Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial

Abstract Background Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove. Methods A cluster-randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within 1 year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population. Results A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline. Conclusions We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI. Trial registration The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

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Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: A cluster-randomized controlled trial.

10.21203/rs.3.rs-53427/v2 ◽

2020 ◽

Author(s):

Mesafint Molla Adane ◽

Getu Degu Alene ◽

Seid Tiku Mereta ◽

Kristina L Wanyonyi

Keyword(s):

Air Pollution ◽

Controlled Trial ◽

Health Effect ◽

Household Air Pollution ◽

Acute Lower Respiratory Infection ◽

Intention To Treat ◽

Improved Cookstove ◽

Cluster Randomized ◽

Treat Population

Abstract Background: Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove.Methods: A cluster-randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within one year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population.Results: A total of 5,508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5,333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89-1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline.Conclusions: We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI. Trial registration: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

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Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: Cluster randomized controlled trial

10.21203/rs.3.rs-53427/v1 ◽

2020 ◽

Author(s):

Mesafint Molla Adane ◽

Getu Degu Alene ◽

Seid Tiku Mereta ◽

Kristina L Wanyonyi

Keyword(s):

Air Pollution ◽

Controlled Trial ◽

Health Effect ◽

Household Air Pollution ◽

Acute Lower Respiratory Infection ◽

Intention To Treat ◽

Improved Cookstove ◽

Cluster Randomized ◽

Treat Population

Abstract Background: Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove.Methods: A cluster randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within one year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population.Results: A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89-1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline.Conclusions: We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI. Trial registration: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

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Effect of Improved Cookstove Intervention on Childhood Acute Lower Respiratory Infection in Northwest Ethiopia: Cluster Randomized Controlled Trial

10.21203/rs.3.rs-47949/v1 ◽

2020 ◽

Author(s):

Mesafint Molla Adane ◽

Getu Degu Alene ◽

Seid Tiku Mereta ◽

Kristina L Wanyonyi

Keyword(s):

Air Pollution ◽

Respiratory Infection ◽

Controlled Trial ◽

Health Effect ◽

Household Air Pollution ◽

Acute Lower Respiratory Infection ◽

Lower Respiratory Infection ◽

Open Burning ◽

Intention To Treat ◽

Improved Cookstove

Abstract BackgroundHousehold air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection. The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however not clear whether it is possible to prevent household air pollution-related disease burdens with locally made improved cookstoves, and the evidence regarding the health effect of improved cookstove interventions among children still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the customary open burning traditional baking stove.MethodsA cluster randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and intervention was delivered to all households allocated into the intervention arm. A total of four follow-up visits were carried out within one year at approximately 3-month intervals immediately after the delivery of the intervention. The intervention effect was estimated using odds ratio as a measure of effect following a Generalized Estimating Equations modeling approach among the intention-to-treat population.ResultsA total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The intervention was not found to have a statistically significant effect on the outcome with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02) compared with the continuation of an open burning traditional baking stove method.Harms:There was no difference in the overall incidence rates of cooking-related burns between arms with an incidence rate ratio of 0.80 (95% CI: 0.53–1.21), and there were no grounds to stop the trial early for adverse events.ConclusionsWe found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood acute lower respiratory infection compared with the continuation of an open burning traditional baking stove method. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood acute lower respiratory infection.Trial registration: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

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Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: Cluster randomized controlled trial

10.21203/rs.3.rs-28518/v1 ◽

2020 ◽

Author(s):

Mesafint Molla Adane ◽

Getu Degu Alene ◽

Seid Tiku Mereta ◽

Kristina L Wanyonyi

Keyword(s):

