TY - JOUR
T1 - LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries
T2 - Pilot results from the HAPIN trial
AU - Liao, Jiawen
AU - Kirby, Miles A.
AU - Pillarisetti, Ajay
AU - Piedrahita, Ricardo
AU - Balakrishnan, Kalpana
AU - Sambandam, Sankar
AU - Mukhopadhyay, Krishnendu
AU - Ye, Wenlu
AU - Rosa, Ghislaine
AU - Majorin, Fiona
AU - Dusabimana, Ephrem
AU - Ndagijimana, Florien
AU - McCracken, John P.
AU - Mollinedo, Erick
AU - de Leon, Oscar
AU - Díaz-Artiga, Anaité
AU - Thompson, Lisa M.
AU - Kearns, Katherine A.
AU - Naeher, Luke
AU - Rosenthal, Joshua
AU - Clark, Maggie L.
AU - Steenland, Kyle
AU - Waller, Lance A.
AU - Checkley, William
AU - Peel, Jennifer L.
AU - Clasen, Thomas
AU - Johnson, Michael
AU - Aravindalochanan, Vigneswari
AU - Bankundiye, Gloriose
AU - Barr, Dana Boyd
AU - Bussalleu, Alejandra
AU - Canuz, Eduardo
AU - Castañaza, Adly
AU - Chen, Yunyun
AU - Chiang, Marilú
AU - Craik, Rachel
AU - Davila-Roman, Victor G.
AU - de las Fuentes, Lisa
AU - Elon, Lisa
AU - Espinoza, Juan Gabriel
AU - Garg, Sarada
AU - Hamid, Sarah
AU - Hartinger, Stella
AU - Harvey, Steven A.
AU - Hengstermann, Mayari
AU - Hennessee, Ian
AU - Herrera, Phabiola M.
AU - Hossen, Shakir
AU - Howards, Penelope P.
AU - Jaacks, Lindsay
AU - Jabbarzadeh, Shirin
AU - Lenzen, Pattie
AU - Lovvorn, Amy E.
AU - Mbabazi, Jane
AU - McCollum, Eric
AU - Meyers, Rachel
AU - Moulton, Lawrence
AU - Mukeshimana, Alexie
AU - Mutariyani, Bernard
AU - Natesan, Durairaj
AU - Nizam, Azhar
AU - Ntivuguruzwa, Jean de Dieu
AU - Papageorghiou, Aris
AU - Puttaswamy, Naveen
AU - Puzzolo, Elisa
AU - Quinn, Ashlinn
AU - Rajamani, Karthikeyan Dharmapuri
AU - Ramakrishnan, Usha
AU - Ramasami, Rengaraj
AU - Ramirez, Alexander
AU - Ryan, P. Barry
AU - Saidam, Sudhakar
AU - Sarnat, Jeremy A.
AU - Simkovich, Suzanne
AU - Sinharoy, Sheela S.
AU - Smith, Kirk R.
AU - Swearing, Damien
AU - Thangavel, Gurusamy
AU - Toenjes, Ashley
AU - Valdes, Viviane
AU - Williams, Kendra N.
AU - Young, Bonnie N.
N1 - Funding Information:
The HAPIN trial is funded by the U.S. National Institutes of Health (cooperative agreement 1UM1HL134590 ) in collaboration with the Bill & Melinda Gates Foundation [ OPP1131279 ].
Funding Information:
The HAPIN trial is funded by the U.S. National Institutes of Health (cooperative agreement 1UM1HL134590) in collaboration with the Bill & Melinda Gates Foundation [OPP1131279]. We would like to express our deep and sincere gratitude to the households that graciously invited us into their homes for this study. We also would like to thank the field teams, which worked diligently to collect the data presented here. A multidisciplinary, independent Data and Safety Monitoring Board (DSMB) appointed by the National Heart, Lung, and Blood Institute (NHLBI) monitors the quality of the data and protects the safety of patients enrolled in the HAPIN trial. NHLBI DSMB: Nancy R Cook, Stephen Hecht, Catherine Karr (Chair), Joseph Millum, Nalini Sathiakumar, Paul K Whelton, Gail G Weinmann (Executive Secretary). Program Coordination: Gail Rodgers, Bill & Melinda Gates Foundation; Claudia L Thompson, National Institute of Environmental Health Science; Mark J. Parascandola, National Cancer Institute; Marion Koso-Thomas, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Joshua P Rosenthal, Fogarty International Center; Conception R Nierras, NIH Office of Strategic Coordination Common Fund; Katherine Kavounis, Dong- Yun Kim, Antonello Punturieri, and Barry S Schmetter, NHLBI. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US National Institutes of Health or Department of Health and Human Services. The study protocol has been reviewed and approved by institutional review boards (IRBs) or Ethics Committees at Emory University (00089799), Johns Hopkins University (00007464), Sri Ramachandra Institute of Higher Education and Research (IEC-N1/16/JUL/54/49) and the Indian Council of Medical Research ? Health Ministry Screening Committee (5/8/4?30/(Env)/Indo-US/2016-NCD-I), Universidad del Valle de Guatemala (146-08-2016) and Guatemalan Ministry of Health National Ethics Committee (11?2016), the London School of Hygiene and Tropical Medicine (11664?5) and the Rwandan National Ethics Committee (No.357/RNEC/2018), and Washington University in St. Louis (201611159). The HAPIN trial has been registered with ClinicalTrials.gov (Identifier NCT02944682). +HAPIN Investigators: Vigneswari Aravindalochanan, Gloriose Bankundiye, Dana Boyd Barr, Alejandra Bussalleu, Devan Campbell, Eduardo Canuz, Adly Casta?aza, Howard Chang, Yunyun Chen, Maril? Chiang, Rachel Craik, Victor G. Davila-Roman, Lisa de las Fuentes, Lisa Elon, Juan Gabriel Espinoza, Sarada Garg, Sarah Hamid, Stella Hartinger, Steven A. Harvey, Mayari Hengstermann, Ian Hennessee, Phabiola M. Herrera, Shakir Hossen, Penelope P. Howards, Lindsay Jaacks, Shirin Jabbarzadeh, Jacob Kremer, Pattie Lenzen, Amy E. Lovvorn, Jane Mbabazi, Eric McCollum, Rachel Meyers, Lawrence Moulton, Alexie Mukeshimana, Bernard Mutariyani, Durairaj Natesan, Azhar Nizam, Jean de Dieu Ntivuguruzwa, Aris Papageorghiou, Naveen Puttaswamy, Elisa Puzzolo, Ashlinn Quinn, Karthikeyan Dharmapuri Rajamani, Usha Ramakrishnan, Rengaraj Ramasami, Alexander Ramirez, P. Barry Ryan, Sudhakar Saidam, Jeremy A. Sarnat, Suzanne Simkovich, Sheela S. Sinharoy, Kirk R. Smith, Damien Swearing, Gurusamy Thangavel, Ashley Toenjes, Lindsay Underhill, Viviane Valdes, Kendra N. Williams, Bonnie N. Young.
