Publications by authors named "Miles A Kirby"
Rwanda achieved unprecedented malaria control gains from 2000 to 2010, but cases increased 20-fold between 2011 and 2017. Vector control challenges and environmental changes were noted as potential explanations, but no studies have investigated causes of the resurgence or identified which vector species drove transmission. We conducted a retrospective study in four sites in eastern Rwanda that conducted monthly entomological surveillance and outpatient malaria care.
View Article and Find Full Text PDFBackground: Environmental enteric dysfunction (EED) is an acquired, subclinical state of intestinal inflammation common in children and adults in low-income and middle-income countries. Although vitamin D-3 supplementation has purported anti-inflammatory properties, its ability to ameliorate biomarkers of EED remains unclear.
Objectives: This study aimed to examine the effects of maternal vitamin D-3 supplementation during pregnancy and lactation on biomarkers of EED, systemic inflammation, and growth in women living with HIV and their infants in Dar es Salaam, Tanzania.
Article Synopsis
- 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.
Background: Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth.
Methods: The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda.
Article Synopsis
- 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.
Article Synopsis
- 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.
Article Synopsis
- * 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.
Background: Provision of zinc supplementation to young children has been associated with reduced infectious morbidity and better growth outcomes. However, the metabolic pathways underlying these outcomes are unclear, and metabolomic data from humans undergoing zinc supplementation, particularly infants, are generally lacking.
Objectives: This study aimed to examine the effect of zinc supplementation on metabolic profiles in Tanzanian infants aged 6 wk and 6 mo.
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).
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.
View Article and Find Full Text PDFBackground: 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).
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.
View Article and Find Full Text PDFBackground: 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).
Background: Environmental enteric dysfunction (EED) may contribute to poor growth and development in young children. While validated EED biomarkers are currently lacking, multiplex assays are able to capture multiple domains of the condition. The purpose of this exploratory study was to examine the relationship between biomarkers of EED and subsequent growth and development among Tanzanian HIV-exposed uninfected (HEU) infants.
View Article and Find Full Text PDFObjective: Lung ultrasound (LUS) is an alternative to chest radiography to confirm a diagnosis of pneumonia. For research and disease surveillance, methods to use LUS to diagnose pneumonia are needed.
Methods: In the Household Air Pollution Intervention Network (HAPIN) trial, LUS was used to confirm a clinical diagnosis of severe pneumonia in infants.
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.
Background: Environmental enteric dysfunction (EED) may contribute to adverse birth outcomes in low-resource settings. We examined the associations of EED biomarkers with birth outcomes in pregnant women living with human immunodeficiency virus in Dar es Salaam, Tanzania.
Methods: We performed a cohort study of 706 HIV-infected pregnant women.
Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea.
View Article and Find Full Text PDFBackground: 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.
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.
Globally, cleaner cooking fuels are increasingly promoted to reduce household air pollution. However, there is concern that reductions in smoke from biomass fuels could lead to more favorable conditions for mosquitoes and potentially increase vectorborne disease risk. We investigated household entry, host-seeking, household exit, and mortality among Anopheles mosquitoes across three cooking fuel types: wood, charcoal, and liquid petroleum gas (LPG) in six experimental huts in Rwanda.
View Article and Find Full Text PDFBackground: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use.
Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention ( = 1590) or to a control ( = 1605).
The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM) in Guatemala, India, and Rwanda.
View Article and Find Full Text PDFPneumonia 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.
View Article and Find Full Text PDFRationale: 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.