Assessing the 5-Year Effects of a 500-day Liquefied Petroleum Gas Cooking Intervention: Continued Follow up of Participants from the Household Air Pollution Intervention Network (HAPIN) trial

Emory University, Atlanta GA

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Abstract

Nearly 3 billion people continue to use solid fuels (coal, biomass, animal dung) for household cooking needs, primarily in low- and middle-income countries. The household air pollution resulting from cooking with solid fuels is responsible for an estimated 2.3 million premature deaths and additional morbidity burden each year. Our Household Air Pollution Intervention Network (HAPIN) trial (NIH UM1HL134590) evaluated the effect of a free LPG (liquefied petroleum gas) stove and fuel intervention among 800 pregnant women in each of 4 countries (Guatemala, India, Peru, Rwanda) on birth outcomes and child health through age 1; data collection was then extended through age 2. The trial achieved excellent retention (92%), high adherence to the intervention, and a substantial reduction in personal exposure to fine particulate matter (PM2.5) and black carbon. Research suggests that exposure experienced during gestation and early life is linked to a range of longer-term outcomes, and that the benefits of reduced exposure will continue even if the intervention ends. Therefore, we propose to continue to follow HAPIN children through age 5 to evaluate the effects of the original HAPIN intervention on neurological and physical development (Aim 1). Further, given that the intervention ended at age 1, we will continue to characterize the children’s personal exposure to PM2.5 and black carbon (Aim 2), allowing us the unique ability to evaluate exposure-response for several relevant periods of gestation and early childhood (Aim 3). The HAPIN trial is uniquely positioned to address these questions, given the large exposure contrast during the trial and the generation of a rich dataset to examine exposure-response given the expected heterogeneity in exposures among control households and all participants post-trial as they adopt the various fuels and cooking practices typical in LMIC settings. The selected health outcomes are supported by previous literature and have important implications for policy. Our overarching hypotheses are that 1) the original intervention has longer term benefits for neurologic and physical development after the intervention ends, and 2) personal exposure to PM2.5 and black carbon during critical developmental periods will be inversely associated with neurologic and physical development. We propose to explore these aims and hypotheses in HAPIN children in Guatemala, India, and Rwanda (n=2,175 children remaining in the 3 study sites). The proposed work builds on the major investment already made in the HAPIN trial by evaluating whether the benefits of the intervention extend beyond pregnancy and the child’s first year of life, leveraging a well-characterized cohort in 3 diverse settings, using an experienced and proven research team with strong relationships with participants, in order to provide rigorous and widely generalizable answers to questions important for both science and policy. Modified Narrative Section Household air pollution from using solid fuels (wood, charcoal, animal dung) for cooking is responsible for an estimated 2.3 million premature deaths and additional morbidity burden each year, mainly in low- and middle-income countries. This research will leverage the success of the Household Air Pollution Intervention Network Trial (HAPIN) to assess whether providing an LPG stove and fuel intervention during pregnancy and early childhood, and the resulting substantial differences in personal exposure to harmful pollutants, impact child development beyond the child’s first year of life. The findings aim to guide policy by providing rigorous and widely generalizable insight into how such interventions impact neurological and physical development in children through the age of 5, as well as future health and productivity.