battery recycling and electronic waste, there has not been any routine surveillance of blood lead levels in Vietnam. The goal of this study was to assess the prevalence of elevated blood lead levels in the general population of children in Ho Chi Minh City, Vietnam. This was accomplished with the use of the LeadCare II lead testing kit and an accompanying questionnaire in children who were admitted to a pediatric hospital for acute respiratory problems. The 311 children in this study were primarily under 2 years of age (n=232), with a median blood lead level of 3.60 µg/dL (IQI 1.65-6.00). The prevalence of children with elevated blood lead levels >= 10 µg/dL was 7%. In multivariate models, age of the child, province where they lived, attending school outside the home and water source were predictors of elevated blood lead levels. This study confirms that Vietnamese children are currently at risk for lead related disease and may be useful in making public health recommendations and determining the need for additional surveillance.

Fifty years ago, Second Wave feminists theorized that American culture was dominated by patriarchal systems that subordinated women to second class citizenship status (Brown, 1988; Dolan, Deckman & Swers, 2010). In the 21st century, women have become highly visible candidates for office on a national level. Since 1925, 31 women have served as governors; 20 were elected to office, three replaced their husbands, and eight became governor by Constitutional succession (CAWP, 2012). Many women of the Third Wave generation, or Post-feminists, reject the theory that male oppression continues to influence women's life choices, some claiming that there is no need today for organized efforts on behalf of women's equality (Jackson, 2010). However, little is actually known about the leadership experiences of female governors, in part because there are still relatively few to sample (Thomas, 2003). Qualitative research provides the appropriate methodology to determine the impact of gender on the leadership experiences of female governors by documenting their own narratives (Glesne, 1999) about their terms ranging from 1984 through 2005. In the mini-case studies of seven women who served as governor, the degree to which women experienced asymmetrical power as a result of patriarchal systems they encountered in office is examined through their oral histories. The study found that all of the women governors perceived that a double standard applied to their leadership: receiving less support from their colleagues in political parties, as well as more criticism and inequitable coverage from mass media news sources. All of the women reported an inability to discuss gender-related leadership issues for fear of handicapping their administrations. Thus, the study concludes that patriarchal systems continue to affect women governors, despite their winning the highest elected office in the US, short of the Presidency.

The main purpose of this study was to analyze and compare the perceptions of teachers trained in the Madeline Hunter Skills for Effective Teaching Model and teachers without training in this model. The study also sought to find out if any relationship existed between teachers trained in the above model and job satisfaction. Demographic variables of age, level of school taught, years of teaching experience, gender and length of time spent in current school district were also examined to see if they had any relationship to teacher job satisfaction in relation to the Madeline Hunter Skills for Effective Teaching Model. Classroom teachers from selected Wisconsin public school districts constitute the population of the study. A random sample of 200 trained and untrained teachers in this model from the selected public schools consisted of the sample for the study. Data were collected by using the job description index questionnaire. Pearson correlation, t-test, and one and two way analysis of variance procedures were used for data analysis. The results of this study did not reveal any significant relationship between trained and untrained teachers in their level of job satisfaction, or any of the six subscales of the J.D.I. The study did however find that a positive relationship existed for female teachers only on their level of job satisfaction, within the subscale of Job-in-General. The findings also suggest that there was a significant statistical difference at the different building levels. Those teachers trained in the Hunter Model and working at the elementary level were more satisfied with supervision than any other group, trained or untrained, junior high/middle school or high school. This study also discussed job satisfaction theories and their relationship to participatory decision making. A thorough explanation of the Madeline Hunter Skills for Effective Teaching Model was also presented. Of particular importance is the discovery of a link between the Hunter Model and the level of job satisfaction of selected female teachers from Wisconsin.