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The Ghana Randomized Air Pollution and Health Study (GRAPHS)


Household air pollution exposure resulting from cooking with biomass fuels is a major public health burden.  Since 2007, I have collaborated with the Kintampo Health Research Centre in Ghana to develop new evidence on this exposure and its health ramifications. After several years of formative work, in 2014 we launched enrollment for the Ghana Randomized Air Pollution and Health Study (GRAPHS).  GRAPHS tested whether providing pregnant women liquefied petroleum gas (LPG) cookstoves or improved biomass cookstoves would reduce household air pollution exposure, increase birth weight and reduce physician-assessed severe pneumonia in the first 12 months of life, compared with control participants who continued to cook with traditional stoves. Thanks to strong ongoing collaboration with KHRC, with Dr. Steve Chillrud at LDEO, and with Dr. Alison Lee at Mount Sinai School of Medicine, the GRAPHS cohort is still under active followup, with ongoing data collection to assess the long-term implications of early life exposure reduction for respiratory and cardiovascular health. See publications.

summary of key findings:
  1. Null intention to treat results for registered RCT outcomes (birthweight and severe pneumonia)
  2. Exposure response relationship for birthweight and pneumonia and for lung function at age 1 month 
  3. The LPG stove intervention improved: 
  • growth trajectories through age 1 (PMID: 34842444
  • small airway function at age 4 (PMID: 38016085
  • blood pressure at age 4 – 8 (PMID: 38506828; 41038435
  • maternal BP at 4-8 years postpartum (PMID: 41120010
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