title: Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Household air pollution exposure is a major health risk, but validated interventions remain elusive.
  
  
  METHODS
  The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves.
  
  
  CONCLUSIONS
  Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries.
  
  
  BACKGROUND
  The trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. dj2183@cumc.columbia.edu.
authors.forename: Darby W
authors.initials: DW
authors.lastname: Jack
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. kwakupoku.asante@kintampo-hrc.org.
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. BWYLIE@partners.org.
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Wylie
authors.affiliation: Lamont-Doherty Earth Observatory of Columbia University, New York, NY, USA. chilli@ldeo.columbia.edu.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Chillrud
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. rmw5@cumc.columbia.edu.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Whyatt
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. kenneth.asayah@kintampo-hrc.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ae-Ngibise
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. akq3@cumc.columbia.edu.
authors.forename: Ashlinn K
authors.initials: AK
authors.lastname: Quinn
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. abena.yawson@kintampo-hrc.org.
authors.forename: Abena Konadu
authors.initials: AK
authors.lastname: Yawson
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. ellen.boamah@kintampo-hrc.org.
authors.forename: Ellen Abrafi
authors.initials: EA
authors.lastname: Boamah
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. oscar.agyei@kintampo-hrc.org.
authors.forename: Oscar
authors.initials: O
authors.lastname: Agyei
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. mohammed.mujtaba@kintampo-hrc.org.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mujtaba
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. kaali.seyram@kintampo.hrc.org.
authors.forename: Seyram
authors.initials: S
authors.lastname: Kaali
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. plk3@cumc.columbia.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kinney
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana. seth.owusu-agyei@kintampo-hrc.org.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000517:prevention & control; D018533:Biomass; D001724:Birth Weight; D003296:Cooking / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005740:Gases; D005869:Ghana / Q000453:epidemiology; D006798:Housing; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D019570:Inhalation Exposure / Q000009:adverse effects* / Q000517:prevention & control; D010578:Petroleum / Q000009:adverse effects*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005740:Gases; D010578:Petroleum