Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial

Trials. 2015 Sep 22:16:420. doi: 10.1186/s13063-015-0930-8.


Background: Household air pollution exposure is a major health risk, but validated interventions remain elusive.

Methods/design: 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.

Discussion: 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.

Trial registration: The trial was registered with on 13 April 2011 with the identifier NCT01335490 .

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollution, Indoor / adverse effects*
  • Air Pollution, Indoor / prevention & control
  • Biomass*
  • Birth Weight
  • Cooking / instrumentation*
  • Equipment Design
  • Female
  • Gases
  • Ghana / epidemiology
  • Housing*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Inhalation Exposure / adverse effects*
  • Inhalation Exposure / prevention & control
  • Petroleum / adverse effects*
  • Pneumonia / diagnosis
  • Pneumonia / epidemiology
  • Pregnancy
  • Research Design
  • Risk Factors
  • Time Factors


  • Gases
  • Petroleum

Associated data