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,Jean De Dieu Ntivuguruzwa,Juan Gabriel Espinoza,Sankar Sambandam,Alejandra Bussalleu,Lisa De Las Fuentes,Ian Hennessee,Naveen Puttaswamy,Wenlu Ye,Damien Swearing,William Checkley,Kirk R Smith,Jane Mbabazi,Shakir Hossen,Ashley Toenjes,Penelope P Howards,Michael Johnson,Steven A Harvey,John P Mccracken,Rachel Meyers,P Barry Ryan,Rachel Craik,Alexie Mukeshimana,Jennifer L Peel,Maggie L Clark,Erick Mollinedo,Viviane Valdes,Ephrem Dusabimana,Kalpana Balakrishnan,Gurusamy Thangavel,Marilú Chiang,Kendra N Williams,Adly Castañaza,Kyle Steenland,Azhar Nizam,Ashlinn Quinn,Thomas Clasen,Fiona Majorin,Florien Ndagijimana,Sarah Hamid,Miles A Kirby,Ghislaine Rosa,Dana Boyd Barr,Amy E Lovvorn,Sarada Garg,Ricardo Piedrahita,Usha Ramakrishnan,Vigneswari Aravindalochanan,Lance A Waller,Yunyun Chen,Karthikeyan Dharmapuri Rajamani,Gloriose Bankundiye,Rengaraj Ramasami,Bernard Mutariyani,Lisa Elon,Anaité Díaz-Artiga,Elisa Puzzolo,Pattie Lenzen,Ajay Pillarisetti,Sudhakar Saidam,Durairaj Natesan,Bonnie N Young,Jeremy A Sarnat,Alexander Ramirez,Shirin Jabbarzadeh,Kakali Mukhopadhyay ,Aris T Papageorghiou ,Katherine Kearns ,Lawrence H Moulton ,Lindsay M Jaacks ,Luke P Naeher ,Stella M Hartinger ,Suzanne M Simkovich ,Eric D Mccollum ,Lisa Thompson ,Oscar De León ,Mayarí Hengstermann ,Víctor G Dávila‐Román ,Sheela Sinharoy ,Joshua P Rosenthal ,Phabiola Herrera ,Eduardo Canúz

doi:10.1016/j.envpol.2021.118198

Abstract

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. ConclusionsThe 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.

Highlights

Household air pollution due to use of solid fuels such as wood and charcoal for cooking, heating and lighting is a major risk factor for morbidity and premature mortality (GBD, 2017 Risk Factor Collabora tors, 2018)
We modeled the potential health benefits for three of the primary outcomes assessed as part of the main Household Air Pollution Intervention Network (HAPIN) trial (Clasen et al, 2020): systolic blood pressure (SBP), birth weight, and as a proxy for severe pneumonia, acute lower respiratory infection (ALRI) by evaluating changes in outcomes or risk associated with reductions in the median personal PM2.5 exposure before and after liquefied petroleum gas (LPG) intervention based on state-of-the-science exposure-response curves (GBD, 2017 Risk Factor Collaborators, 2018; Steenland et al, 2018)
In Rwandan and Indian households, most women worked as farmers, while in Guatemala, housework was listed as the main occupation

Summary

Introduction

Household air pollution due to use of solid fuels such as wood and charcoal for cooking, heating and lighting is a major risk factor for morbidity and premature mortality (GBD, 2017 Risk Factor Collabora tors, 2018). Over 3 billion households rely on solid fuels for cooking, primarily in low-income settings (Bonjour et al, 2013; Health Effects Institute, 2019; WHO, 2016). Solid fuel cooking interventions have focused on improved combustion efficiency or ventilation and have largely failed to demonstrate substantial exposure reductions or health benefits (Baumgartner et al, 2019; Kirby et al, 2019; Mortimer et al, 2020, 2016; Pope et al, 2017; Quansah et al, 2017). Clean cooking fuels, such as electricity, ethanol, biogas, and liquefied petroleum gas (LPG), are widely considered necessary for obtaining exposure reductions and accompanying health and climate benefits (Grieshop et al, 2011). LPG, in particular, is amenable to large-scale dissemination and uptake, and clean cooking programs focusing on LPG are being scaled up worldwide (Gould and Urpelainen, 2018; Quinn et al, 2018)

Methods

Results

Conclusion