Household Air Pollution and Health: A Multi-Country LPG Intervention Trial

项目摘要/摘要 在全球范围内，近30亿人依赖固体燃料做饭和取暖，其中绝大多数生活在中低收入家庭。 收入国家(LMIC)。由此产生的家庭空气污染(HAP)是导致 2010年全球疾病负担，估计每年有430万人死亡，其中大部分是妇女 和年幼的孩子。以前的干预措施提供了更清洁的生物质炉灶，但都失败了 以减少暴露于能够产生有意义的健康改善的水平。没有发生过大规模的 液化石油气(LPG)炉灶的现场试验可能是最清洁、可扩展的干预措施。在这里我们 建议在4个城市的3200户家庭中进行液化石油气炉具和燃料分配的随机对照试验 LMIC(印度、危地马拉、秘鲁和卢旺达)提供关于潜在健康益处的严格证据 在整个生命周期内。按照一个共同的方案，每个干预点将招募800名孕妇 (18-34岁，怀孕20周)，并将随机分配一半的家庭接受液化石油气 炉灶和30个月的液化石油气供应。控制中心将在#年末收到相同的炉灶和液化石油气供应 这项研究。母亲和她的孩子将被跟踪，直到孩子2岁。我们估计有25% 的家庭将有第二个未怀孕的老年女性(35岁-)，她也将是 在基线时登记，并在30个月的随访期内进行跟踪，以评估心肺功能， 新陈代谢和癌症后果。为了优化干预使用，我们将实施行为改变策略 根据以前的经验和一年级的形成性研究。我们将评估炉灶的使用，进行 反复进行个人接触HAP(PM2.5、黑碳、一氧化碳)的评估，并收集干燥的 所有参与者的血点和尿样用于生物标志物分析和生物样品储存 时间点。主要结果是低出生体重、肺炎发病率和儿童的直线增长， 以及老年女性的血压。次要结局包括早产和粗大运动 儿童发育、孕期母体血压、血管内皮功能、呼吸 老年女性的损伤、致癌代谢物和生活质量。我们将解决 以下具体目标：(1)使用意向处理分析，确定随机液化石油气炉子的效果 并使用共同方案对四个不同LMIC人群的健康进行燃料干预；(2)确定 HAP与健康的暴露-反应关系；以及(3)确定液化石油气之间的关系 干预措施以及暴露/健康影响的定向和探索性生物标记物。拟议中的审判， 有能力检测四个LMIC人群内部和之间的健康影响，将提供令人信服的 证据，包括成本和实施战略，为国家和全球政策提供关于扩大规模的信息 在弱势群体中使用液化石油气炉灶。归根结底，这也将促进更深入的政策层面的讨论 确定在全球范围内启动和维持HAP干预的要求。

PROJECT SUMMARY/ABSTRACT Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority in low- and middle- income countries (LMICs). The resulting household air pollution (HAP) is the third leading risk factor in the 2010 global burden of disease, accounting for an estimated 4.3 million deaths annually, largely among women and young children. Previous interventions have provided cleaner biomass-based cookstoves, but have failed to reduce exposure to levels that produce meaningful health improvements. There have been no large-scale field trials with liquefied petroleum gas (LPG) cookstoves, likely the cleanest scalable intervention. Here we propose to conduct a randomized controlled trial of LPG stove and fuel distribution in 3,200 households in four LMICs (India, Guatemala, Peru, and Rwanda) to deliver rigorous evidence regarding potential health benefits across the lifespan. Following a common protocol, each intervention site will recruit 800 pregnant women (aged 18-34 years, <20 weeks gestation), and will randomly assign half their households to receive LPG stoves and a 30-month supply of LPG. Controls will receive the same cookstoves and LPG supply at the end of the study. The mother will be followed along with her child until the child is 2 years old. We estimate that 25% of households will have a second, non-pregnant older adult woman (aged 35-64 years) who will also be enrolled at baseline and followed during the 30-month follow-up period in order to assess cardiopulmonary, metabolic, and cancer outcomes. To optimize intervention use, we will implement behavior change strategies informed by previous experiences and formative research in Year 1. We will assess cookstove use, conduct repeated personal exposure assessments to HAP (PM2.5, black carbon, carbon monoxide), and collect dried blood spots and urinary samples for biomarker analysis and biospecimen storage on all participants at multiple time points. The primary outcomes are low birthweight, pneumonia incidence, and linear growth in the child, and blood pressure in the older adult woman. Secondary outcomes include preterm birth and gross motor development in the child, maternal blood pressure during pregnancy, and endothelial function, respiratory impairment, carcinogenic metabolites, and quality of life in the older adult woman. We will address the following specific aims: (1) using an intent-to-treat analysis, determine the effect of a randomized LPG stove and fuel intervention on health in four diverse LMIC populations using a common protocol; (2) determine the exposure-response relationships for HAP and health; and (3) determine relationships between LPG intervention and both targeted and exploratory biomarkers of exposure/health effects. The proposed trial, powered to detect health effects both within and across four LMIC populations, will provide compelling evidence, including costs and implementation strategies, to inform national and global policies on scaling up LPG stoves among vulnerable populations. Ultimately, this will facilitate deeper policy-level discussions as well as identify requirements for initiating and sustaining HAP interventions globally.