Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution

Abstract

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low-and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2:5 lm (PM 2:5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations.

Effectiveness of Gas and Chimney Biomass Stoves for Reducing Household Air Pollution Pregnancy Exposure in Guatemala: Sociodemographic Effect Modifiers

“…Pregnancy might change cooking behaviors and time spent in the kitchen over the course of the pregnancy as other household members assume cooking roles [10]; therefore, exposure in non-pregnant women might generalize to pregnant women. However, only a few studies of personal exposure to PM 2.5 during pregnancy have collected or are planned to collect repeated measures to estimate typical exposures [11][12][13][14].…”

An Integrated Sensor Data Logging, Survey, and Analytics Platform for Field Research and Its Application in HAPIN, a Multi-Center Household Energy Intervention Trial

“…The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing randomized controlled trial (RCT) enrolling 3200 households in Guatemala, India, Peru, and Rwanda. HAPIN is evaluating the impact of cooking with liquefied petroleum gas (LPG) versus traditional biomass-fueled stoves on birth outcomes in pregnant women, pneumonia and stunting in infants, and blood pressure in older adult women [19]. Mixed use of traditional and clean cooking fuels is common in household air pollution intervention studies [8,9,15,20].…”

“…Finally, HAPIN uses a modified version of FireFinder to create summary data by household on the frequency and duration of traditional stove use. These data will be used in statistical models to estimate the influence of stove usage on exposure to household air pollutants, among other analyses [19].…”

Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

“…[38][39][40][41] We sought to overcome these barriers within the Household Air Pollution Intervention Network (HAPIN) trial. 42 The HAPIN trial aims to measure the effect of an LPG cooking intervention on HAP and health among study populations in Guatemala, India, Peru and Rwanda. Using a randomised controlled design, HAPIN will enrol 800 pregnant women (9 to <20 weeks gestational age) and up to 200 older adult women residing in the same homes in each country.…”