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, 16:420

First Online: 22 September 2015Received: 23 March 2015Accepted: 27 August 2015DOI: 10.1186-s13063-015-0930-8

Cite this article as: Jack, D.W., Asante, K.P., Wylie, B.J. et al. Trials 2015 16: 420. doi:10.1186-s13063-015-0930-8


BackgroundHousehold air pollution exposure is a major health risk, but validated interventions remain elusive.

Methods-DesignThe 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.

DiscussionHousehold 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.

Trial registrationThe trial was registered with on 13 April 2011 with the identifier NCT01335490.

KeywordsHousehold air pollution LPG Cookstove Ghana Pneumonia Birth weight AbbreviationsABPambulatory blood pressure

ALRIacute lower respiratory infections

COcarbon monoxide

DALYsdisability-adjusted life years

DSMBData and Safety Monitoring Board

GRAPHSGhana Randomized Air Pollution and Health Study

HAPhousehold air pollution

KHDSSKintampo Health and Demographic Surveillance System

KHRCKintampo Health Research Center

ITNinsecticide-treated net

LPGliquefied petroleum gas

ODOptimal design software

PAHspolyaromatic hydrocarbons

PCRpolymerase chain reaction

PM2.5particulate matter less than 2.5 microns in diameter fine particles

RRrelative risk

USBUniversal Bus

WHOWorld Health Organization

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Autor: Darby W. Jack - Kwaku Poku Asante - Blair J. Wylie - Steve N. Chillrud - Robin M. Whyatt - Kenneth A. Ae-Ngibise - Ash


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