scholarly journals 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

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.

scholarly journals 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

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.

scholarly journals Exposure contrasts of pregnant women during the Household Air Pollution Intervention Network randomized controlled trial

2021 ◽  
Author(s):  
Michael Johnson ◽  
Ajay Pillarisetti ◽  
Ricardo Piedrahita ◽  
Kalpana Balakrishnan ◽  
Jennifer L Peel ◽  
...  
Keyword(s):  
Air Pollution ◽  
Randomized Controlled Trial ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Mixed Effect ◽  
Randomized Controlled ◽  
Life Years ◽  
The Impact

Background: Exposure to PM2.5 arising from solid fuel combustion is estimated to result in approximately 2.3 million premature deaths and 90 million lost disability-adjusted life years annually. 'Clean' cooking interventions attempting to mitigate this burden have had limited success in reducing exposures to levels that may yield improved health outcomes. 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 3195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. 24-hour exposures to PM2.5, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (n=1605) and LPG arms (n=1590) 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 exposures of PM2.5, BC, and CO post-randomization in the intervention arm were lower by 66% (70.7 versus 24.0 µg/m3), 71% (9.6 versus 2.8 µg/m3), and 83% (1.2 versus 0.2 ppm), respectively, compared to the control arm. Exposure reductions were similar across research locations. Post-intervention 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 WHO Annual Interim Target 1 of 35 µg/m3. Discussion: This study indicates that an LPG intervention with high displacement of traditional cooking can reduce exposures to levels thought to be associated with health benefits. Success in reducing exposures was likely due to strong performance of, and high adherence to the intervention. Keywords (5-8): Liquefied petroleum gas, clean cooking, intervention, exposure assessment, PM2.5

scholarly journals The Power of Perception: Limitations of Information in Reducing Air Pollution Exposure

2021 ◽  
Author(s):  
Rema Hanna ◽  
Bridget Hoffmann ◽  
Paulina Oliva ◽  
Jake Schneider
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Avoidance Behavior ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
The Past ◽  
Air Pollution Exposure ◽  
High Pollution ◽  
Pollution Exposure

We conduct a randomized controlled trial in Mexico City to determine willingness to pay (WTP) for SMS air quality alerts and to study the effects of air quality alerts, reminders, and a reusable N95 mask on air pollution information and avoidance behavior. At baseline, we elicit WTP for the alerts service after revealing whether the household will receive an N95 mask and participant compensation, but before revealing whether they will receive alert or reminder services. While we observe no significant impact of mask provision on WTP, higher compensation increases WTP, suggesting a possible cash-on-hand constraint. The perception of high pollution days prior to the survey is positively correlated with WTP, but the presence of actual high pollution days is not correlated with WTP. Follow-up survey data demonstrate that the alerts treatment increases reporting of receiving air pollution information via SMS, a high pollution day in the past week, and staying indoors on the most recent perceived high pollution day. However, we observe no significant effect on the ability to correctly identify which specific days had high pollution. Similarly, households that received an N95 mask are more likely to report utilizing a mask with filter in the past two weeks, but we observe no effect on using a filter mask on the specific days with high particulate matter. Although we nd that air quality alerts increased the salience of air quality and avoidance behavior, these results illustrate the difficulty that information treatments face in overcoming perceptions to effectively reduce exposure to air pollution.

scholarly journals Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial

2020 ◽  
Vol 6 (1) ◽  
pp. 00308-2019
Author(s):  
Suzanne M. Simkovich ◽  
Lindsay J. Underhill ◽  
Miles A. Kirby ◽  
Dina Goodman ◽  
Mary E. Crocker ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cause Of Death ◽  
Controlled Trial ◽  
Severe Pneumonia ◽  
Clean Energy ◽  
Household Air Pollution ◽  
World Health ◽  
Liquefied Petroleum Gas ◽  
Preventable Risk Factor ◽  
Difficulty Breathing

Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.

scholarly journals Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala

2021 ◽  
pp. 109019812199628
Author(s):  
Mayarí Hengstermann ◽  
Anaité Díaz-Artiga ◽  
Roberto Otzóy-Sucúc ◽  
Ana Laura Maria Ruiz-Aguilar ◽  
Lisa M. Thompson ◽  
...  
Keyword(s):  
Air Pollution ◽  
Focus Group ◽  
Controlled Trial ◽  
Household Air Pollution ◽  
Liquefied Petroleum Gas ◽  
Traditional Foods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Flip Chart ◽  
Cooking Fuels

Background Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method We conducted ethnographic research, including direct observation ( n = 36), in-depth ( n = 18), and semistructured ( n = 6) interviews, and 24 focus group discussions ( n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.

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

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).

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

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).

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

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.

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

2021 ◽  
Vol 21 (1) ◽  
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 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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