Researchers conducted a randomized controlled trial with 3200 pregnant women aged 18 to 34 in four low- and middle-income countries. Women at 9 to less than 20 weeks gestation were randomly assigned to either the intervention group, using a free LPG cookstove with continuous fuel delivery for 18 months, or the control group, continuing with a biomass cookstove. Infant lengths were measured at 12 months, and personal exposures to fine particulate matter were tracked from pregnancy to the infants' first year. The primary outcome presented here is stunting at 12 months, defined as a length-for-age z score more than two standard deviations below the growth standard median. Intention-to-treat analyses were conducted to estimate the relative risk of stunting.
Findings:
- Compliance with the intervention was notable, leading to reduced prenatal and postnatal 24-hour personal exposure to fine particulate matter compared to the control group (average prenatal exposure: 35.0 μg per cubic meter vs. 103.3 μg per cubic meter; average postnatal exposure: 37.9 μg per cubic meter vs. 109.2 μg per cubic meter).
- Among 3061 live births, 76.2% of infants born to intervention group women and 77.8% to control group women had valid 12-month length measurements.
- Despite the success in reducing pollution exposure, the study's primary outcome, stunting at 12 months, did not show a significant difference between the two groups.
- Stunting occurred in 27.4% and 25.2% of infants in the intervention and control groups, respectively.
- The calculated relative risk of stunting was 1.10, with a confidence interval of 0.94 to 1.29, suggesting no statistically significant variance between the groups (P=0.12).
The results indicate that the well-executed intervention strategy, initiated during pregnancy to alleviate household air pollution, did not yield the anticipated reduction in the risk of stunting in infants. This finding prompts a deeper exploration of the intricate factors influencing child health and development in resource-constrained settings. The findings contribute to the ongoing discussion on the multifaceted factors influencing child health and development in low- and middle-income countries.
While the study contributes valuable insights into the complexities of addressing household air pollution's impact on child health, it underscores the need for comprehensive strategies that consider various determinants of infant growth. The study's implications extend beyond its immediate findings, sparking further discussions on the broader context of child health and well-being in low- and middle-income countries.
Further reading: Checkley W, Thompson LM, Sinharoy SS, et al. Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants.
N Engl J Med. 2024;390(1):44-54. doi:
10.1056/NEJMoa2302687
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