NACER II: Reducing Prenatal Exposures to Household Air Pollution in Rural Guatemala Through a Gas Stove/Behavior Intervention to Improve Neonatal Health

University of California, San Francisco50 enrolled

Overview

Greater efforts are needed to bring affordable, clean stoves and adaptive behavioral strategies to the millions of households worldwide that continue to burn solid cooking fuels using inefficient stoves. Two of the leading causes of infant mortality, preterm birth and pneumonia, are associated with high exposures to household air pollution during pregnancy and early infancy. The proposed study will assess the feasibility and acceptability of an introduced liquid petroleum gas stove, complemented by two alternative approaches to delivering tailored behavioral change interventions, among pregnant women and their neonates.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

Conditions

Premature Birth Fetal Growth Retardation Infections, Respiratory Exposure to Environmental Pollution, Non-occupational

Interventions

Low-cost gas stoveOTHER

Women will be provided with a 3-burner liquid propane gas stove and one year's supply of gas

Peer education classesBEHAVIORAL

Women will participate in four classes on how to safely use gas stoves and methods to reduce exposure to air pollution

Resource-intensive behavioral intervention approachBEHAVIORAL

Women will participate in four classes on how to safely use gas stoves and methods to reduce exposure to air pollution. Additionally, peer educators will visit each home after group classes to help the woman, and key decision-makers in her family, identify top priority strategies to reduce air pollution. Using a checklist, peer educators will observe whether household members are adhering to tailored strategies at subsequent home visits, and provide ongoing support to women and their families.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Pregnant woman less than 20 weeks gestation * Does not smoke cigarettes * Uses an open fire or deteriorated woodstove for cooking * Purchases wood * Intends to stay in the study area for at least one year * Uses Ministry of Health clinics for routine prenatal care * Has a mobile phone * Primary person responsible for cooking in the household * Able to give Informed Consent Exclusion Criteria: * Multiple pregnancy (eg twins) * Identified as a high-risk pregnancy by physician * Regularly taking prescription medication * Smokes cigarettes * Routinely carries a child less than 2 years old on their back

Outcomes

Primary Outcomes

Change in urinary polycyclic aromatic hydrocarbon (PAH) and volatile organic compound (VOC) metabolite concentrations

Time frame: 1) <20 weeks gestation; 2) 28-32 weeks gestation

Change in 48-hour mean personal carbon monoxide exposure

Time frame: 1) <20 weeks gestation; 2) 28-32 weeks gestation; 3) Following participation in each behavior change intervention class at 18-24 weeks, 22-28 weeks, and 26-32 weeks gestation; 4) Neonatal after 48 hours, 2 & 4 weeks of life

Change in 48-hour mean kitchen particulate matter concentration

Change in 48-hour mean personal particulate matter exposure

Change in weekly use of gas stoves (cooking events and total cooking time) using temperature loggers

Time frame: Every month from recruitment to neonatal one month of life (up to 9 months)

Secondary Outcomes

Preterm birth

Time frame: At time of birth (within 48 hours)

Low birth weight