Assessing the Effect of Liquefied Petroleum Gas (LPG) stoves on Child Mortality through the Household Air Pollution Intervention Network (HAPIN) Trial Restricted; Files Only

Abstract

Background: Household air pollution (HAP) has been cited as a leading environmental cause of global disease burden. The use of solid fuels for cooking and heating is an important and prevalent contributor to HAP, with nearly 3 billion people using solid fuels around the world, especially in Low- to Middle- Income Countries (LMICs). Young children are especially affected by HAP, being vulnerable to the toxic effects both in utero and as a developing infant. Liquified petroleum gas (LPG) stoves are a promising, scalable, clean alternative to solid fuels. This study aims to investigate the effect of a possible alternative to solid fuel HAP and its effect on child health, in particular child mortality.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial is a multi-center randomized control trial that assigned pregnant women in Guatemala, India, Peru, and Rwanda to receive a free LPG stove and fuel (intervention) or to continue using a traditional stove (control). Women and their children were followed through pregnancy and until the child was 24-months. Cox proportional hazards models were used to assess the effect of the intervention on child mortality.

Results: 3200 pregnant women were randomized to the treatment groups, resulting in 3061 live births. 64 children died over a 24-month follow-up period, with 40 deaths in the neonatal period (less than 28 days of life). The hazard rate of death among children in the intervention group was 0.772 (0.471, 1.266) times the hazard rate of death among children in the control group.

Conclusions: There was no statistically significant difference in child mortality through 24-months when comparing the intervention group (LPG cookstoves) to the control group (traditional stoves).

Table of Contents

1. Introduction

a.    Household Air Pollution (HAP)

b.    Child Health Disparities

c.    HAP and Child Health and Mortality

d.    HAPIN Trial

e.    Study Aims

2. Methods

a.    Study Design

b.    Participants

c.    Intervention

d.    Randomization

e.    Outcomes

f.     Statistical Analysis

3.  Results

a.    Maternal and Child Baseline Characteristics

b.    Environmental Health Theory of Change: Fidelity, Adherence, and Exposure

c.    Child Mortality: Summary

d.    Child Mortality: Survival Analysis

e.    Cox Proportional Hazards Model

f.     Child Mortality Analysis: Cox Proportional Hazards Model

g.    Child Mortality: Sensitivity Analysis

4. Discussion

a.    Summary of Results

b.    Reflection on Results

c.    Strengths, Limitations, and Further Research

d.    Relatability and Generalizability

5.  Works Cited

6.  Tables and Figures

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	Child Mortality Air Pollution Global Health
Committee Chair / Thesis Advisor	Thomas Clasen, Emory University

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