The Poriborton : Change trial: Household Air Pollution and Perinatal and early Neonatal mortality.

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Globally, household air pollution (HAP) is the 3rd leading health risk for mortality, and the most important global environmental health risk (1). The South Asian burden is acute, and it is their most considered health risk (1). The global mortality attributable to HAP is 4.3 million deaths or 7.7% of all deaths (1). Approximately, 3 billion people depend on biomass fuels (e.g. wood, dung, crop waste), and this combined with incomplete combustion using inefficient stoves, in poorly ventilated areas, over long hours of cooking and heating, causes the exposure with women and children bearing the greatest burden, and being particularly vulnerable (2, 3). The impact on pregnancy is unknown. The epidemiological evidence is suggestive of an association, however, there is a paucity of good quality prospective data (4). Perinatal mortality (defined as stillbirth less than 28 weeks and early neonatal death up to and equal to 7 days after birth) is recognized as a major global health disease burden. The global burden of Stillbirth is high with ~2.6 million stillbirths per year (5), and stillbirth estimates in Bangladesh are high at 35 per 1000, and are worse in rural areas (6,7), where there is universal reliance on polluting usual stoves (8,9). We propose to conduct a community based cluster randomized trial to explore the effectiveness and cost effectiveness of cleaner cooking (LPG and ICS) in preventing adverse perinatal outcomes. This trial is needed as it will address several important gaps of the impact of HAP and the impact on pregnancy outcomes. REFERENCES 1. Lim, S.S.etal., A comparative risk assessment of burden of disease …a systematic analysis for the Global Burden of Disease Study 2010.Lancet, 2012. 380(9859): p. 2224-60. 2. Fullerton, D.G.etal., Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Royal Society of Trop Med Hyg, 2008. 102(9): p. 843. 3. WHO, Indoor Air Poll from Solid Fuels and risk of low birth weight and stillbirth. 2005. 4. Tielsch, J.M.etal., Exposure to indoor biomass fuel and tobacco smoke and risk of adverse reproductive outcomes, International Journal of Epidemiology, 2009. 38(5): p. 1351-1363. 5. Rehfuess, E., Fuel for life - household energy and health.World Health Organization, 2006. 6.United Nations., The Millennium Development Goals Report. 2014: New York. 7. Lawn, J.E. Stillbirths: rates, risk factors, and accelerating towards 2030. Lancet, 2016. 387: 587. 8. UNICEF., Levels and Trends in Child Mortality. 2014, UNICEF. 9. Lawn, J.E.etal., 4 million neo… deaths:When? Where? Why? Lancet, 2005. 365(9462): 891.