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  • Findings Between July and March we

    2019-05-21

    Findings Between July, 2013, and March, 2015, we enrolled 324 pregnant women (162 to each study group); 18 women were lost to follow up before delivery. Measurements of biomarkers made more than 60 days before randomisation (17 participants) or more than 300 days after randomisation (26 participants) were excluded from amalysis, as were data for 17 other women because of inconsistent dates. Thus data from 246 women were included in analysis. Mean (SD) change in RBP, MDA, TNF-α, IL-6, and IL-8 between baseline and the third trimester was −2·16 (4·47), −19·6 (46·4), 3·72 (37·2), 0·51 (14·4), and 13·2 (197), respectively, in the intervention group and −2·25 (4·30), −24·6 (43·6), 7·17 (32·6), −1·79, (11·4), and 31·3 (296) in the control group. None of the mean changes differed significantly between the two study groups. However, changes from baseline in TNF-α levels were significantly different between the intervention and control groups in the subset of women (n=99) who were using firewood before the trial (−7·03 [32·9] vs +12·4 [33·6]; 95% CI for group difference: −35·4 to −3·4, p=0·018). Third trimester concentrations of MDA were also significantly lower in initial firewood users allocated to the CleanCook group compared with those in the control group who continued to use firewood (ANCOVA p=0·030). There were no significant favourable differences in the interval change of biomarkers in women who initially used kerosene stoves. Women in the control group were offered CleanCook stoves at the end of the trial. Interpretation The decrease in serum concentrations of TNF-α from the first to third trimesters in women who used the CleanCook stove could indicate the reduction of cardiovascular stress and prothrombotic effects from decreased amounts of household air pollution. Furthermore, our findings suggest that the replacement of wood-burning There’s a reason stoves with ethanol-burning stoves might decrease concentrations of inflammatory markers and, therefore, mitigate cardiovascular and pulmonary disease in pregnant women. Funding Global Alliance for Clean Cookstoves through United Nations Foundation. Declaration of interests
    Abstract Introduction Access to cardiac surgical care in Haiti is restricted for the many children and young adults with congenital and rheumatic heart disease. Before 2013, doctors and organisations independently advocated for individual patients in need of cardiac surgery; no national-level effort existed to coordinate surgical access. We describe the performance of Haiti Cardiac Alliance (HCA), a cross-partner collaboration founded in July, 2013, that facilitates diagnosis, surgical referral, and long-term follow-up for Haitian cardiac patients. Methods HCA has developed a national referral system and centralised registry for all Haitian children and young adults awaiting diagnostic evaluation, cardiac surgery, or both. All participating partners throughout Haiti can now efficiently refer patients into this system. When cardiac surgery is indicated, HCA matches patients with surgical partners based on urgency and clinical profile. We analysed the HCA registry to quantify referral, diagnosis, and enrolment; cardiac surgical activity; and patient mortality before and after surgery. Findings Between July, 2013, and October, 2015, HCA workers assessed more than 1000 outpatients and enrolled 410 Haitian patients into its cardiac surgery registry. Of these patients, 134 (33%) have since undergone surgery; 72 (18%) are matched and awaiting surgery in the near term; 147 (36%) are awaiting surgical matches; and 57 (14%) died on the waiting list before surgery could be arranged. By October, 2015, an additional 137 new patients were waiting for an initial assessment from a cardiologist. Of the 134 patients who underwent surgery facilitated by HCA, 49 surgeries (37%) were in Haiti, and 85 surgeries took place in seven other countries. Three surgical patients have died since surgery, for a 30-day mortality rate of 0·7% and an overall programme mortality rate by October, 2015, was 2·2%. The most common surgical indications have been ventricular septal defect (26), patent ductus arteriosus (24), and tetralogy of Fallot (23).