Air Pollution ◽

Respiratory Infection ◽

Controlled Trial ◽

Health Effect ◽

Household Air Pollution ◽

Acute Lower Respiratory Infection ◽

Lower Respiratory Infection ◽

Open Burning ◽

Intention To Treat ◽

Improved Cookstove

Abstract BackgroundHousehold air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection. The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however not clear whether it is possible to prevent household air pollution-related disease burdens with locally made improved cookstoves, and the evidence regarding the health effect of improved cookstove interventions among children still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the customary open burning traditional baking stove.MethodsA cluster randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and intervention was delivered to all households allocated into the intervention arm. A total of four follow-up visits were carried out within one year at approximately 3-month intervals immediately after the delivery of the intervention. The intervention effect was estimated using odds ratio as a measure of effect following a Generalized Estimating Equations modeling approach among the intention-to-treat population.ResultsA total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The intervention was not found to have a statistically significant effect on the outcome with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02) compared with the continuation of an open burning traditional baking stove method. Harms: There was no difference in the overall incidence rates of cooking-related burns between arms with an incidence rate ratio of 0.80 (95% CI: 0.53–1.21), and there were no grounds to stop the trial early for adverse events.ConclusionsWe found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood acute lower respiratory infection compared with the continuation of an open burning traditional baking stove method. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood acute lower respiratory infection.

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Biomass-fuelled improved cookstove intervention to prevent household air pollution in Northwest Ethiopia: a cluster randomized controlled trial

Environmental Health and Preventive Medicine ◽

10.1186/s12199-020-00923-z ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Mesafint Molla Adane ◽

Getu Degu Alene ◽

Seid Tiku Mereta

Keyword(s):

Risk Factors ◽

Air Pollution ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Household Air Pollution ◽

Randomized Controlled ◽

Link Type ◽

Improved Cookstove ◽

Cluster Randomized

Abstract Background Household air pollution from biomass fuels burning in traditional cookstoves currently appeared as one of the most serious threats to public health with a recent burden estimate of 2.6 million premature deaths every year worldwide, ranking highest among environmental risk factors and one of the major risk factors of any type globally. Improved cookstove interventions have been widely practiced as potential solutions. However, studies on the effect of improved cookstove interventions are limited and heterogeneous which suggested the need for further research. Methods A cluster randomized controlled trial study was conducted to assess the effect of biomass-fuelled improved cookstove intervention on the concentration of household air pollution compared with the continuation of an open burning traditional cookstove. A total of 36 clusters were randomly allocated to both arms at a 1:1 ratio, and improved cookstove intervention was delivered to all households allocated into the treatment arm. All households in the included clusters were biomass fuel users and relatively homogenous in terms of basic socio-demographic and cooking-related characteristics. Household air pollution was determined by measuring the concentration of indoor fine particulate, and the effect of the intervention was estimated using the Generalized Estimating Equation. Results A total of 2031 household was enrolled in the study across 36 randomly selected clusters in both arms, among which data were obtained from a total of 1977 households for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The improved cookstove intervention significantly reduces the concentration of household air pollution by about 343 μg/m3 (Ḃ = − 343, 95% CI − 350, − 336) compared to the traditional cookstove method. The overall reduction was found to be about 46% from the baseline value of 859 (95% CI 837–881) to 465 (95% CI 458–472) in the intervention arm compared to only about 5% reduction from 850 (95% CI 828–872) to 805 (95% CI 794–817) in the control arm. Conclusions The biomass-fuelled improved cookstove intervention significantly reduces the concentration of household air pollution compared to the traditional method. This suggests that the implementation of these cookstove technologies may be necessary to achieve household air pollution exposure reductions. Trial registration The trial project was retrospectively registered on August 2, 2018, at the clinical trials.gov registry database (https://clinicaltrials.gov/) with the NCT03612362 registration identifier number.

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Gemcitabine and cisplatin (GP) induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) versus CCRT alone in locoregionally advanced nasopharyngeal carcinoma (NPC): A phase 3, multicenter, randomized controlled trial.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6003 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6003-6003 ◽

Cited By ~ 2

Author(s):

Jun Ma ◽

Yuan Zhang ◽

Ying Sun ◽

Fangyun Xie ◽

Weihan Hu ◽

...

