LPG as a Clean Cooking Fuel: Adoption, Use, and Impact in Rural India

Household Air Pollution Interventions to Improve Health in Low- and Middle-Income Countries: An Official American Thoracic Society Research Statement

Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.

Prediction of consumers refill frequency of LPG: A study using explainable machine learning

Launched in 2016, the PMUY Programme of the Government of India aimed to provide 8 crore LPG connections to women in rural households over four years. After acquiring a new connection, some households appeared uninterested in ordering subsequent subsidized LPG refills, impacting programme's sustainability, and targeting strategy. We propose a prediction model using "Explainable Machine Learning" to anticipate the beneficiaries' refill frequency with a view to improving LPG-refills and social targeting. In this paper, we suggest an enhanced stacked SVM (ISS) model for classification, which is contrasted with state-of-art ML models: Random Forest (RF), SVM-RBF, Naive Bayes (NB), and Decision Tree (C5.0). Some of the performance matrices that are used to evaluate the models include accuracy, sensitivity, specificity, Cohen's Kappa statistics, Receiver Operating Characteristic curve (ROC), and area under the curve (AUC). The proposed approach, which was validated with 10-fold cross validation, produced the best overall accuracies for data splits of 50-50, 66-34, and 80-20. The "Explainable AI (XAI)" model has also been used to describe how models and features interact, and to discuss the importance of features and their contributions to prediction. The recommended XAI will aid in efficient "beneficiary targeting" and "policy interventions".

Explaining the rise of economic and rural-urban inequality in clean cooking fuel use in Tanzania

Despite the high rate of economic growth and electrification in the last two decades in Tanzania, only 6.9 % of the nation's households have access to clean cooking fuel technology which is concentrated among the rich urban households. Analysing data from two waves of the Tanzania National Panel Survey (2014/15 and 2020/21), we estimate the economic and rural-urban inequalities in the use of clean cooking fuel. Using the concentration curve, Erreygers concentration index and non-linear Fairlie decomposition, we find an increase in economic inequality and rural-urban inequality in the use of clean cooking fuel. Based on our analysis, factors such as the household head's education, household economic status and household connection to electricity contribute to the rural-urban inequality in the use of clean cooking fuel. Policy changes are vital for ensuring both rural and urban households have equitable access to education, electricity connection and household economic status to address inequality in the use of clean cooking fuel.

The fate of rice crop residues and context-dependent greenhouse gas emissions: Model-based insights from Eastern India

Crop residue burning is a common practice in many parts of the world that causes air pollution and greenhouse gas (GHG) emissions. Regenerative practices that return residues to the soil offer a 'no burn' pathway for addressing air pollution while building soil organic carbon (SOC). Nevertheless, GHG emissions in rice-based agricultural systems are complex and difficult to anticipate, particularly in production contexts with highly variable hydrologic conditions. Here we predict long-term net GHG fluxes for four rice residue management strategies in the context of rice-wheat cropping systems in Eastern India: burning, soil incorporation, livestock fodder, and biochar. Estimations were based on a combination of Tier 1, 2, and 3 modelling approaches, including 100-year DNDC simulations across three representative soil hydrologic categories (i.e., dry, median, and wet). Overall, residue burning resulted in total direct GHG fluxes of 2.5, 6.1, and 8.7 Mg CO2-e in the dry, median, and wet hydrologic categories, respectively. Relative to emissions from burning (positive values indicate an increase) for the same dry to wet hydrologic categories, soil incorporation resulted in a -0.2, 1.8, or 3.1 Mg CO2-e change in emissions whereas use of residues for livestock fodder increased emissions by 2.0, 2.1, or 2.3 Mg CO2-e. Biochar reduced emissions relative to burning by 2.9 Mg CO2-e in all hydrologic categories. This study showed that the production environment has a controlling effect on methane and, therefore, net GHG balance. For example, wetter sites had 2.8-4.0 times greater CH4 emissions, on average, than dry sites when rice residues were returned to the soil. To effectively mitigate burning without undermining climate change mitigation goals, our results suggest that geographically-target approaches should be used in the rice-based systems of Eastern India to incentivize the adoption of regenerative 'no burn' residue management practices.

