1/2-Bangladesh Center for Global Environmental and Occupational Health- Bangladesh

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PROJECT SUMMARY Almost 3 billion people worldwide, including 89% people in Bangladesh, are exposed to harmful household air pollutants (HAP) emitted from combustion of biomass (wood, agricultural residue, cow dung, etc.) fuel use for cooking. While health risks associated with air-pollution have been reasonably well-studied in developed countries, there is little evidence on health benefits achievable by HAP reduction through clean fuel use, especially in low- and middle-income countries (LMICs). Bangladesh GEOHealth hub has established a cohort of biomass fuel users (n=660). We observed that an increased HAP exposure was associated with lung function decline, increased blood pressure and disruption of innate and adaptive immune function. We observed a drastic reduction in HAP exposure by exclusive liquified petroleum gas (LPG) stove use for 24 months, resulting changes in immune and inflammatory responses in women and in children. However, changes in chronic cardio-pulmonary markers were challenging mostly due to short duration of follow up. In quest for an innovative cost effective, adaptable, and scalable intervention as the possible next step, we planned to conduct a large household level randomized controlled trial by educational intervention using mobile phone (mHealth) based technology. In addition, we will continue following the cohort and will conduct rigorous and repeated personalized (24-48 hours) and area (over 5 days) assessments of PM2.5 and black carbon (BC) exposure to examine the long-term effects of HAP reduction on subclinical measures of cardio-pulmonary and immune dysfunction including effect of HAP exposure on antibody response to vaccine. We will also use deep learning methods to identify lung pathology in relation to HAP. Finally, we propose two exploratory studies on health effects of industrial waste and garment industry work. The aims of this study are scientifically important and directly policy-relevant and consistent with the GEOHealth program agenda. 1