Keyword(s):

Controlled Trial ◽

Intensity Modulated Radiotherapy ◽

Free Survival ◽

Intention To Treat ◽

Multicenter Randomized Controlled Trial ◽

Common Grade ◽

Grade 3 ◽

To Receive ◽

Treat Population

6003 Background: GP regimen has been established as the standard first-line treatment option for patients with recurrent/metastatic NPC. However, its efficacy in locoregionally advanced disease remains unclear. Methods: Patients with previously untreated, non-metastatic stage III-IVB (except T3-4N0M0, AJCC 7th) NPC, aged 18–64 years without severe comorbidities were eligible. They were randomly assigned (1:1) to receive GP IC (gemcitabine 1 g/m2on days 1 & 8, cisplatin 80 mg/m2 on day 1, q3w for 3 cycles) plus CCRT (cisplatin 100 mg/m2, q3w for 3 cycles, concurrently with intensity-modulated radiotherapy) or CCRT alone. The primary endpoint was failure-free survival (FFS). The calculated sample size was 238 per group, with an 80% power (two-sided α 0.05) to detect a treatment failure hazard ratio (HR) of 0.52. Results: From Dec 2013 to Sep 2016, 480 patients from 12 centers were randomly assigned to IC+CCRT (n = 242) or CCRT alone (n = 238) group. Baseline characteristics were well balanced. After a median follow-up of 39 months, 3-year FFS was 85.8% in the IC+CCRT group and 77.2% in the CCRT alone group (intention-to-treat population; HR 0.53, 95% confidence interval 0.34–0.81; P = 0.003). In GP+CCRT group, 239 patients started GP IC and 231 (96.7%) completed all three cycles. The most common ≥grade 3 adverse events (AE) in IC+CCRT and CCRT group were mucositis (28.9% vs. 32.1%), neutropenia (28.0% vs. 10.5%) and leukopenia (26.4% vs. 20.3%). Conclusions: Adding GP IC to CCRT significantly improved FFS in locoregionally advanced NPC and is well tolerated with favorable toxicity profile. Clinical trial information: NCT01872962. [Table: see text]

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Evaluation of the smoking intervention X:IT after the second year: A randomized controlled trial

Scandinavian Journal of Public Health ◽

10.1177/1403494818799837 ◽

2018 ◽

Vol 47 (8) ◽

pp. 885-889 ◽

Cited By ~ 1

Author(s):

Anette Andersen ◽

Lotus S. Bast ◽

Pernille Due ◽

Lau C. Thygesen

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

First Year ◽

Long Term Effects ◽

Intention To Treat ◽

Randomized Controlled ◽

Smoking Intervention ◽

Second Year ◽

Cluster Randomized

Aims:Review studies on the long-term effects of school-based smoking interventions show mixed results. X:IT was a three-year cluster randomized controlled trial to prevent uptake of smoking among Danish students from age 13 years until age 15 years which previously proved effective in preventing smoking after the first year of intervention. The aim of this paper was to conduct the pre-planned analyses of the effects of the X:IT intervention on smoking after the second year. Methods: We used self-reported questionnaire data from students at baseline, first, second, and third follow-up ( n at second follow-up=3269, response rate=79.4%). Data from third follow-up were not suitable for analysis. Outcome measure: ‘current smoking’, dichotomised into smoke daily, weekly, monthly or more seldom versus do not smoke. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. Results: The prevalence of smoking increased from 5.8% at baseline to 17.0% at second follow-up among students at intervention schools, and from 7.6% to 18.7% among students at control schools. Analyses of available cases and ITT analyses did not support X:IT being effective in preventing smoking after the second year of intervention. Conclusions: Although X:IT was effective after the first year of intervention, we were not able to demonstrate any effects after the second year. Implementation of the intervention was lower in the second year compared to the first year which indicates that the missing effect of the intervention at second follow-up is due to lack of implementation.