Funding Information:
A multidisciplinary, independent Data and Safety Monitoring Board (DSMB) appointed by the National Heart, Lung, and Blood Institute (NHLBI) monitors the quality of the data and protects the safety of patients enrolled in the HAPIN trial. NHLBI DSMB: Nancy R Cook, Stephen Hecht, Catherine Karr (Chair), Joseph Millum, Nalini Sathiakumar, Paul K Whelton, Gail G Weinmann (Executive Secretary). Program Coordination: Gail Rodgers, Bill & Melinda Gates Foundation; Claudia L Thompson, National Institute of Environmental Health Science; Mark J. Parascandola, National Cancer Institute; Marion Koso-Thomas, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Joshua P Rosenthal, Fogarty International Center; Conception R Nierras, NIH Office of Strategic Coordination Common Fund; Katherine Kavounis, Dong- Yun Kim, Antonello Punturieri, and Barry S Schmetter, NHLBI. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US National Institutes of Health or Department of Health and Human Services.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12/15
Y1 - 2021/12/15
N2 - The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM2.5 for 24 or 48 h using gravimetric-based PM2.5 samplers at baseline and two follow-ups over two months after delivery of an LPG cookstove and free fuel supply. Mixed models were used to estimate PM2.5 reductions. Median kitchen PM2.5 concentrations were 296 μg/m3 at baseline (interquartile range, IQR: 158–507), 24 μg/m3 at first follow-up (IQR: 18–37), and 23 μg/m3 at second follow-up (IQR: 14–37). Median personal exposures to PM2.5 were 134 μg/m3 at baseline (IQR: 71–224), 35 μg/m3 at first follow-up (IQR: 23–51), and 32 μg/m3 at second follow-up (IQR: 23–47). Overall, the LPG intervention was associated with a 92% (95% confidence interval (CI): 90–94%) reduction in kitchen PM2.5 concentrations and a 74% (95% CI: 70–79%) reduction in personal PM2.5 exposures. Results were similar for each site. Conclusions: The intervention was associated with substantial reductions in kitchen and personal PM2.5 overall and in all sites. Results suggest LPG interventions in these rural settings may lower exposures to the WHO annual interim target-1 of 35 μg/m3. The range of exposure contrasts falls on steep sections of estimated exposure-response curves for birthweight, blood pressure, and acute lower respiratory infections, implying potentially important health benefits when transitioning from solid fuels to LPG.
AB - The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM2.5 for 24 or 48 h using gravimetric-based PM2.5 samplers at baseline and two follow-ups over two months after delivery of an LPG cookstove and free fuel supply. Mixed models were used to estimate PM2.5 reductions. Median kitchen PM2.5 concentrations were 296 μg/m3 at baseline (interquartile range, IQR: 158–507), 24 μg/m3 at first follow-up (IQR: 18–37), and 23 μg/m3 at second follow-up (IQR: 14–37). Median personal exposures to PM2.5 were 134 μg/m3 at baseline (IQR: 71–224), 35 μg/m3 at first follow-up (IQR: 23–51), and 32 μg/m3 at second follow-up (IQR: 23–47). Overall, the LPG intervention was associated with a 92% (95% confidence interval (CI): 90–94%) reduction in kitchen PM2.5 concentrations and a 74% (95% CI: 70–79%) reduction in personal PM2.5 exposures. Results were similar for each site. Conclusions: The intervention was associated with substantial reductions in kitchen and personal PM2.5 overall and in all sites. Results suggest LPG interventions in these rural settings may lower exposures to the WHO annual interim target-1 of 35 μg/m3. The range of exposure contrasts falls on steep sections of estimated exposure-response curves for birthweight, blood pressure, and acute lower respiratory infections, implying potentially important health benefits when transitioning from solid fuels to LPG.
KW - Clean cooking fuel
KW - Cookstove
KW - Household air pollution
KW - Intervention
KW - PM
KW - Personal exposure
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U2 - 10.1016/j.envpol.2021.118198
DO - 10.1016/j.envpol.2021.118198
M3 - Article
C2 - 34740288
AN - SCOPUS:85116506611
SN - 0269-7491
VL - 291
JO - Environmental Pollution
JF - Environmental Pollution
M1 - 118198
ER -