***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries . We conducted a 5-month household r and omised controlled trial among 566 households in rural Rw and a to assess uptake , compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free . Compliance was measured monthly by self-report and spot-check observations . Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a r and om sub sample of 121 households to assess household air pollution  , while sample s of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms . Adoption was generally high , with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove . However , some householders continued to drink untreated water and most continued to cook on traditional stoves . The intervention was associated with a 97.5 % reduction in mean faecal indicator bacteria ( Williams means 0.5 vs. 20.2 TTC/100 mL , p<0.001 ) and a median reduction of 48 % of 24-h PM2.5 concentrations in the cooking area ( p = 0.005 ) . Further studies to increase compliance should be undertaken to better inform large-scale interventions . Trial registration : Clinical trials.gov ; NCT01882777 ; http:// clinical trials.gov/ct2/ results ? term = NCT01882777 & Search = Background : A large body of evidence suggests that fine particulate matter ( PM ) air pollution is a cause of cardiovascular disease , but little is known in particular about the cardiovascular effects of indoor air pollution from household use of solid fuels in developing countries . RESPIRE ( R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) was a r and omized trial of a chimney woodstove that reduces wood smoke exposure . Objectives : We tested the hypotheses that the stove intervention , compared with open fire use , would reduce ST-segment depression and increase heart rate variability ( HRV ) . Methods : We used two complementary study design s : a ) between-groups comparisons based on r and omized stove assignment , and b ) before- and -after comparisons within control subjects who used open fires during the trial and received chimney stoves after the trial . Electrocardiogram sessions that lasted 20 hr were repeated up to three times among 49 intervention and 70 control women 38–84 years of age , and 55 control subjects were also assessed after receiving stoves . HRV and ST-segment values were assessed for each 30-min period . ST-segment depression was defined as an average value below –1.00 mm . Personal fine PM [ aerodynamic diameter ≤ 2.5 μm ( PM2.5 ) ] exposures were measured for 24 hr before each electrocardiogram . Results : PM2.5 exposure means were 266 and 102 μg/m3 during the trial period in the control and intervention groups , respectively . During the trial , the stove intervention was associated with an odds ratio of 0.26 ( 95 % confidence interval , 0.08–0.90 ) for ST-segment depression . We found similar associations with the before- and -after comparison . The intervention was not significantly associated with HRV . Conclusions : The stove intervention was associated with reduced occurrence of nonspecific ST-segment depression , suggesting that household wood smoke exposures affect ventricular repolarization and potentially cardiovascular health Background and Objective RESPIRE , a r and omized trial of an improved cookstove , was conducted in Guatemala to assess health effects of long-term reductions in wood smoke exposure . Given the evidence that ambient particles increase blood pressure , we hypothesized that the intervention would lower blood pressure . Methods Two study design s were used : a ) between-group comparisons based on r and omized stove assignment , and b ) before- and -after comparisons within subjects before and after they received improved stoves . From 2003 to 2005 , we measured personal fine particle ( particulate matter with aerodynamic diameter < 2.5 μm ; PM2.5 ) exposures and systolic ( SBP ) and diastolic blood pressure ( DBP ) among women > 38 years of age from the chimney woodstove intervention group ( 49 subjects ) and traditional open wood fire control group ( 71 subjects ) . Measures were repeated up to three occasions . Results Daily average PM2.5 exposures were 264 and 102 μg/m3 in the control and intervention groups , respectively . After adjusting for age , body mass index , an asset index , smoking , secondh and tobacco smoke , apparent temperature , season , day of week , time of day , and a r and om subject intercept , the improved stove intervention was associated with 3.7 mm Hg lower SBP [ 95 % confidence interval ( CI ) , −8.1 to 0.6 ] and 3.0 mm Hg lower DBP ( 95 % CI , −5.7 to −0.4 ) compared with controls . In the second study design , among 55 control subjects measured both before and after receiving chimney stoves , similar associations were observed . Conclusion The between-group comparisons provide evidence , particularly for DBP , that the chimney stove reduces blood pressure , and the before- and -after comparisons are consistent with this evidence During the first r and omized intervention trial ( RESPIRE : R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) in air pollution epidemiology , we pioneered application of passive carbon monoxide ( CO ) diffusion tubes to measure long-term personal exposures to woodsmoke . Here we report on the protocol s and validations of the method , trends in personal exposure for mothers and their young children , and the efficacy of the introduced improved chimney stove in reducing personal exposures and kitchen concentrations . Passive diffusion tubes originally developed for industrial hygiene applications were deployed on a quarterly basis to measure 48-hour integrated personal carbon monoxide exposures among 515 children 0 - 18 months of age and 532 mothers aged 15 - 55 years and area sample s in a sub sample of 77 kitchens , in households r and omized into control and intervention groups . Instrument comparisons among types of passive diffusion tubes and against a continuous electrochemical CO monitor indicated that tubes responded nonlinearly to CO , and regression calibration was used to reduce this bias . Before stove introduction , the baseline arithmetic ( geometric ) mean 48-h child ( n=270 ) , mother ( n=529 ) and kitchen ( n=65 ) levels were , respectively , 3.4 ( 2.8 ) , 3.4 ( 2.8 ) and 10.2 ( 8.4 ) p.p.m . The between-group analysis of the 3355 post-baseline measurements found CO levels to be significantly lower among the intervention group during the trial period : kitchen levels : −90 % ; mothers : −61 % ; and children : −52 % in geometric means . No significant deterioration in stove effect was observed over the 18 months of surveillance . The reliability of these findings is strengthened by the large sample size made feasible by these unobtrusive and inexpensive tubes , measurement error reduction through instrument calibration , and a r and omized , longitudinal study design . These results from the first r and omized trial of improved household energy technology in a developing country and demonstrate that a simple chimney stove can substantially reduce chronic exposures to harmful indoor air pollutants among women and infants Background Indoor air pollution ( IAP ) from solid fuels is a serious health problem in low-income countries that can be alleviated using improved stoves . Although women are the principal users , few studies have investigated the self-assessed impact of the stoves on their health and lives . Methods This study was conducted in rural highl and Guatemala , involving 89 intervention and 80 control Mayan Indian young women ( mean 27.8 years , SD 7.2 ) . Outcomes were assessed after approximately 18 months use of the new stove . Our objectives were to compare self-rated health and change in health among women participating in a r and omised control trial comparing a chimney stove with an open fire , to describe impacts on women 's daily lives and their perceptions of how reduced kitchen smoke affects their own and their children 's health . Results On intention-to-treat analysis , 52.8 % of intervention women reported improvement in health , compared to 23.8 % of control women ( p < 0.001 ) . Among 84 intervention women who reported reduced kitchen smoke as an important change , 88 % linked this to improvement in their own health , particularly for non-respiratory symptoms ( for example eye discomfort , headache ) ; 57 % linked reduced smoke to improvement in their children 's health , particularly sore eyes . Conclusion Women 's perception of their health was improved , but although smoke reduction was valued , this was linked mainly with alleviation of non-respiratory symptoms like eye discomfort and headache . More focus on such symptoms may help in promoting dem and for improved stoves and cleaner fuels , but education about more severe consequences of IAP exposure is also required Background : Cooking with biomass fuels on open fires results in exposure to health-damaging pollutants such as carbon monoxide ( CO ) , polycyclic aromatic hydrocarbons ( PAHs ) , and particulate matter . Objective : We compared CO exposures and urinary PAH biomarkers pre- and postintervention with an improved biomass stove , the Patsari stove . Methods : In a sub sample of 63 women participating in a r and omized controlled trial in central Mexico , we measured personal CO exposure for 8 hr during the day using continuous monitors and passive sample rs . In addition , first-morning urine sample s obtained the next day were analyzed for monohydroxylated PAH metabolites by gas chromatography/isotope dilution/high-resolution mass spectrometry . Exposure data were collected during the use of an open fire ( preintervention ) and after installation of the improved stove ( postintervention ) for 47 women , enabling paired comparisons . Results : Median pre- and postintervention values were 4 and 1 ppm for continuous personal CO and 3 and 1 ppm for passive sample r CO , respectively . Postintervention measurements indicated an average reduction of 42 % for hydroxylated metabolites of naphthalene , fluorene , phenanthrene , and pyrene on a whole-weight concentration basis ( micrograms per liter of urine ) , and a 34 % reduction on a creatinine-adjusted basis ( micrograms per gram of creatinine ) . Pre- and postintervention geometric mean values for 1-hydroxypyrene were 3.2 and 2.0 μg/g creatinine , respectively . Conclusion : Use of the Patsari stove significantly reduced CO and  PAH exposures in women . However , levels of many PAH biomarkers remained higher than those reported among smokers Background : A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes , such as  low birth weight ( LBW )  , in re source -poor countries . Objective : We examined the effect of reduced wood smoke exposure in pregnancy on LBW  of Guatemalan infants in RESPIRE ( R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) . Methods : Pregnant women ( n = 266 ) either received a chimney stove ( intervention ) or continued to cook over an open fire ( control ) . Between October 2002 and December 2004 we weighed 174 eligible infants ( 69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy ) within 48 hr of birth . Multivariate linear regression and adjusted odds ratios ( ORs ) were used to estimate differences in birth weight and LBW ( < 2,500 g ) associated with chimney-stove versus open-fire use during pregnancy . Results : Pregnant women using chimney stoves had a 39 % reduction in mean exposure to carbon monoxide compared with those using open fires . LBW prevalence was high at 22.4 % . On average , infants born to mothers who used a stove weighed 89 g more [ 95 % confidence interval ( CI ) , –27 to 204 g ] than infants whose mothers used open fires after adjusting for maternal height , diastolic blood pressure , gravidity , and season of birth . The adjusted OR for LBW was 0.74 ( 95 % CI , 0.33–1.66 ) among infants of stove users compared with open-fire users . Average birth weight was 296 g higher ( 95 % CI , 109–482 g ) in infants born during the cold season ( after harvest ) than in other infants ; this unanticipated finding may reflect the role of maternal nutrition on birth weight in an impoverished region . Conclusions : A chimney stove reduced wood smoke exposures and was associated with reduced LBW occurrence . Although not statistically significant , the estimated effect was consistent with previous studies Background Household air pollution exposure is a major health risk , but vali date d interventions remain elusive . Methods / Design The Ghana R and omized Air Pollution and Health Study ( GRAPHS ) is a cluster-r and omized 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 inter 
    Output:
    
Thus , care should be taken in concluding that HAP interventions - as currently design ed and implemented - support reductions in the average kitchen and personal levels of PM and CO .
Further , there is limited evidence that current st and -alone HAP interventions yield any health benefits .