Did COVID-19 Change the Availability and Use of Clean Energy for Cooking? Evidence From Ghana

A major part of Ghana's current household energy policy is focused on using a branded cylinder recirculation model (BCRM) to promote the safe use of Liquefied Petroleum Gas (LPG) for primary cooking. The implementation of the BCRM is expected to increase LPG adoption by households to the announced policy goal of 50% of the population by 2030. We investigated the impact of the COVID-19 pandemic on the implementation of the BCRM, availability, and household use of cleaner fuels. This was assessed using existing data on clean fuel use prior to the COVID-19 pandemic. Additional data was collected using questionnaire-based household surveys and qualitative interviews. It was found that the expansion of BCRM was significantly impacted by the COVID-19 pandemic. Planning activities such as baseline data collection and stakeholder engagement were delayed due to the COVID-19 restrictions. Changes in household incomes during the pandemic had the biggest percentage effect on household choice of cooking fuel, causing a regression in some cases, to polluting fuel use. This study provides insights that could be valuable in future understanding of the interactions between pandemic control measures and economic disruptions that may affect household energy choices for cooking.

The impact of household fuel usage on adverse pregnancy outcomes in rural Ma'anshan City, Anhui Province: a birth cohort study

The combustion of cooking fuels generates detrimental gases significantly impacting human health, particularly for vulnerable populations like expectant mothers. Prenatal exposure of such hazardous emissions raises the probability of adverse pregnancy outcomes, including preterm birth (PTB) and low birth weight (LBW). Our research aims to explore the association between cooking fuel utilization and adverse birth outcomes in rural Ma'anshan, Anhui Province. A prospective cohort study was executed, employing the Maternal and Infant Health Assessment questionnaire to classify fuels into clean (natural gas, electricity) and polluting energy sources (coal, coal gas, firewood). Multivariate logistic regression models were conducted to evaluate the association between fuel consumption and postpartum maternal and infant outcomes. Among the 442 surveyed pregnant women, 38.2% (N=169) utilized polluting fuels. After adjusting for covariates such as age and BMI, the relative risks of preterm birth, low birth weight, and postpartum hemorrhage in the polluting fuel group compared to the clean fuel group were OR: 3.27, 95% CI: 1.34, 8.00; OR: 3.50, 95% CI: 1.12, 10.90; and OR: 3.18, 95% CI: 1.06, 9.46, respectively. These results indicate that the usage of polluting fuels during pregnancy may heighten the risk of adverse birth outcomes. Consequently, additional research is advised to mitigate the harmful emissions generated by cooking fuels and advocate for clean energy adoption, enhancing maternal and infant well-being.

The association between access to key household resources and violence against women

We provide the first comprehensive analysis of the association between two key household resources (drinking water and toilet access) and both non-partner violence (NPV) and intimate partner violence (IPV) experienced by women. We use data from a nationally representative household survey for India obtained from the latest (fourth) round of the National Family Health Survey conducted in 2015-16. We employ logistic regression method and also use inverse-probability-weighted regression adjustment to control for selection bias. We find that NPV decreases with access to drinking water, while IPV decreases with provision of toilets. These results are found to be robust to an alternative method viz. propensity score matching and selection on unobservables using the Rosenbaum bounds approach.

Does access to clean cooking fuels reduce environmental degradation? Evidence from BRICS nations

Promotion of clean cooking fuel and technologies helps countries in achieving its sustainable development goals, thereby fulfilling environmental sustainability and empowering the status of women. Against this backdrop, the prime focus of this paper is to examine the impact of clean cooking fuels and technologies on overall greenhouse gas emissions. To do so, we draw data from BRICS nations since 2000-2016, employ the fixed-effect model, and show the robustness of the results by using Driscoll-Kraay standard error approach to address the panel data econometric issues. The empirical results show that energy use (LNEC), trade openness (LNTRADEOPEN), and urbanization (LNUP) promote emissions of greenhouse gases. Further, the finding also indicates that the use of clean cooking (LNCLCO) and foreign capital (FDI_NI) can help reduce the environmental degradation in achieving environmental sustainability in the BRICS nations. Overall findings endorse the development of clean energy at macro level, subsidizing and financing the clean cooking fuel and technologies, and promoting its usage at the household level to combat environmental degradation.

