Publications by authors named "Lindsay Underhill"

Background: Hypertension is the leading modifiable risk factor for premature death globally despite the existence of evidence-based and cost-effective treatments. Medication nonadherence is cited as the main cause of treatment failure for hypertension. In Peru, adherence to anti-hypertensive medications of individuals with both hypertension and type 2 diabetes (T2D) is not well studied.

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Article Synopsis
  • - This study focuses on tackling hypertension in Peru through a hybrid research design testing a community health worker (CHW)-led program, aiming to improve blood pressure control within the national primary care system in Puno.
  • - A total of 1068 adults with hypertension will be recruited and randomly assigned to either usual care or a 12-month intervention, which includes home-based monitoring, medication support, and lifestyle counseling.
  • - The trial will evaluate clinical effectiveness (like changes in blood pressure) and implementation outcomes (such as program acceptance and cost-effectiveness), providing valuable insights for future health strategies in Peru and similar low- to middle-income countries (LMICs).
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Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru.

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  • Residential biomass burning significantly contributes to black carbon (BC) exposure in rural communities, especially among pregnant women in low- and middle-income countries.
  • In a study involving 3103 pregnant women, those who received liquefied petroleum gas stoves showed much lower BC exposure (2.8 μg/m) compared to those using traditional biomass stoves (9.6 μg/m).
  • The study identified primary stove type as the strongest predictor of BC exposure, and highlights the need to consider various factors, such as kitchen location and adherence to stove use, to improve the efficacy of cookstove intervention trials.
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  • Household air pollution (HAP) from solid fuel cooking is linked to negative pregnancy outcomes, and the HAPIN trial aimed to assess the effects of using LPG stoves in various countries like Guatemala, India, Peru, and Rwanda.
  • The study involved 3200 pregnant women who were either assigned to use LPG stoves or kept in a control group, with regular monitoring of fetal and neonatal outcomes as well as personal exposure to pollutants like particulate matter and carbon monoxide.
  • Results indicated that the LPG intervention didn't significantly lower risks of stillbirth, congenital anomalies, or neonatal mortality, nor did higher exposure levels to pollutants show a strong statistical association with these adverse outcomes.
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  • Household air pollution from biomass cooking fuels may contribute to stunted growth in infants, raising questions about whether switching to cleaner liquefied petroleum gas (LPG) can help reduce this risk.
  • A randomized trial with 3200 pregnant women in low- and middle-income countries was conducted, comparing the impact of using LPG cookstoves against traditional biomass cookstoves on infant growth at 12 months old.
  • Results showed that the intervention group using LPG had significantly lower exposure to fine particulate matter and a stunting rate of 27.4%, while the control group had a slightly higher stunting rate of 25.2%, indicating a potential benefit of switching to LPG.
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  • * Conducted between May 2018 and September 2021, the trial involved 3,195 pregnant women who were randomly assigned to use either LPG stoves (intervention group) or biomass fuel (control group), and their children's exposure to air pollution was measured.
  • * Results showed a slight reduction in severe pneumonia incidents among infants in the LPG group compared to the biomass group, but the difference was not statistically significant, suggesting that while LPG reduced air pollution exposure, it did not significantly lower pneumonia rates.
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Background: Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n = 1,590), with controls expected to continue cooking with biomass fuels (n = 1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs).

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Background: Household air pollution due to the burning of solid fuels is one of the leading risk factors for disease and mortality worldwide, resulting in an estimated three million deaths annually. Peru's national LPG access program, FISE, aims to reduce the use of biomass fuels and increase access to cleaner fuels for cooking in low-income Peruvian households through public-private partnerships. Perspectives from front-end program implementers are needed to better understand barriers and facilitators to program implementation and to identify strategies to strengthen program reach, uptake, and health impact.

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Exposure to household air pollution is a leading cause of ill-health globally. The Household Air Pollution Intervention Network (HAPIN) randomized controlled trial evaluated the impact of a free liquefied petroleum gas stove and fuel intervention on birth outcomes and maternal and child health. As part of HAPIN, an extensive exposure assessment was conducted.

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Background: Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n=1,590), with controls expected to continue cooking with biomass fuels (n=1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs).

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Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight.

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Background: Household air pollution (HAP) from solid fuel use is associated with adverse birth outcomes, but data for exposure-response relationships are scarce. We examined associations between HAP exposures and birthweight in rural Guatemala, India, Peru, and Rwanda during the Household Air Pollution Intervention Network (HAPIN) trial.

Methods: The HAPIN trial recruited pregnant women (9-<20 weeks of gestation) in rural Guatemala, India, Peru, and Rwanda and randomly allocated them to receive a liquefied petroleum gas stove or not (ie, and continue to use biomass fuel).

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Introduction: Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs).

Methods: All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD.

Results: We surveyed all 63 pharmacies in respective study areas in Nepal (95.

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Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study.

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Here, we present a visual representation of standard procedures to collect population-level data on personal exposures to household air pollution (HAP) from two different study sites in a resource-constrained setting of Tamil Nadu, India. Particulate matter PM2.5 (particles smaller than 2.

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Background: Exposure during pregnancy to household air pollution caused by the burning of solid biomass fuel is associated with adverse health outcomes, including low birth weight. Whether the replacement of a biomass cookstove with a liquefied petroleum gas (LPG) cookstove would result in an increase in birth weight is unclear.

Methods: We performed a randomized, controlled trial involving pregnant women (18 to <35 years of age and at 9 to <20 weeks' gestation as confirmed on ultrasonography) in Guatemala, India, Peru, and Rwanda.

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Background: Exposure to arising from solid fuel combustion is estimated to result in million premature deaths and 91 million lost disability-adjusted life years annually. Interventions attempting to mitigate this burden have had limited success in reducing exposures to levels thought to provide substantive health benefits.

Objectives: This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial.

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Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda.

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Article Synopsis
  • - The Household Air Pollution Intervention Network (HAPIN) study tested a non-drug intervention in four low- and middle-income countries to reduce household air pollution and enhance health outcomes by providing families with LPG stoves and ongoing support for 18 months.
  • - Participants, made up of HAPIN investigators, evaluated the study design using a scale from very explanatory to very pragmatic, focusing on different trial aspects like recruitment and follow-up processes.
  • - Results showed that only 17% of investigators viewed all design aspects as very explanatory, highlighting that many elements, especially those related to the delivery and relevance of the intervention, were considered more pragmatic by over 50% of respondents.
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Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings.

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Rationale: The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk.

Objectives: In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial conducted in rural, low-resource settings, we developed a framework to assess the risk of each trial activity and to guide protective measures.

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Background: Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities.

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Rationale: The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk.

Objectives: In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial, we developed a framework to assess the risk of each trial activity and to guide protective measures.

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Background: High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru.

Objectives: The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures.

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