• Energy Research

More than 75% of the population in Ghana relies on biomass fuels for cooking and heating. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality. HAP is a modifiable risk factor in the global burden of disease, exposure to which can be reduced.This study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana.We analyzed current respiratory health symptoms and CO exposures upon enrollment in a subset (n = 840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPHS randomized clinical control trial. Personal CO was measured using Lascar continuous monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models.There was a positive association between CO exposure per 1 ppm increase and a composite respiratory symptom score of current cough (lasting >5 days), wheeze and/or dyspnea (OR: 1.2, p = 0.03). CO was also positively associated with wheeze (OR: 1.3, p = 0.05), phlegm (OR: 1.2, p = 0.08) and reported clinic visit for respiratory infection in past 4 weeks (OR: 1.2, p = 0.09). Multivariate models showed significant associations between second-hand tobacco smoke and a composite outcome (OR: 2.1, p 5 days (OR: 3.1, p = 0.01), wheeze (OR: 2.7, p < 0.01) and dyspnea (OR: 2.2, p = 0.01). Other covariates found to be significantly associated with respiratory outcomes include involvement in charcoal production business and dyspnea, and involvement in burning grass/field and wheeze. Results suggest that exposure to HAP increases the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.

L'exposition à la pollution de l'air domestique est un risque majeur pour la santé, mais les interventions validées restent insaisissables. L'étude randomisée sur la pollution de l'air et la santé au Ghana (GRAPHS) est un essai randomisé en grappes qui évalue l'efficacité des combustibles propres (gaz de pétrole liquéfié ou GPL) et des poêles à biomasse efficaces dans la région de Brong-Ahafo au centre du Ghana. Nous recrutons des femmes enceintes pour le GPL, une cuisinière efficace et des bras de contrôle et suivons le poids à la naissance et l'incidence de la pneumonie sévère évaluée par le médecin au cours de la première année de vie. Une femme est admissible à participer si elle est au premier ou au deuxième trimestre de la grossesse et porte un fœtus vivant, si elle est la cuisinière principale et si elle ne fume pas. Nous émettons l'hypothèse que les bébés nés de mères d'intervention pèseront plus et auront moins de cas de pneumonie sévère évalués par un médecin au cours de la première année de vie. De plus, un vaste effort personnel de surveillance de l'exposition à la pollution de l'air ouvre la voie à des analyses exposition-réponse, que nous présenterons aux côtés des analyses en intention de traiter. Un financement important a été fourni par l'Institut national des sciences de la santé environnementale, le Thrasher Research Fund et la Global Alliance for Clean Cookstoves. L'exposition à la pollution de l'air des ménages est un risque majeur pour la santé qui nécessite des interventions bien testées. LES GRAPHIQUES fourniront de nouvelles preuves importantes sur l'efficacité des poêles à biomasse efficaces et du GPL, et aideront ainsi à éclairer les politiques de santé et d'énergie dans les pays en développement. L'essai a été enregistré auprès de clinicaltrials.gov le 13 avril 2011 sous l'identifiant NCT01335490 . La exposición a la contaminación del aire en los hogares es un riesgo importante para la salud, pero las intervenciones validadas siguen siendo difíciles de alcanzar. El Ghana Randomized Air Pollution and Health Study (GRAPHS) es un ensayo aleatorizado por grupos que evalúa la eficacia de los combustibles limpios (gas licuado de petróleo o GLP) y las estufas de biomasa eficientes en la región de Brong-Ahafo, en el centro de Ghana. Reclutamos a mujeres embarazadas en GLP, estufas eficientes y brazos de control y rastreamos el peso al nacer y la incidencia de neumonía grave evaluada por el médico en el primer año de vida. Una mujer es elegible para participar si está en el primer o segundo trimestre del embarazo y lleva un feto único vivo, si es la cocinera principal y si no fuma. Presumimos que los bebés nacidos de madres de intervención pesarán más y tendrán menos casos de neumonía grave evaluada por el médico en el primer año de vida. Además, un extenso esfuerzo personal de monitoreo de la exposición a la contaminación del aire abre el camino para los análisis de exposición-respuesta, que presentaremos junto con los análisis de intención de tratar. El Instituto Nacional de Ciencias de la Salud Ambiental, el Fondo de Investigación Thrasher y la Alianza Mundial para Estufas Limpias proporcionaron fondos importantes. La exposición a la contaminación del aire en el hogar es un riesgo importante para la salud que requiere intervenciones bien probadas. LOS GRÁFICOS proporcionarán nuevas pruebas importantes sobre la eficacia tanto de las estufas de biomasa eficientes como del GLP y, por lo tanto, ayudarán a informar las políticas de salud y energía en los países en desarrollo. El ensayo se registró en clinicaltrials.gov el 13 de abril de 2011 con el identificador NCT01335490 . Household air pollution exposure is a major health risk, but validated interventions remain elusive.The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves.Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries.The trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 . يمثل التعرض لتلوث الهواء المنزلي خطرًا صحيًا كبيرًا، لكن التدخلات التي تم التحقق منها لا تزال بعيدة المنال. دراسة تلوث الهواء والصحة العشوائية في غانا (الرسوم البيانية) هي تجربة عشوائية عنقودية تقيم فعالية الوقود النظيف (غاز البترول المسال) ومواقد الطهي ذات الكتلة الحيوية الفعالة في منطقة برونغ أهافو في وسط غانا. نقوم بتجنيد النساء الحوامل في غاز البترول المسال، وموقد الطهي الفعال، والتحكم في الأذرع وتتبع الوزن عند الولادة وحدوث الالتهاب الرئوي الحاد الذي يقدره الطبيب في السنة الأولى من العمر. يحق للمرأة المشاركة إذا كانت في الثلث الأول أو الثاني من الحمل وتحمل جنينًا فرديًا حيًا، وإذا كانت هي الطاهية الرئيسية، وإذا كانت لا تدخن. نحن نفترض أن الأطفال المولودين لأمهات التدخل سيكون وزنهم أكثر وسيصابون بعدد أقل من حالات الالتهاب الرئوي الحاد التي يقيمها الطبيب في السنة الأولى من الحياة. بالإضافة إلى ذلك، فإن جهد مراقبة التعرض الشخصي المكثف لتلوث الهواء يفتح الطريق أمام تحليلات التعرض والاستجابة، والتي سنقدمها جنبًا إلى جنب مع تحليلات نية العلاج. تم توفير تمويل كبير من قبل المعهد الوطني لعلوم الصحة البيئية، وصندوق ثراشر للبحوث، والتحالف العالمي لمواقد الطهي النظيفة. يعد التعرض لتلوث الهواء المنزلي خطرًا صحيًا كبيرًا يتطلب تدخلات تم اختبارها جيدًا. ستوفر الرسوم البيانية أدلة جديدة مهمة على فعالية كل من مواقد الطهي ذات الكتلة الحيوية الفعالة وغاز البترول المسال، وبالتالي ستساعد في إثراء سياسات الصحة والطاقة في البلدان النامية. تم تسجيل التجربة لدى clinicaltrials.gov في 13 أبريل 2011 بالمعرف NCT01335490 .

