Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial

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.

Training physicians in India to interpret pediatric chest radiographs according to World Health Organization research methodology

“…A chest radiograph reading panel was established to support two research projects in India that aimed to evaluate pneumococcal conjugate vaccine effectiveness and estimate liquified petroleum gas efficacy against child pneumonia [ 18 , 19 ]. The revised WHO Chest Radiography in Epidemiological Studies definitions and training and support tools were adapted for a 3-day training in Agra, India, during May 2019.…”

A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic

“…Investigators in the Household Air Pollution Intervention Network (HAPIN) trial initially suspended data collection due to the pandemic and have since restarted collection of behavioural, environmental, biological and clinical measurements in the fth year of a ve-year, multi-country trial. [5][6][7][8] HAPIN is a randomized controlled trial in Guatemala, India, Peru, and Rwanda that is assessing the health bene ts of providing lique ed petroleum gas (LPG) stoves and an 18-month supply of free LPG to 3,200 households that otherwise depend on solid biomass fuel (wood, animal dung, or crop residue) for cooking.…”

“…Measurements of cooking behavior, personal and in-home exposure to air pollution, biological samples and clinical measurements are being collected longitudinally from pregnant women and their newborns in every household, along with an older adult woman, if present. [5][6][7][8] Our study involves home visits, as well as visits to health centers and hospitals during the woman's pregnancy and the rst year of the child's life.…”

Ultrasound Core Laboratory for the Household Air Pollution Intervention Network Trial: Standardized Training and Image Management for Field Studies Using Portable Ultrasound in Fetal, Lung, and Vascular Evaluations

“…Ultrasound lectures and laboratories included the topics outlined in Table 1 . Lectures were complemented daily by 4 h hands-on workshops that included both simulations and real-time imaging of healthy participants for performance of lung ultrasound, CIMT and BART and pregnant volunteers for fetal ultrasound based on previous experiences and research ( de Las Fuentes et al 2008 , 2009 ; Nguyen-Thanh and Benzaquen 2009 ; Painschab et al 2013 ; Papageorghiou et al 2014a , 2014b ; Reddy et al 2014 ; Ellington et al 2017 ; Lin et al 2017 ; Goodman et al 2019 ; McGill et al 2019 ; Minardi et al 2019 ; Simkovich et al 2020 ).…”