LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial

• Type of Material: Article
• Authors: Jiawen Liao, Emory University; Miles A Kirby, Emory University; Ajay Pillarisetti, Emory University; Ricardo Piedrahita, Berkeley Air Monitoring Group; Kalpana Balakrishnan, Sri Ramachandra Institute of Higher Education & Research; Sankar Sambandam, Sri Ramachandra Institute of Higher Education & Research; Krishnendu Mukhopadhyay, Sri Ramachandra Institute of Higher Education & Research; Wenlu Ye, Emory University; Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Fiona Majorin, London School of Hygiene & Tropical Medicine; Ephrem Dusabimana, Eagle Research Center; Florien Ndagijimana, Eagle Research Center; John P McCracken, Universidad del Valle De Guatemala; Erick Mollinedo, Universidad del Valle De Guatemala; Oscar de Leon, Emory University; Anaité Díaz-Artiga, Universidad del Valle De Guatemala; Lisa Thompson, Emory University; Katherine A Kearns, University of Georgia; Luke Naeher, University of Georgia; Joshua Rosenthal, National Institutes of Health, BethesdaNational Institutes of Health, Bethesda; Maggie L Clark, Colorado State University; Nelson Steenland, Emory University; Lance Waller, Emory University; William Checkley, Johns Hopkins University; Jennifer L Peel, Colorado State University; Thomas Clasen, Emory University; Michael Johnson, Berkeley Air Monitoring Grp
• Language: English
• Date: 2021-10-05
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envpol.2021.118198
• Title of Journal or Parent Work: ENVIRONMENTAL POLLUTION
• Volume: 291
• Start Page: 118198
• End Page: 118198
• Keywords: PERFORMANCE; Environmental Sciences & Ecology; Personal exposure; Clean cooking fuel; HOUSEHOLD; PATTERNS; CLEAN COOKING; RURAL MALAWI; PM2.5; HEALTH; Household air pollution; Life Sciences & Biomedicine; Science & Technology; SOLID-FUEL; Environmental Sciences; COOKSTOVE; Cookstove; Intervention; USAGE
• Research Categories: Environmental Sciences; Health Sciences, Nursing; Health Sciences, Public Health; Health Sciences, Radiology

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. Conclusions: The 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.