Pneumonia, a leading cause of childhood mortality, is associated with household air pollution (HAP) exposure. Mechanisms between HAP and pneumonia are poorly understood, but studies suggest that HAP may increase the likelihood of bacterial, instead of viral, pneumonia. We assessed the relationship between HAP and infant microbial nasal carriage among 260 infants participating in the Ghana Randomized Air Pollution and Health Study (GRAPHS).Data are from GRAPHS, a cluster-randomized controlled trial of cookstove interventions (improved biomass or LPG) versus the 3-stone (baseline) cookstove. Infants were surveyed for pneumonia during the first year of life and had routine personal exposure assessments. Nasopharyngeal swabs collected from pneumonia cases (n = 130) and healthy controls (n = 130) were analyzed for presence of 22 common respiratory microbes by MassTag polymerase chain reaction. Data analyses included intention-to-treat (ITT) comparisons of microbial species presence by study arm, and exposure-response relationships.In ITT analyses, 3-stone arm participants had a higher mean number of microbial species than the LPG (LPG: 2.71, 3-stone: 3.34, p < 0.0001, n = 260). This difference was driven by increased bacterial (p < 0.0001) rather than viral species presence (non-significant). Results were pronounced in pneumonia cases and attenuated in healthy controls. Higher prevalence bacterial species were Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Exposure-response relationships did not yield significant associations between measured CO and nasal microbial carriage.Our intention-to-treat findings are consistent with a link between HAP and bacterial nasal carriage. No relationships were found for viral carriage. Given the null results in exposure-response analysis, it is likely that a pollutant besides CO is driving these differences.

Background Repeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana. Methods Participants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring. Results ABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of −2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria. Conclusions We demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions.

Household air pollution (HAP) is a leading cause of morbidity and mortality worldwide. To limit HAP exposure and environmental degradation from biomass fuel use, the Government of Ghana promotes liquefied petroleum gas (LPG) use in rural Ghana via the Rural LPG program (RLP). We assessed the experiences of the RLP in 2015, 2 years after its launch. A mixed methods approach was used involving Focus Group Discussions (19) and in-depth interviews (25). In addition, a survey questionnaire was administered to elicit socio-demographic characteristics, household cooking practices and stove use patterns of 200 randomly selected respondents. At about 9 months after LPG acquisition, < 5% of LPG beneficiaries used their stoves. Some of the reasons ascribed to the low usage of the LPG cookstoves were financial constraints, distance to LPG filling point and fear of burns. Community members appreciate the convenience of using LPG. Our results underscore a need for innovative funding mechanisms contextualized within an overall economic empowerment of rural folks to encourage sustained LPG use. It emphasizes the need for innovative accessibility interventions. This could include establishing new LPG filling stations in RLP beneficiary districts to overcome the barriers to sustained LPG use.