Abstract

Background:

Exposure to ${\mathrm{PM}}_{2.5}$ arising from solid fuel combustion is estimated to result in $\sim 2.3$ million premature deaths and 91 million lost disability-adjusted life years annually. Interventions attempting to mitigate this burden have had limited success in reducing exposures to levels thought to provide substantive health benefits.

Objectives:

This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial.

Methods:

The HAPIN trial included 3,195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. Twenty-four-hour exposures to ${\mathrm{PM}}_{2.5}$, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control ($n=\mathrm{1,605}$) and LPG ($n=\mathrm{1,590}$) arms and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels.

Results:

Median postrandomization exposures of particulate matter (PM) with aerodynamic diameter $\le 2.5\mathrm{\mu }\mathrm{m}$ (${\mathrm{PM}}_{2.5}$) in the intervention arm were lower by 66% at the first (71.5 vs. $24.1{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$), and second follow-up visits (69.5 vs. $23.7{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$) compared to controls. BC exposures were lower in the intervention arm by 72% (9.7 vs. $2.7{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$) and 70% (9.6 vs. $2.8{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$) at the first and second follow-up visits, respectively, and carbon monoxide exposure was 82% lower at both visits (1.1 vs. $0.2\text{\hspace{0.17em}ppm}$) in comparison with controls. Exposure reductions were consistent over time and were similar across research locations.

Discussion:

Postintervention ${\mathrm{PM}}_{2.5}$ exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of ${\mathrm{PM}}_{2.5}$ samples falling below the World Health Organization Annual Interim Target 1 of $35{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$. This study indicates that an LPG intervention can reduce ${\mathrm{PM}}_{2.5}$ exposures to levels at or below WHO targets. https://doi.org/10.1289/EHP10295

中文翻译：

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孕妇家庭空气污染干预网络随机对照试验期间的暴露对比

摘要

背景：

接触${\mathrm{下午}}_{2.5}$固体燃料燃烧产生的估计会导致$～2.3$每年有 100 万人过早死亡，损失 9100 万人的伤残调整生命年。试图减轻这一负担的干预措施在将暴露水平降低到被认为能提供实质性健康益处的水平方面收效有限。

目标：

本文报告了家庭空气污染干预网络 (HAPIN) 随机对照试验中怀孕母亲通过液化石油气 (LPG) 炉和燃料干预所实现的接触减少。

方法：

HAPIN 试验包括危地马拉、印度、秘鲁和卢旺达的 3,195 个主要使用生物质烹饪的家庭。二十四小时暴露于${\mathrm{下午}}_{2.5}$、一氧化碳 (CO) 和黑碳 (BC) 在随机分配到对照组之前对孕妇进行一次测量（$n=\mathrm{1,605}$）和液化石油气（$n=\mathrm{1,590\; 人}$）手臂，此后两次（与三个月一致）。通过直接比较干预组和对照组之间的暴露并使用线性混合效应模型来估计干预对暴露水平的影响来估计暴露的变化。

结果：

具有空气动力学直径的颗粒物 (PM) 随机化后暴露中值$\le 2.5\mathrm{\mu }\mathrm{米}$（${\mathrm{下午}}_{2.5}$）在第一个干预组中降低了 66%（71.5 vs.$24.1{\mathrm{\mu }\mathrm{G}/\mathrm{米}}^3$）和第二次随访（69.5 vs.$23.7{\mathrm{\mu }\mathrm{G}/\mathrm{米}}^3$）与对照相比。干预组的 BC 暴露量降低了 72%（9.7 vs.$2.7{\mathrm{\mu }\mathrm{G}/\mathrm{米}}^3$）和 70%（9.6 对比$2.8{\mathrm{\mu }\mathrm{G}/\mathrm{米}}^3$）在第一次和第二次随访时分别减少了 82%（1.1 vs 1.1）。$0.2\text{\hspace{0.17em}百万分之一}$）与对照相比。随着时间的推移，暴露量的减少是一致的，并且各个研究地点的暴露量减少情况相似。

讨论：

干预后${\mathrm{下午}}_{2.5}$干预组中的暴露量处于已报告的液化石油气和其他清洁燃料干预措施的较低水平，其中 69%${\mathrm{下午}}_{2.5}$低于世界卫生组织年度中期目标 1 的样本$35{\mathrm{\mu }\mathrm{G}/\mathrm{米}}^3$。这项研究表明液化石油气干预可以减少${\mathrm{下午}}_{2.5}$暴露水平等于或低于世界卫生组织目标。https://doi.org/10.1289/EHP10295