Exposure Contrasts of Pregnant Women during the Household Air Pollution Intervention Network Randomized Controlled Trial

Michael Johnson, Ajay Pillarisetti, Ricardo Piedrahita, Kalpana Balakrishnan, Jennifer L. Peel, Kyle Steenland, Lindsay J. Underhill, Ghislaine Rosa, Miles A. Kirby, Anaité Díaz-Artiga, John McCracken, Maggie L. Clark, Lance Waller, Howard H. Chang, Jiantong Wang, Ephrem Dusabimana, Florien Ndagijimana, Sankar Sambandam, Krishnendu Mukhopadhyay, Katherine A. KearnsDevan Campbell, Jacob Kremer, Joshua P. Rosenthal, William Checkley, Thomas Clasen, Luke Naeher

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3 Scopus citations


BACKGROUND: Exposure to PM2:5 arising from solid fuel combustion is estimated to result in ∼ 2:3 million premature deaths and 91 million lost disability-adjusted life years annually. Interventions attempting to mitigate this burden have had limited success in reducing exposures to levels thought to provide substantive health benefits. OBJECTIVES: This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial. METHODS: The HAPIN trial included 3,195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. Twenty-four-hour exposures to PM2:5, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (n = 1,605) and LPG (n = 1,590) arms and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels. RESULTS: Median postrandomization exposures of particulate matter (PM) with aerodynamic diameter ≤2:5 lm (PM2:5) in the intervention arm were lower by 66% at the first (71.5 vs. 24:1 lg=m3), and second follow-up visits (69.5 vs. 23:7 lg=m3) compared to controls. BC exposures were lower in the intervention arm by 72% (9.7 vs. 2:7 lg=m3) and 70% (9.6 vs. 2:8 lg=m3) at the first and second follow-up visits, respectively, and carbon monoxide exposure was 82% lower at both visits (1.1 vs. 0:2 ppm) in comparison with controls. Exposure reductions were consistent over time and were similar across research locations. DISCUSSION: Postintervention PM2:5 exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of PM2:5 samples falling below the World Health Organization Annual Interim Target 1 of 35 lg=m3 . This study indicates that an LPG intervention can reduce PM2:5 exposures to levels at or below WHO targets.

Original languageEnglish
Article number097005
JournalEnvironmental Health Perspectives
Issue number9
StatePublished - Sep 2022


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