Enhancing LPG Use During Pregnancya collaboration between KEM Health Research Center, Sri Ramachanda University, and University of California, Berkeley An explanatory presentation provided to ProPublica.org

1. Enhancing LPG Use During
Pregnancy
a collaboration between KEM Health Research Center,
Sri Ramachanda University, and University of California,
Berkeley
May 25-26, 2017 Junnar Field Headquarters, Maharashtra, Indi

2. About the team
Household energy
in India
a very brief review
Our project
May 25-26, 2017 Junnar Field Headquarters, Maharashtra, Indi

3. About the team
Household energy
in India
a very brief review
Our project
May 25-26, 2017 Junnar Field Headquarters, Maharashtra, Indi

4. KEM Hospital Pune
The KEM Hospital, Pune, the largest NGO hospital in Pune District. It is
registered under the Societies' Registration Act 1860 and the Bombay Public
Trusts Act 1950. Centenary Year : 2012
©2010, KEMHRC Pune

5. KEM Hospital Research Centre Pune (KEMHRC)
• KEMHRC was registered in 1985, as an independent society under
the Societies Registration Act 1860.
• Recognized as Center of National Importance from ICMR - 1988
• Recognition by DSIR – Scientific and Industrial Research
Organization (SIROs) - 1988
• National Institute of Health and Family Welfare recognized as
Collaborating Training Institute (CTIs) for RCH program - 2000
• NABH/NABL accreditation
• Initiated Vadu Rural Health Program
©2010, KEMHRC Pune

6. - 1970: Vadu Primary Health Unit
- 1985: Shirdi Sai Baba Rural Hospital (tripartite
partnership with governments)
- 1987: VRHP as out reach program
- 1988: Research by KEMHRC from Pune
- 2002: Vadu HDSS
- 2003: Vadu Research Unit
History

7. Vadu

10. University
Sri Ramachandra University was established in the year 1985 as part of the Sri
Ramachandra Educational & Health
Declared under section 3 of the UGC Act, 1956
Accredited by NAAC with 'A' Grade ( CGPA 3.62 on a 4 point scale )
Medical Centre
The University Medical Centre is the focus of the clinical teaching activity of the University.
A 1800 bedded facility with the largest ICU in the region with state of the art equipment,
the medical centre is a tertiary care facility that provides the trainee with the opportunity to
acquire knowledge and skills from the finest doctors in the country
Department of Environmental Health Engineering
Established in 1998 as Environmental Health Engineering Cell by UNIDO-CLRI
to provide Occupational Safety and Health Services to the Leather Industry
Department Director:
Dr.Kalpana Balakrishnan, Phd. FAMS, Associate Dean-Research,
Director for WHO Collaborating center for Occupational and Environmetal Health
Director for ICMR-CAR for Air Quality, Climate & Health.
Head of the Department: Dr.S.Sankar Msc. Phd

11. CURRENT SCALE OF OPERATION
• 34 Research/teaching personnel including 11 Faculty members
• 10 Concurrent On-going Research Projects
• Advisory Consultancy for Industries
Involvement with
• 6 Central Ministries (Health,Environment,Labour,Renewable
Energy,Earth Sciences,Science and Technology)
• 3 State Ministries(Health,Environment,Labour)
• 3 UN Agencies(Who, ILO, UNEP)
• 4 bilateral agencies(GTZ,USEPA,CDC,NIH)
• 10 Long term international collaborators
• 40-50 Local Institutional Collaborators

12. Research, Consultancy & Extension
“Net-Working” Collaborations MOU Partners
University of California, Berkeley,USA
National Institutes of Health-USA
TUFTS University-USA
Smile Train – Cleft Lip Palate ,USA
Transforming Faces (TF), Canada
Utah State University, USA
International Agency Partners
World Bank
ILO
WHO
UNIDO
UNDP
UNEP
Fogarty International Center,NIH, USA
USEPA, USA
GTZ-CIM, Germany
EU, Brussels
IDRC, Canada
SIDA, Sweden
Research Partners
Washington Univerity, St. Louis,USA
Johns Hopkins University,USA
Harvard School of Public Health,USA
University of Ann Arbor , Michigan,USA
NUS, Singapore
Australian National University, Australia
University of Umea,Sweden
Lund University, Sweden
University of Montreal, Canada
University of Illinois, IL,USA
Clarkson University, NY,USA
University of Minnesota, MN,USA
University of Sao Paulo, Brazil
University of Kebansaan, Malaysia
MOPH, Thailand