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Inhaled and intranasal ciclesonide for the treatment of covid-19 in adult outpatients: CONTAIN phase II randomised controlled trial

BMJ ◽

10.1136/bmj-2021-068060 ◽

2021 ◽

pp. e068060

Author(s):

Nicole Ezer ◽

Sara Belga ◽

Nick Daneman ◽

Adrienne Chan ◽

Benjamin M Smith ◽

...

Keyword(s):

Respiratory Symptoms ◽

Controlled Trial ◽

Intervention Group ◽

Dose Inhaler ◽

Control Group ◽

Double Blind ◽

Adjusted Risk ◽

Intention To Treat ◽

Treat Population

Abstract Objective To determine if inhaled and intranasal ciclesonide are superior to placebo at decreasing respiratory symptoms in adult outpatients with covid-19. Design Randomised, double blind, placebo controlled trial. Setting Three Canadian provinces (Quebec, Ontario, and British Columbia). Participants 203 adults aged 18 years and older with polymerase chain reaction confirmed covid-19, presenting with fever, cough, or dyspnoea. Intervention Participants were randomised to receive either inhaled ciclesonide (600 μg twice daily) and intranasal ciclesonide (200 μg daily) or metered dose inhaler and nasal saline placebos for 14 days. Main outcome measures The primary outcome was symptom resolution at day 7. Analyses were conducted on the modified intention-to-treat population (participants who took at least one dose of study drug and completed one follow-up survey) and adjusted for stratified randomisation by sex. Results The modified intention-to-treat population included 203 participants: 105 were randomly assigned to ciclesonide (excluding two dropouts and one loss to follow-up) and 98 to placebo (excluding three dropouts and six losses to follow-up). The median age was 35 years (interquartile range 27-47 years) and 54% were women. The proportion of participants with resolution of symptoms by day 7 did not differ significantly between the intervention group (42/105, 40%) and control group (34/98, 35%); absolute adjusted risk difference 5.5% (95% confidence interval −7.8% to 18.8%). Results might be limited to the population studied, which mainly included younger adults without comorbidities. The trial was stopped early, therefore could have been underpowered. Conclusion Compared with placebo, the combination of inhaled and intranasal ciclesonide did not show a statistically significant increase in resolution of symptoms among healthier young adults with covid-19 presenting with prominent respiratory symptoms. As evidence is insufficient to determine the benefit of inhaled and intranasal corticosteroids in the treatment of covid-19, further research is needed. Trial registration ClinicalTrials.gov NCT04435795 .

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Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312592 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12592

Author(s):

Ashlinn K. Quinn ◽

Kendra N. Williams ◽

Lisa M. Thompson ◽

Steven A. Harvey ◽

Ricardo Piedrahita ◽

...

Keyword(s):

Air Pollution ◽

Controlled Trial ◽

Interquartile Range ◽

Household Air Pollution ◽

Liquefied Petroleum Gas ◽

Randomized Controlled ◽

Fuel Delivery ◽

Adherence Intervention ◽

Infant Birth

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and had a gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

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Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention During Gestation: The Multi-country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

10.20944/preprints202111.0188.v1 ◽

2021 ◽

Author(s):

Ashlinn K Quinn ◽

Kendra N Williams ◽

Lisa M Thompson ◽

Steven Harvey ◽

Ricardo Piedrahita ◽

...

Keyword(s):

Air Pollution ◽

Controlled Trial ◽

Interquartile Range ◽

Household Air Pollution ◽

Liquefied Petroleum Gas ◽

Randomized Controlled ◽

Fuel Delivery ◽

Adherence Intervention ◽

Infant Birth

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of the stoves, with simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda either to a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention, at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of intervention households. 31.4% removed their traditional stoves upon receipt of the intervention, and among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: Fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

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