Reduced exposure to household air pollution from cooking compared with traditional cooking on perinatal mortality: the Poriborton clusterRCT. — The Association Specialists
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  3. Reduced exposure to household air pollution from cooking compared with traditional cooking on perinatal mortality: the Poriborton clusterRCT.

Reduced exposure to household air pollution from cooking compared with traditional cooking on perinatal mortality: the Poriborton clusterRCT. (24030)

Camille Raynes-Greenow 1 , Sk Masum Billah 1 , Jonathan Thornburg 2 , Sajia Islam 3 , SM Rokonuzzaman 3 , Neeloy Alam 1 , Michelle McCombs 2 , Kingsley Agho 4 , Shams El Aifreen 3 , Michael Dibley 1
  1. Unversity of Sydney, Sydney, NSW, Australia
  2. RTI International , Research Triangle Park, North Carolina, USA
  3. Icddr,b, Dhaka, Bangladesh
  4. Western Sydney University , Campbelltown, NSW, Australia

Background

Household air pollution from unclean fuel is a major contributor to adverse perinatal outcomes globally. Evidence from randomised trials assessing whether cleaner cooking fuels reduce perinatal mortality remains inconclusive. We aimed to determine whether provision of liquefied petroleum gas (LPG) for cooking during pregnancy reduces perinatal mortality (PM) in a rural Bangladeshi setting with high reliance on biomass fuels.

 

Methods

We conducted a community‑based, two‑arm parallel cluster randomised controlled trial in Sherpur , Bangladesh. Pregnant women aged 15–49 years, 40–120 days’ gestation, permanent residents, and planning to give birth within their cluster were eligible. Clusters were randomised to receive an LPG stove with free fuel from enrolment until birth, or to continue usual cooking . The primary outcome was PM. Secondary outcomes included early neonatal mortality, neonatal mortality, and exposure to PM2.5. Analyses were conducted at the individual level using intention‑to‑treat.

Results

4,944 women were recruited (2,472 per group); final birth outcomes were available for 4,592 participants. The perinatal mortality rate was 50 per 1,000 births in the intervention compared with 61 per 1,000 in the control group (relative risk [RR] 0.83; 95% CI 0.65–1.06). Early neonatal mortality was lower in the intervention (22%) than in controls (30%) (RR 0.73; 95% CI 0.50–1.05). Mean PM2.5 exposure was significantly lower in intervention participants. In subgroup analysis, PM was significantly lower in smaller vs larger households (adjusted RR 0.75; 95% CI 0.56–1.00).

Conclusion

Provision of LPG during pregnancy resulted in reductions in exposure and a non‑significant reduction in perinatal mortality overall. Benefits were more evident in smaller households, suggesting that fuel security may be critical to achieving mortality reductions. These findings have important implications for energy transition to improve perinatal survival.