Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution.

Thomas Clasen,Ghislaine Rosa,Lindsay M Jaacks,Kalpana Balakrishnan,Joshua P Rosenthal,Kyle Steenland,William Checkley,Eric D Mccollum,Maggie L Clark,Lance A Waller,Howard H Chang,Dana Boyd Barr,Dong-Yun Kim,Jennifer L Peel,John P Mccracken,J Jaime Miranda,Aris T Papageorghiou ,Lisa Thompson ,Víctor G Dávila‐Román ,Michael Johnson ,Hapin Investigators

doi:10.1289/ehp6407

Abstract

Background:Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention.Objective:This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda).Methods:We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter (), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682).Conclusions:This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407

Highlights

Nearly 3 billion people rely on solid fuels for cooking and heating (Bonjour et al 2013)
This paper summarizes the rationale, study design, and methods of the Household Air Pollution Intervention Network (HAPIN) trial, a recently launched randomized controlled trial (RCT) that seeks to provide the evidence necessary for policy makers to determine what health benefits that can be achieved by implementing a scalable intervention aimed directly at reducing household air pollution (HAP) in low- and middle-income countries (LMICs)
CI, confidence interval; HAPIN, Household Air Pollution Intervention Network. aOur key population parameters were the variance of continuous measures (r2) or the incidence rates among controls (p1) for relative risks

Summary

BACKGROUND

Nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention

METHODS

Background

Methods

Findings

Discussion