13. May 25-26, 2017 Junnar Field Headquarters, Maharashtra, Indi
About the team
Household energy
in India
a very brief review
Our project

14. 66% of households use biomass for cooking
Little change in abs. numbers using biomass
over time – percentage changes, but
population growth continues
Leads to ~10% of national mortality
900,000 deaths per year
~25% of ambient air pollution

15. Three innovative, national Indian
LPG programs
PAHAL
Paid fuel subsidies directly into bank accounts.
All LPG sold at market rates, reducing diversion of fuel intended for
households into other sectors.
Give It Up
Encouraged middle and upper class households to give up their
subsidy, which was targeted one-to-one to the poor.
XX million households have given up their subsidy to date.
PMUY or Ujjwala
Provides reduced cost connections to 50 million poor households by
2019 – as of early 2017, had reached over 20 million already.

16. 1 billion USD internal foreign aid program
Now must shift focus to facilitating and
increasing exclusive usage to obtain
health benefits
Apply learning from other health
interventions – latrines, salt, condoms,
bednets, TB drugs, etc

17. May 25-26, 2017 Junnar Field Headquarters, Maharashtra, Indi
About the team
Household energy
in India
a very brief review
Our project

18. Maharashtra

19. Junnar Block

20. Location
Junnar Block, Pune district, Maharashtra, India
• 76,700 households • 360,000 people
• 14,000 BPL families
• 1250 pregnancies in BPL families per year
• 150 weddings per wedding season (60% pregnant
within a year)
• 12 PHCs – we target 3

21. 1. NFHS 4 report, Pune District
2. DLHS 07-08, Pune District
Indicator Urban Rural Total
Mothers who had antenatal check-up in the first
trimester (%)
88.9 87.3 88.2
Mothers who had at least 4 antenatal care visits
(%)
85.7 83.2 84.5
Mothers who had at least one antenatal care
visits in government facility (%)
43.9
Mothers who had at least one antenatal care
visits (%) 2 97.7
Institutional births (%) 92.8 94.2 93.5
Age at Marriage 19.7

22. Given that pregnancy is a vulnerable
period for mother and child, can we
increase the number of months of a
pregnancy covered by LPG, a clean fuel?
Target two important life course events to
increase adoption and usage of LPG

23. Control Arm
Households receive the intervention
package: connection, stove, table, tubing,
lighter, 2 x cylinder
‘Pink Key’ Arm
Intervention package + 2 INR / meal
payment for cooking with gas. Use
observed with novel meal-counting stove
use monitor
Free Fuel Arm
Intervention package + up to 1 free
refill per month
Marriage Arm
Households receive the intervention
package shortly after marriage
Pregnancy
Increase number of months covered by clean fuels. Identified in cooperation with local healthcare workers
(ASHAs + ANMs)
Marriage
Cover the crucial early pregnancy period. Target
marriages through ASHA workers and through
community-scale weddings.

24. Measurements
Across all arms, LPG and the primary traditional
stoves will be equipped with data-logging
temperature sensors called “Stove Use
Monitors.” The LPG + CCT arm will also be
equipped with a Pink Key.
In 30 homes per arm, we will measure kitchen air
pollution and personal exposure before and after
intervention.

25. LPG
Chula
May 04 May 05 May 06
50
100
150
50
100
150
Date
DegreesC
Location
Chula
LPG - Left
LPG - Right
Sample Stove Use Monitoring Data

26. 0
10
20
30
Mar 08 12:00 Mar 08 18:00 Mar 09 00:00 Mar 09 06:00 Mar 09 12:00
Date
PM2.5(mg/m3)
Location Kitchen Measurement Personal Measurement
Sample PM2.5 Data

27. Current Status
93 pregnancies recruited; 49 have received LPG
connection
Pre-intervention air sampling finished in 84
houses; post-intervention sampling completed in
14 houses
Refills starting to pick up speed
Marriage recruitment starting

28. Plan for the next two days
Today
- Visit LPG Distributor in Junnar
- Visit warehouse / godown
- Visit Ganesh Temple and have dinner nearby
Tomorrow
- Visit homes in control and free fuel arms
- In each arm, visit non-participant homes