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Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): An effectiveness-implementation hybrid study

The aim of the MCLASS II project is to develop and test the effectiveness and cost-effectiveness of a community-based intervention called 'Muslims for better Health', with or without Indoor Air Quality (IAQ) feedback, in reducing exposure to second-hand smoke in homes in Dhaka, Bangladesh.

Breathing in other people's smoke is called passive smoking; also referred to as enviornmental or second-hand smoking. Second-hand smoke (SHS) is a serious health hazard to non-smokers and is estimated to cost more than 600,000 lives per year, worldwide, mainly due to lung diseases. For most non-smokers, cars and homes remain the most likely places for them to breathe in SHS. There is a need to make cars and homes completely smoke free.

SHS is a major public health problem and a priority for policy making in Bangladesh. We have been working with the Islamic Foundation, Bangladesh to develop and test a community-based intervention called 'Muslims for better Health' (M4bH) where we will train imams based in mosques to encourage their congregations to make a positive change in their smoking behaviours. We have also developed a cheap and efficient home installation meter to measure IAQ.

We are undertaking a large study to examine how effective and cost-effective the M4bH intervention is, with or without IAQ feedback, in reducing exposure to SHS in homes, frequency and severity of respiratory symptoms, and healthcare service use and in improving quality of life.

A pragmatic, three-arm open label, cluster randomised controlled trial (cRCT) with concurrent economic evaluation and process evaluation will be conducted in 45 mosques and their catchment communities in Mirpur area of Dhaka, Bangladesh. The three trial arms are as follows:

1. Arm 1: M4bH intervention and IAQ feedback
2. Arm 2: M4bH intevention alone
3. Arm 3: Usual services

The primary outcome will be household SHS concentration measured as fine Particulate Matter less than 2.5 microns diameter (PM₂₅) at 3 months post-randomisation. PM₂₅ will be measured in homes using the Dylos DC 1700 (Dylos, California, USA) a low-cost particulate counter validated for use in domestic settings. Data from Scotland indicate that a smoke-free home will have PM₂₅ concentrations that are generally about 5-10 times lower than a home where smoking takes place. 

We will also conduct a budget impact analysis using secondary data and develop a simple monitoring framework which could be efficiently employed as the intervention gets disseminated widely.

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