LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial

Jiawen Liao, Miles A. Kirby, Ajay Pillarisetti, Ricardo Piedrahita, Kalpana Balakrishnan, Sankar Sambandam, Krishnendu Mukhopadhyay, Wenlu Ye, Ghislaine Rosa, Fiona Majorin, Ephrem Dusabimana, Florien Ndagijimana, John P. McCracken, Erick Mollinedo, Oscar de Leon, Anaité Díaz-Artiga, Lisa M. Thompson, Katherine A. Kearns, Luke Naeher, Joshua RosenthalMaggie L. Clark, Kyle Steenland, Lance A. Waller, William Checkley, Jennifer L. Peel, Thomas Clasen, Michael Johnson, Vigneswari Aravindalochanan, Gloriose Bankundiye, Dana Boyd Barr, Alejandra Bussalleu, Eduardo Canuz, Adly Castañaza, Yunyun Chen, Marilú 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, 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, Viviane Valdes, Kendra N. Williams, Bonnie N. Young

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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.

Original languageEnglish
Article number118198
JournalEnvironmental Pollution
StatePublished - Dec 15 2021


  • Clean cooking fuel
  • Cookstove
  • Household air pollution
  • Intervention
  • PM
  • Personal exposure


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