Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial

Area of Science:

• Environmental Health
• Global Health
• Public Health Interventions

Background:

• Household air pollution (HAP) poses a significant global health risk, particularly in developing nations.
• Validated interventions to mitigate HAP exposure and its associated health impacts are urgently needed.
• The Ghana Randomized Air Pollution and Health Study (GRAPHS) addresses this gap by evaluating clean fuel interventions.

Purpose of the Study:

• To evaluate the efficacy of clean fuels, specifically liquefied petroleum gas (LPG) and efficient biomass cookstoves, in reducing adverse health outcomes.
• To assess the impact of these interventions on infant birth weight and the incidence of severe pneumonia in the first year of life.
• To conduct exposure-response analyses using extensive personal air pollution monitoring data.

Main Methods:

• A cluster-randomized trial design was employed in the Brong-Ahafo region of central Ghana.
• Pregnant women in their first or second trimester, who were primary cooks and non-smokers, were recruited into LPG, efficient cookstove, or control arms.
• Key outcomes tracked included infant birth weight and physician-assessed severe pneumonia incidence.

Main Results:

• Hypothesized improvements in birth weight and reductions in severe pneumonia incidence among infants born to mothers in intervention groups.
• Intention-to-treat analyses will be presented alongside detailed exposure-response findings.
• The study provides robust data on the health benefits of clean fuel interventions.

Conclusions:

• Household air pollution is a major health risk necessitating effective, evidence-based interventions.
• GRAPHS will generate crucial evidence on the effectiveness of efficient biomass cookstoves and LPG.
• Findings will inform public health and energy policies in developing countries to reduce HAP-related morbidity and mortality.