Visualizing Field Data Collection Procedures of Exposure and Biomarker Assessments for the Household Air Pollution Intervention Network Trial in India

Summary

We detail the consistent, high-quality procedures used throughout air and biological sampling processes at Indian field sites during a large randomized controlled trial. Insights gathered from the oversight of applications of innovative technologies, adapted for exposure assessment in rural regions, enable better field data collection practices with more reliable outcomes.

Abstract

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 PM_2.5 (particles smaller than 2.5 microns in aerodynamic diameter), carbon monoxide (CO), and black carbon (BC) were measured in pregnant mothers (M), other adult women (OAW), and children (C) at various times over a 4 year period. In addition, stove usage monitoring (SUMs) with data-logging thermometers and ambient measurements of air pollution were carried out. Furthermore, the feasibility of collecting biological samples (urine and dried blood spots [DBSs]) from study participants at the field sites was successfully demonstrated. Based on findings from this and earlier studies, the methods used here have enhanced the data quality and avoided issues with household air pollution and biological sample collection in resource-constrained situations. The procedures established may be a valuable educational tool and resource for researchers conducting similar air pollution and health studies in India and other low- and middle-income countries (LMICs).

Introduction

Globally, exposure to household air pollution (HAP), mostly from solid-fuel cooking, is a major cause of morbidity and mortality^1,2,3. Cooking and heating with solid fuels (biomass-such as wood, dung, crop residues, and coal) is widespread in low- and middle-income countries (LMICs), posing various health, environmental, and economic issues. PM_2.5 is a 'silent killer,' occurring both indoors and outdoors^4,5. Indoor air quality in India is often considerably worse than outside air quality, and it has....

Protocol

The Institutional Ethics Committee at Sri Ramachandra Institute of Higher Education and Research (IEC-N1/16/JUL/54/49), Emory University Institutional Review Board (00089799), and the Indian Council of Medical Research-Health Ministry Screening Committee (5/8/4-30/(Env)/ Indo-US/2016-NCD-I) approved the HAPIN trial. The HAPIN trial is identified as NCT02944682 on clinicaltrials.gov. Written informed consents were collected from the study participants prior to their participation and the study was conducted according to ethical guidelines.

NOTE: The case report forms (CRF) administered during the sampling and data collection are available in....

Discussion

We demonstrated and visually represented standard procedures to collect population-level data on personal exposures to household air pollution in the multi-country HAPIN trial^{19, 24}. The field-based environmental and biomarker sampling methods described here are appropriate and feasible, particularly in vulnerable populations in resource-limited settings where PM_2.5 exposures are several orders of magnitude higher than the WHO Air Quality Guideline (AQ.......

Materials

Name	Company	Catalog Number	Comments
BD adult lancet	BD Biosciences	366594	DBS collection from finger
BD Quikheek infant safety lancet	BD Biosciences	368100 & 368101	Heel prick DBS collection
Beacon	Roximity	O/EM	Time and location monitor [TLM] (Personal monitor)
Beacon Logger	Berkley Air Monitoring group	xxxx	Time and location logger [TLL] (Indirect measurement)
Crdo ProMed Pelican Bag	Peli Biothermal USA		Cooler bag
Enhanced Children MicroPEM (ECM)	RTI International, Durham, NC, US	xxxx	Personal monitor of PM2.5
E-sampler	Met One Instruments	9800	Indirect measurement of ambient PM2.5
Geocene	Geocene Inc., Vallejo,CA	xxxx	for stove use monitoring
Humidity indicating card	DESSICARE, INC.	04BV14C10	Sample integrity indicator
Lascar	Lascar Electronics	EL-USB-300	Carbon monoxide (CO) data logger
PTS collect capillary tubes- 40 µL	PTS collect	2866	To collect heel prick DBS from children
Sartorius	Sartorius Lab Instruments, GmbH & Co, Germany	MSA6-6S-000-DF	Microbalance (Weighing filters)
SootScanTM	Magee Scientific Co, Berkeley, USA	OT21	Black carbon measurement
Vaccine Bag	Apex International, India	AIVC-46	Vaccine Bag
Whatman 903 Protein Saver card	GE Healthcare Life Sciences	10534612	Collection of capillary blood samples (Dried Blood Spot)