1. GROUP III Karma Wangdi 1, Rada Dukpa 2, Nar Bdr Khatiwora 3, Kinley Dorji 4, Karma Tenzin 5 1-2 Department of Public Health, Ministry of Health 3 Climate Change Mitigation and Energy, UNDP, Bhutan 4 Dzongkhag Health Sector, Pemagatshel 5 Faculty of Postgraduate medicine, Khesar Gyalpo University of Medical sciences of Bhutan

2. Assessment of knowledge, attitude and practice on stove and fuel use and health effects in Different communities of Pemagatshel Dzongkhag in Eastern Bhutan

3. Background Estimated 69% rural population Dependent on biomass (91%), while the remaining 9% of the energy demand is met through electricity (4%), LPG (2.1%), kerosene (2.4%) (DRE/UNDP 2005) A 2013 DRE/UNDP study – 1.17m 3 annual per capita fuel wood consumption Bhutan does not have record or evidence to show on the prevalence of stove and fuel use pattern

4. WHO air quality guidelines lists scores of health effects on humans including child due to Household Air Pollution (HAP) A 2013 UNDP study reported that more than 56 percent of the respondents complain of eye irritation (main problem) as a result of fuel wood burning, followed by nasal problems (26.4%) and associated breathing problems (17.2%) with no gender difference Numerous interventional studies in India and other countries

5. Many reported on stove staking – for purpose and seasons, food preferences etc Adopting these interventions to Bhutanese context without understanding the behavior and purpose will lead failure In Bhutan, still many families are using fuel and stoves, therefore, there is a need to conduct a study on KAP to inform ongoing intervention program or to inform the policy maker to move the ICS program successfully.

6. Research Questions What is the current level of use and availability of stove and fuel? What is the level of understanding on the use of different stove and its health effects? What are the factors that influence cooking behavior, choice of stove and fuel use? What are the preferences and barriers of using stoves and electrical appliances? What is the current level of knowledge on availability of electrical appliances?

7. Study objectives To assess the current cooking practices, stoves use and fuel consumption To assess knowledge on health effects of household air pollution To assess the awareness on Improved Cooking Stoves To identify the factors in influencing the use of cook stoves and electrical appliances To assess the longitudinal use of stoves

8. Methods Prospective observational study Simple random sampling using PPS (probability- proportional-to-size) Communities located under 3 Basic Health Units (Gonpa Singma, Yurung & Norbugang) of Pemagatshel Dzongkhag (Geographical area by agro-ecological zone, Population density and poverty rate)

9. Study site:

10. Sample size calculation Sample size – 400 household

11. Methods continue…. March 2016 to June 2017 Ethical clearance will be sort from REBH and also an administrative approval from NSB and MoH Focused/Social group discussion – prior to designing Questionnaire Questionnaire assessment – Knowledge, attitude and practice on stove and fuel use – Housing characteristics – Education and income level – Fuel – types commonly used – Types of Stove and electrical appliances – Knowledge on health effects – Eye, Respiratory, Reproductive, etc – Measures to minimize the health effects of HAP – Willingness to pay for clean cooking stove and replace the traditional stoves

12. Methods continue….  Assessment of stove use using SUMs to validate the questionnaire in a subset of households (10%)  Record data for 2 weeks in each quarter  Follow up visit quarterly for 12 months (for seasonal variation)

13. Ethical Consideration Participants will be recruited on voluntary basis only Participants will be explained regarding the study purpose and need There after an informed consent will be obtained The identity of the participants will be protected by the use of a code number (Confidentiality) Any participant will be given the complete freedom to withdraw anytime with no implication of any sort(Autonomy)

14. USE OF RESULTS: This study will provide: Baseline data on the knowledge, attitude and practice on use of stoves and its health effects. Prevalence of stove usage among the study households under Pemagatshel Dzongkhag Target population might become aware about the health effects of stove and fuels. This should help change their duration, pattern and behavior of use of stove. Appraise the policy makers on the findings and need for any policy change, if any.

15. Timeline Sl # Activity2016 2017 Q1Q2Q3Q4Q1Q2Q3 1 Development of Proposal 2 Ethical approval 3 Recruitment of data enumerators 4 Piloting and validation of questionnaire 5 Data Collection and entry 6 Data analysis and report writing 7 Dissemination of information and submit for publication

16. Budget Sl #Activity headingEstimated cost (in NU) 1Stationeries and other office logistics 50,000.00 2Data processing / Computer charges, Photocopy, report writing: 100,000.00 3Training of data collectors 300,000.00 4Remunerations of data collectors 200,000.00 5Monitoring and evaluations 500,000.00 5Data analysis and Report writing 100,000.00 6SUMs/Adaptors ( 40 nos) 100,000.00 7Publication 100,000.00

17. Discussion/Future Steps Add more variables and replicate the study in another set up Plan awareness activities among the participants accordingly

18. Feedback on the workshop First of it’s kind in Country Novel in nature – participatory Monitors – availability and capacity??

19. Immediate plan following this workshop Carry forward this proposal seriously and look for funding Potential research collaboration To include HAPs (ongoing and future projects too)

20. Thank you