Effects of a Liquefied Petroleum Gas, Continuous Fuel Delivery and Behavioral Messaging Intervention on Linear Growth in Children With Exposure to Household Air Pollution: A Multi-country Randomized Controlled Trial

Steenland, K; Johnson, M; Jabbarzadeh, S; McCracken, J; Ramakrishnan, U; Hossen, S; Waller, L; Rosa, G; Aravindalochanan, V; Diaz-Artiga, A; Kirby, M; Chaing, M; Checkley, W; Hartinger Peña, Stella Maria; Moulton, L; Sinharoy, S; Thompson, L; Papageorghiou, A; McCollum, ED; Williams, KN; Rosenthal, JP; Balakrishnan, K; Chang, H; Pillarisetti, A; Garg, S; Clasen, T; Ndagijimana, F; Thangavel, G; Wang, J; Mukeshimana, A; Nicolaou, L

dc.contributor.author	Checkley, W
dc.contributor.author	Thompson, L
dc.contributor.author	Sinharoy, S
dc.contributor.author	Hossen, S
dc.contributor.author	Moulton, L
dc.contributor.author	Chang, H
dc.contributor.author	Waller, L
dc.contributor.author	Steenland, K
dc.contributor.author	Rosa, G
dc.contributor.author	Mukeshimana, A
dc.contributor.author	Ndagijimana, F
dc.contributor.author	McCracken, J
dc.contributor.author	Diaz-Artiga, A
dc.contributor.author	Balakrishnan, K
dc.contributor.author	Garg, S
dc.contributor.author	Thangavel, G
dc.contributor.author	Aravindalochanan, V
dc.contributor.author	Hartinger Peña, Stella Maria
dc.contributor.author	Chaing, M
dc.contributor.author	Kirby, M
dc.contributor.author	Papageorghiou, A
dc.contributor.author	Ramakrishnan, U
dc.contributor.author	Williams, KN
dc.contributor.author	Nicolaou, L
dc.contributor.author	Jabbarzadeh, S
dc.contributor.author	Wang, J
dc.contributor.author	Johnson, M
dc.contributor.author	Pillarisetti, A
dc.contributor.author	Rosenthal, JP
dc.contributor.author	McCollum, ED
dc.contributor.author	Clasen, T
dc.date.accessioned	2023-10-12T15:30:09Z
dc.date.available	2023-10-12T15:30:09Z
dc.date.issued	2023
dc.identifier.uri	https://hdl.handle.net/20.500.12866/14301
dc.description.abstract	Background: Household air pollution (HAP) is a widespread environmental exposure in low- andmiddle-income countries and may lead to stunted growth in children. We evaluated whether aliquefied petroleum gas (LPG) intervention to mitigate HAP lowered the risk of childhood stunting.Methods: We conducted a randomized controlled trial in four resource-poor settings of Guatemala,India, Peru, and Rwanda where biomass fuels are used as the primary source of energy forcooking. Stunting (length-for-age Z-score two standard deviations below the median of standardpopulation) at age 12 months was one of four primary outcomes. We randomized pregnant womenaged 18-34 years at 9-19 weeks gestation confirmed by ultrasound. Intervention participantsreceived a LPG stove, continuous free fuel delivery and regular behavioral reinforcements for 18months. Controls continued usual cooking practices. We assessed children for linear growth at 12months and monitored personal exposures to PM2.5 and carbon monoxide starting at pregnancythrough the first year of life. We conducted an intention-to-treat analysis adjusted for randomizationstrata to estimate the relative risk (RR) of stunting and the difference in length-for-age Z-score at 12months for intervention children when compared to controls. Given that the trial has four primaryoutcomes, the threshold for statistical significance was set at 0.0125 and thus we present a 98.75%CI for the primary stunting outcome to control the familywise Type I error rate at 0.05. The study wasconducted between May 2018 and September 2021. Results: We randomized 3200 pregnantwomen, and 3061 (96%) children were born alive. Of these, 1171 (76%) and 1186 (78%) had alength measurement at age 12 months, and 320 (27%) and 300 (25%) were stunted in theintervention and control arms, respectively. The COVID-19 pandemic did not affect delivery of theintervention, but some length measurements were missed. Children in the intervention arm had asimilar risk of stunting (RR=1.10, 95% familywise CI 0.97 to 1.24; p=0.15) and similar mean length-for-age Z-score (difference= -0.03 Z-scores, 95% CI -0.11 to 0.05; p=0.45) at age 12 months whencompared to controls. Conclusions: An intervention strategy aimed at mitigating HAP from mid-pregnancy through infancy did not reduce the risk of childhood stunting at one year of age.	en_US
dc.language.iso	eng
dc.publisher	American Thoracic Society
dc.relation.ispartofseries	American Journal of Respiratory and Critical Care Medicine
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Liquefied Petroleum Gas	en_US
dc.subject	Continuous Fuel Delivery	en_US
dc.subject	Behavioral Messaging	en_US
dc.subject	Children	en_US
dc.subject	Household Air Pollution	en_US
dc.subject.mesh	Industria del Petróleo y Gas
dc.subject.mesh	Aceites Combustibles
dc.subject.mesh	Niños
dc.subject.mesh	Contaminación del Aire
dc.title	Effects of a Liquefied Petroleum Gas, Continuous Fuel Delivery and Behavioral Messaging Intervention on Linear Growth in Children With Exposure to Household Air Pollution: A Multi-country Randomized Controlled Trial	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A2786
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.07
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.08
dc.relation.issn	1535-4970