This study is a randomized controlled trial of liquefied petroleum gas (LPG) stove and fuel distribution in 3,200 households in four countries (India, Guatemala, Peru, and Rwanda). Following a common protocol, each intervention site will recruit 800 pregnant women (aged 18-34 years, 9 - \<20 weeks gestation), and will randomly assign half their households to receive LPG stoves and an 18-month supply of LPG. Control households are anticipated to continue to cook primarily with solid biomass fuels, and will receive compensation based on a uniform set of trial-wide principles, customized to each site based on formative research. The mother will be followed along with her child until the child is 1 year old. The researchers estimate that 15% of households will have a second, non-pregnant older adult woman (aged 40 to \<80 years) who will also be enrolled at baseline and followed during the 18-month follow-up period. To optimize intervention use, the researchers will implement behavior change strategies informed by previous experiences and formative research in Year 1. This study will assess cookstove use, conduct repeated personal exposure assessments of household air pollution, and collect dried blood spots and urinary samples for biomarker analysis and biospecimen storage. The primary outcomes are low birth weight, severe pneumonia incidence, and stunting of the child, and systolic blood pressure in the older adult woman. Participants in India, Guatemala and Rwanda will be followed until the child is 5 years old to assess the longer-term effects of the intervention.
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Birth weight
Timeframe: Within 24 hours of birth (up to 5 months post-randomization of mother)
Incidence of HAPIN Defined Severe Pneumonia
Timeframe: Up to 12 months after birth
Length-for-age z-score 2 standard deviations below the standard
Timeframe: 12 months after birth
Change in Systolic Blood Pressure
Timeframe: Baseline, 3, 5, 9, 12, and 18 months post-randomization (24, 36, 48, and 60 months of age)
Change in Child Linear Growth
Timeframe: Birth (3-5 months post-randomization), and 3, 6, 9, 12, 24, 36, 48 and 60 months of age
Change in Caregiver Reported Early Childhood Development Instrument (CREDI) Score
Timeframe: 3 months of age to 24 months of age
Change in Malawi Developmental Assessment Tool (MDAT) Score
Timeframe: 36, 48 and 60 months of age