Simple and Safe “100-dollar-kitchen” to Prevent Low-Birth-Weight in Rural Bangladesh: A Cluster Randomized Controlled Trial

Session: Innovative Approaches to Improve Maternal, Newborn and Child Nutrition

Presenter: Anisuddin Ahmed, icddr,b
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Background: Low-birth-weight (LBW) is a major adverse pregnancy outcome and cause of neonatal mortality in resource-poor countries. Exposure to biomass fuels (BmFs) during cooking is highly associated with LBW. There is unlikely to be any significant change in use of BmFs in near future. Therefore, intervention targeted to reduce BmFs exposure on pregnancy outcomes is urgently needed. To address this need, icddr,b conducted a cluster randomized controlled trial in Shahjadpur sub-district of Bangladesh between 2012 and 2014 to determine the effect of “100-dollar-kitchen”($100Kc) on LBW.

Methodology: The $100Kc was a locally-made inexpensive environment-friendly prefabricated model kitchen with improved clean-combustion cookstoves (ICC). The study was operationalized among 628 and 639 pregnant women at their 8-12 weeks of gestation for intervention and control groups respectively with follow-up visit until 42-days postpartum. All the enrolled pregnant women were subjected to non-invasive Masimo SET Pulse CO-Oximetric analysis for carboxyhemoglobin (SpCO) and methomoglobin (SpMet) measurement during their 2nd and 3rd trimester. All the birth outcomes were noted within 72-hrs of deliveries and weighted by Seca-scale.

Results: The use of the $100Kc with ICC during antennal period resulted in significant reduction of LBW prevalence (34.0%) among the rural newborns. The intervention group pregnant women who used the $100Kc with IC delivered 23.5% LBW newborns as compared to those who used the traditional cookstove delivered 35.9% LBW newborns. Mean-difference of blood SpCO level was 8.9% and 11.5% and blood SpMet level was 0.8% and 1.1% among pregnant women of intervention and control groups respectively which was statistically significant.

Conclusion: The $100Kc with the ICC is a preventive approach of addressing environmental causes of LBW newborns. This simple rural-focus intervention significantly reduced BmFs exposure to pregnant women and helped in delivering healthy newborns. Scaling-up of this intervention will advance our thinking on physiological changes in pregnant women leading to LBW newborns regarding BmFs exposure.