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

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 (PM_2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM_2.5 for 24 or 48 h using gravimetric-based PM_2.5 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 PM_2.5 reductions. Median kitchen PM_2.5 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 PM_2.5 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 PM_2.5 concentrations and a 74% (95% CI: 70-79%) reduction in personal PM_2.5 exposures. Results were similar for each site. CONCLUSIONS: The intervention was associated with substantial reductions in kitchen and personal PM_2.5 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.

Keywords: Clean cooking fuel; Cookstove; Household air pollution; Intervention; PM(2.5); Personal exposure.

Fig. 1

Distributions of kitchen PM_2.5 concentrations and personal PM_2.5 exposure before (biomass) and after LPG intervention for 591 Samples.

Fig. 2

Potential effects of changes in PM_2.5 personal exposure on systolic blood pressure (SBP) and birth weight (BW) (both adapted from Steenland et al., 2018) and relative risk (RR) of acute lower respiratory infection (ALRI) (adapted (GBD, 2017 Risk Factor Collaborators, 2018). Across all panels, the modeled exposure response curve is shown as a solid black line with uncertainty intervals in light grey. The pink dashed line is the median personal exposure during the baseline period; the green solid line is the median personal exposure during the follow-up period after LPG intervention. The correspondingly colored shaded areas are the IQR of measurements during that period. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)