The Ghana Randomized Air Pollution and Health Study (GRAPHS): a cluster randomized trial of Liquified petroleum gas (LPG) and efficient biomass cookstoves delivered during pregnancy

Abstract

OPS 33: Health impact of interventions 2, Room 411, Floor 4, August 28, 2019, 10:30 AM - 12:00 PM Background/Aim: Household air pollution from inefficient biomass cookstoves causes millions of avoidable deaths annually. We urgently need reliable information on potential interventions. The Ghana Randomized Air Pollution and Health Study (GRAPHS) was a cluster randomized trial assessing the effect of a cookstove intervention delivered during the first two trimesters of pregnancy on birth weight and on physician-assessed pneumonia during the first year of life. Methods: We recruited pregnant women in Kintampo North and South districts in Ghana prior to 24 weeks gestation, as determined via ultrasound performed by trained midwife, and assigned them to one of three study arms. In control arm communities, study participants continued to cook with traditional cookstoves. In LPG communities, households received one two-burner LPG cookstove and free LPG. In efficient biomass cookstove communities, households received two fan-assisted improved biomass-burning stoves. Control and efficient cookstove participants received LPG stoves at the end of the trial. Birth weight was assessed by study staff stationed in birth clinics, or, in the case of home births, by home visit within 24 hours of delivery; in both settings, birth weights were measured using calibrated digital scales. Trained field staff visited study children weekly during the first year of life, and referred all community-assessed respiratory illnesses to a study physician, who assessed pneumonia status using the WHO Integrated Management of Childhood Illness (IMCI) guidelines. Results: We enrolled 1414 non-smoking, pregnant women resulting in 1303 live births. 1122 infants completed follow-up through the first year of life, with 54,768 child-weeks of fieldworker surveillance. Our intention to treat analysis showed no significant difference in birth weight or physician-assessed IMCI pneumonia in either of the intervention arms. Conclusions: Neither intervention reduced pneumonia risk or increased birth weight. Future intervention studies should consider community-level energy system transitions.