{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T18:29:17Z","timestamp":1772044157634,"version":"3.50.1"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"unspecified","delay-in-days":233,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2732494X25100776_as1\">\n\t    <jats:title>Objective:<\/jats:title>\n\t    <jats:p>To evaluate the effectiveness and acceptability of ventilation interventions in naturally ventilated hospitals in Liberia.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as2\">\n\t    <jats:title>Design:<\/jats:title>\n\t    <jats:p>Difference-in-differences analysis of pre- and post-air changes per hour of intervention and control spaces.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as3\">\n\t    <jats:title>Setting:<\/jats:title>\n\t    <jats:p>Hospitals in Bong and Montserrado Counties, Liberia.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as4\">\n\t    <jats:title>Participants:<\/jats:title>\n\t    <jats:p>Seventy patient care spaces were evaluated at baseline. Six spaces underwent physical intervention modifications, while 2 spaces were assessed for indirect effects and 2 others used as controls. Healthcare workers were interviewed to assess ventilation knowledge and acceptability.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as5\">\n\t    <jats:title>Interventions:<\/jats:title>\n\t    <jats:p>Ventilation interventions included the installation of window screens, louvered doors and windows, and wind turbines.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as6\">\n\t    <jats:title>Methods:<\/jats:title>\n\t    <jats:p>We measured carbon dioxide levels with portable meters and documented persons per room to estimate per-person ventilation rates in both L\/s\/person for the initial assessment and air changes per hour (ACH) in the intervention. Measurements were taken in patient care spaces in 7 hospitals in Liberia. Healthcare worker acceptability was evaluated via structured interviews.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as7\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>Two-thirds (46\/70) of patient care spaces were below the WHO-recommended ventilation threshold of 60 L\/s\/person. Six spaces underwent ventilation interventions, including placement of window screens (3), wind turbines (2), and louvered doors and windows (1), with 2 additional spaces being indirectly affected by these interventions and 2 more spaces serving as controls. Ventilation improved by an average of 2 ACH in the spaces with wind turbines and louvered doors and windows. Overall acceptability of the interventions was high.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100776_as8\">\n\t    <jats:title>Conclusions:<\/jats:title>\n\t    <jats:p>Implementing interventions to improve ventilation in naturally ventilated healthcare facilities is efficacious, feasible, and acceptable, though longer-term evaluations should assess sustainability.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/ash.2025.10077","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T05:31:57Z","timestamp":1755840717000},"source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness and acceptability of ventilation modifications in healthcare facilities, Liberia 2022\u20132023"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8513-8348","authenticated-orcid":false,"given":"Ronan F.","family":"Arthur","sequence":"first","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-8087","authenticated-orcid":false,"given":"Ashley","family":"Styczynski","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krithika","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amos","family":"Tandanpolie","sequence":"additional","affiliation":[{"name":"Partnership for Research on Vaccines and Infectious Diseases in Liberia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Bemah","sequence":"additional","affiliation":[{"name":"National Public Health Institute of Liberia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Bell","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason R.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Baer","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge L.","family":"Salinas","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"S2732494X25100776_ref25","doi-asserted-by":"publisher","DOI":"10.3390\/en14020435"},{"key":"S2732494X25100776_ref28","first-page":"226","article-title":"An investigation of ventilation control strategies for louver windows in different climate zones","volume":"20","author":"Scheuring","year":"2021","journal-title":"Int J Vent"},{"key":"S2732494X25100776_ref22","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000001248"},{"key":"S2732494X25100776_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-9-81"},{"key":"S2732494X25100776_ref18","doi-asserted-by":"publisher","DOI":"10.3201\/eid1011.040797_01"},{"key":"S2732494X25100776_ref23","doi-asserted-by":"publisher","DOI":"10.1111\/ina.12608"},{"key":"S2732494X25100776_ref19","volume-title":"Basics of Qualitative Research: Procedures and Techniques for Generating Grounded Theory","author":"Strauss","year":"1998"},{"key":"S2732494X25100776_ref26","doi-asserted-by":"publisher","DOI":"10.1098\/rsos.200680"},{"key":"S2732494X25100776_ref27","doi-asserted-by":"publisher","DOI":"10.3390\/buildings5020381"},{"key":"S2732494X25100776_ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-3717-9"},{"key":"S2732494X25100776_ref14","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0668.2003.00189.x"},{"key":"S2732494X25100776_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61458-4"},{"key":"S2732494X25100776_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(96)90147-4"},{"key":"S2732494X25100776_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(98)90326-7"},{"key":"S2732494X25100776_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/0195-6701(87)90048-X"},{"key":"S2732494X25100776_ref3","unstructured":"3. 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