Domestic fuel affordability and accessibility in urban Rwanda' policy lessons in a time of crisis?

Background Cooking fuel choice and fuel switching behaviours can be influenced by both social and economic contextual factors;with implications for household air pollution exposure. The Rwandan Government have recently proposed a charcoal sale ban to reduce domestic reliance upon charcoal fuels and reduce associated respiratory health harms. Methods A semi-structured mobile telephone survey administered to 85 participants in an informal settlement in Kigali, Rwanda to identify (i) fuel switching as a result of COVID-19 emergency health protection ‘lockdown’ measures (ii) awareness of proposed charcoal sale restrictions and willingness to pay for alternative domestic cooking fuels. Results Of the 85 interviewed participants, 15 (17.6 %) reported a change in primary cooking fuel since the first national COVID-19 emergency ‘lockdown’ period (March – May), with Liquid Petroleum Gas (LPG) users moving to charcoal (n = 3;20 %), and charcoal users to firewood (n = 7;46.7 %) or LPG (n = 4;26.7 %) and one firewood user to charcoal (n = 1;6.6 %). Awareness of the forthcoming LPG subsidy (81.5 %) and charcoal ban policy proposals was high among all participants (81.5 %), with 90.7 % indicating they would change their cooking fuel as a consequence. LPG was the preferred alternative fuel of choice (89.8 %), with cost, ease of use and cleanliness reported as rationale. Forty-four percent of participants reported a willingness to pay less, 38 % to pay the same and 25 % to pay more than their current cooking fuel expenditure for a cleaner alternative fuel. Conclusion Domestic fuel switching as a result of economic and energy market volatility, was observed in an informal settlement in urban Rwanda as a consequence of COVID-19 emergency measures, most notably by substitution of firewood for charcoal, reflecting a regressive step in the energy ladder. Our findings demonstrate a high level of awareness and engagement with forthcoming domestic fuel policy changes in Kigali, and a large proportion of those interviewed would consider transition to cleaner domestic energy sources. This novel primary research has implications for developing domestic energy resilience to disruptive economic impacts and ensuring effective clean fuel policy implementation in East Africa.

Community lung health service design for COPD patients in China by the Breathe Well group.

COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients' and general practitioners' (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) offering health education, exercise, self-management, smoking cessation and mental health support. Using a convergent mixed methods design, data were collected from patients and GPs using focus groups (FGs) in four Chinese cities, questionnaires were also used to collect data from patients. FGs were audio-recorded and transcribed. Quantitative data were analysed descriptively, thematic framework analysis was used for the qualitative data. Two-hundred fifty-one patients completed the questionnaire; 39 patients and 30 GPs participated in ten separate FGs. Three overarching themes were identified: patients' lack of knowledge/understanding of COPD, current management of COPD not meeting patients' needs and LHS design, which was well received by patients and GPs. Participants wanted COPD education, TaiChi, psychological support and WeChat for social support. 39% of survey responders did not know what to do when their breathing worsened and 24% did not know how to use their inhalers. 36% of survey respondents requested guided relaxation. Overall, participants did not fully understand the implications of COPD and current treatment was sub-optimal. There was support for developing a culturally appropriate intervention meeting Chinese patients' needs, health beliefs, and local healthcare delivery. Further research should explore the feasibility of such a service.

Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol.

INTRODUCTION: People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain. METHODS AND ANALYSIS: The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options. ETHICS AND DISSEMINATION: The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites. TRIAL REGISTRATION NUMBER: ISRCTN46948079.