Impact of cooking with liquefied petroleum gas compared with traditional cooking practices on perinatal and early neonatal mortality: the Poriborton cluster randomised controlled trial

Objective: To determine whether liquefied petroleum gas (LPG) can reduce perinatal mortality in a setting with high reliance on biomass fuels for cooking. Design: Community-based two-arm parallel cluster randomised controlled trial, in Sherpur, Bangladesh. Participants: 4944 pregnant women were recruited, with 2472 in each group. Eligible women were pregnant between 40 and 120 days, aged 15–49 years, permanent residents and planning to give birth in their cluster of residence. Intervention: LPG stove and fuel to birth. Controls continued with usual cooking practices. Main outcome: Primary outcome at the individual level: perinatal mortality. Secondary outcomes: early neonatal mortality, neonatal mortality, preterm birth and personal exposure to particulate matter 2.5 (PM2.5). Results: The final birth outcomes included 4592 participants. The perinatal mortality rate (PMR) was 50 per 1000 births in the intervention group compared with 61 per 1000 births in the control group (relative risk (RR) 0.83; 95%CI 0.65 to 1.06). PM2.5 concentrations were 47.2µg/m³ in the intervention versus 60.3 µg/m³ in the control; mean difference −0.133 (95% CI −0.194 to −0.072). In late pregnancy, it was 62·7 µg/m³ in the intervention versus 88·7 µg/m³ in the control, mean difference −0.149 (−0.198 to –0.101). Early neonatal mortality was 22% in the intervention compared with 30% in the control (RR 0.73; 95%CI 0.50 to 1.05). Preterm birth rates were similar. In post hoc subgroup of small versus large households (HH), the PMR was lower in the smaller HH in the intervention group (67, rate 54 per 1000 births) than in the control group (102, 71 per 1000 births, adjusted RR 0.75; 95%CI 0.56 to 1.00; p=0.047). Conclusions: Reductions in perinatal mortality favoured the intervention but were statistically non-significant. These findings demonstrate a reduction in mortality in smaller HH when cooking needs are adequately covered by clean fuel.