Abstract
Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.
Abstract
We describe a facility-based surveillance strategy to determine the incidence of pneumonia in children less than 1 year of age across study settings in Guatemala, India, Peru and Rwanda http://bit.ly/31RjDQy
Footnotes
This study is registered at www.clinicaltrials.gov with identifier number NCT02944682. Sharing of data generated by this project is an essential part of the proposed research and will be accomplished by a variety of means, including presentations at local, national and international scientific meetings, workshops and conferences; publications in peer-reviewed scientific journals; and sharing of final research data. As outlined in the body of the proposal, any presentation or publication arising from the study will have an associated analytic data set consisting of all data values and accompanying documentation. Our plan allows sharing of these data sets among the investigators involved in the project as well as with other interested investigators and members of the general public.
Conflict of interest: S.M. Simkovich has nothing to disclose.
Conflict of interest: L.J. Underhill has nothing to disclose.
Conflict of interest: M.A. Kirby has nothing to disclose.
Conflict of interest: D. Goodman has nothing to disclose.
Conflict of interest: M.E. Crocker has nothing to disclose.
Conflict of interest: S. Hossen has nothing to disclose.
Conflict of interest: J.P. McCracken has nothing to disclose.
Conflict of interest: O. de León has nothing to disclose.
Conflict of interest: L.M. Thompson has nothing to disclose.
Conflict of interest: S.S. Garg has nothing to disclose.
Conflict of interest: K. Balakrishnan has nothing to disclose.
Conflict of interest: G. Thangavel has nothing to disclose.
Conflict of interest: G. Rosa has nothing to disclose.
Conflict of interest: J.L. Peel has nothing to disclose.
Conflict of interest: T. Clasen has nothing to disclose.
Conflict of interest: E.D. McCollum has nothing to disclose.
Conflict of interest: W. Checkley has nothing to disclose.
Support statement: This study is funded by the US National Institutes of Health (NIH) (cooperative agreement UM1HL134590) in collaboration with the Bill & Melinda Gates Foundation (OPP1131279). Participating NIH organisations include the National Heart, Lung and Blood Institute (NHLBI), National Institute of Environmental Health Sciences (NIEHS), National Cancer Institute, National Institute of Child Health and Human Development, Fogarty International Center, and the NIH Common Fund. S.M. Simkovich was supported by the National Heart, Lung, And Blood Institute of the NIH under Award Numbers T32HL007534 and F32HL143909, and the Lietman Fellowship award of the Bloomberg School of Public Health, Johns Hopkins University. L.J. Underhill was supported by NIH Research Training Grant number D43 TW009340 funded by the NIH Fogarty International Center, National Institute of Neurological Disorders and Stroke, National Institute of Mental Health, NHLBI and NIEHS. Sponsors participated in weekly conference calls, made recommendations about study design and participated in final decision-making of the study protocol; however, they had no role in the writing of this report or decision to submit it for publication. The corresponding authors share final responsibility for the decision to submit for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
HAPIN Investigators: Vigneswari Aravindalochanan, Kalpana Balakrishnan, Dana Boyd Barr, Vanessa Burrowes, Devan Campbell, Eduardo Canuz, Adly Castañaza, Howard Chang, William Checkley, Yunyun Chen, Marilú Chiang, Maggie L. Clark, Thomas Clasen, Rachel Craik, Mary Crocker, Victor Davila-Roman, Lisa de las Fuentes, Oscar De León, Anaité Diaz-Artiga, Ephrem Dusabimana, Lisa Elon, Juan Gabriel Espinoza, Irma Sayury Pineda Fuentes, Sarada Garg, Dina Goodman, Savannah Gupton, Meghan Hardison, Stella Hartinger, Steven A. Harvey, Mayari Hengstermann, Phabiola Herrera, Shakir Hossen, Penelope Howards, Lindsay Jaacks, Shirin Jabbarzadeh, Michael A. Johnson, Abigail Jones, Katherine Kearns, Miles Kirby, Jacob Kremer, Margaret Laws, Jiawen Liao, Amy E. Lovvorn, Fiona Majorin, Eric D. McCollum, John McCracken, Julia N. McPeek, Rachel Meyers, J. Jaime Miranda, Erick Mollinedo, Lawrence Moulton, Krishnendu Mukhopadhyay, Luke Naeher, Abidan Nambajimana, Florien Ndagijimana, Azhar Nizam, Jean de Dieu Ntivuguruzwa, Aris Papageorghiou, Jennifer Peel, Ricardo Piedrahita, Ajay Pillarisetti, Naveen Puttaswamy, Elisa Puzzolo, Ashlinn K. Quinn, Sarah Rajkumar, Usha Ramakrishnan, Davis Reardon, Ghislaine Rosa, Joshua Rosenthal, P. Barry Ryan, Zoe Sakas, Sankar Sambandam, Jeremy Sarnat, Suzanne Simkovich, Sheela S. Sinharoy, Kirk R. Smith, Kyle Steenland, Damien Swearing, Gurusamy Thangavel, Lisa M. Thompson, Ashley Toenjes, Lindsay Underhill, Jean Damascene Uwizeyimana, Viviane Valdes, Amit Verma, Lance Waller, Megan Warnock, Kendra Williams, Wenlu Ye and Bonnie Young.
- Received November 6, 2019.
- Accepted February 6, 2020.
- Copyright ©ERS 2020
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