Deepened socioeconomic inequality in clean cooking fuel use in India from 2005-2006 to 2015-2016

Uptake of clean cooking fuels (CCF), such as liquefied petroleum gas (LPG), in place of traditional cooking fuels such as wood, charcoal, and kerosene can improve public health by reducing household air pollution exposures. Though studies have cross-sectionally examined socioeconomic determinants of cooking fuel adoption, little is known about socioeconomic disparities in CCF use over time. Data from the third (2005-06) and fourth (2015-16) rounds of the National Family Health Survey covering 109,041 and 601,509 households, respectively, were used to examine inequities in CCF use in India. While CCF use in India increased nationally from 25% in 2005-06 to 44% in 2015-16, the adoption of CCF varied widely across states and socio-economic groups. Approximately 2% of households in the poorest wealth quintile gained access to LPG during the study period, compared with an increase of 10% or more among households in the middle or richer wealth quintiles; the LPG access gap between the low (0.2%) and middle class (19.2%) was 19% in 2005-06 and nearly doubled to 35% (2.5% vs. 37.4%, respectively) in 2015-16. At the state level, there was a four-fold difference in the uptake of CCF over the two survey periods. The use of CCF increased by less than 10% in Himachal Pradesh, Bihar, Assam, Manipur, Mizoram, and Meghalaya as compared to the increases of at least 30% in Tamil Nadu (42%), undivided Andhra Pradesh (34%), and Kerala (30%). Further, in wealthier states (Delhi, Goa, Punjab, Haryana, Tamil Nadu, Kerala, and undivided Andhra Pradesh), CCF use increased by more than 20% among the poorest individuals compared with less than 1% among the poorest families in lower income states (Tripura, Meghalaya, Madhya Pradesh, Jharkhand, Chhattisgarh, Bihar). To promote a more equitable clean energy transition, poorer and rural Indian households should be prioritized for CCF promotion programs.

Household air pollution and cognitive health among Indian older adults: Evidence from LASI

BACKGROUND

Previous shreds of evidence have suggested that ambient air pollution is negatively associated with cognitive health among older adults, but whether indoor air pollutants such as cooking fuel, tobacco smoke, and incense burning exposure affect the cognitive score is unknown, especially in limited-resource areas.

METHOD

The study has utilized the recently released data from the Longitudinal Ageing Study of India (LASI), Wave 1, conducted from 2017 to 2018. A total of 63,883 (≥45 years) older adults were considered for the analysis. Descriptive statistics, bivariate analysis and ordinary least squares regression were employed in the study.

RESULTS

The estimated mean cognitive score was 25.4 and the percentage of solid fuel users was 45.6 in India. The cognitive score gap between the two groups was more remarkable in Tamil Nadu (clean fuels: 29.7; solid fuels: 23.9). A significant cognitive score gap was observed for all indoor air pollutants, i.e., cooking fuel (clean: 29.7 and solid fuels: 23.9), exposure to tobacco smoke (not exposed: 25.7 and exposed: 24.4), and exposure to daily incense burning (not exposed: 25.9 and exposed: 24.8). The unadjusted model found that a one-unit increase of using charcoal/lignite/coal reduces the cognitive score by 5 (95% CI: -5.36, -4.61). A similar effect of exposure to tobacco smoke (β = -0.79, 95% CI: -0.89, -0.68) and incense burning (β = -0.28, 95% CI: -0.30, -0.26) was explored in the study. After adjusting socioeconomic and demographic characteristics, indoor air pollution was found to be a significant determinant of cognitive health.

CONCLUSIONS

The study has identified exposure to indoor air pollution as a risk factor for cognitive impairment among older adults. Therefore, we suggest an urgent need of promoting existing schemes like the Pradhan Mantri Ujjwala Yojana and creating awareness about the adverse effects of indoor air pollutants for a better future.

Clean Household Energy Consumption and Residents' Well-Being: Empirical Analysis and Mechanism Test

Improving well-being is a critical problem for worldwide social progress. Research on well-being effects of clean household energy consumption is of great significance for the realization of United Nation's Sustainable Development Goals (SDGs). Due to the multifaceted role of clean household energy in enhancing well-being as a sustainable development goal, it has attracted extensive academic attention and research but still needs to be further refined through new perspectives. This paper uses data from the 2018 China Health and Retirement Longitudinal Study to conduct an empirical analysis of clean household energy consumption and residents' well-being using an ordered probit model, the instrumental variables method, a conditional mixed process (CMP) method, and a mechanism analysis model. The results show that (1) household clean energy consumption contributes to residents' well-being, and the results remained significant after selecting "Do you have an electric Bicycle?" as an instrumental variable to address the endogeneity question. (2) According to heterogeneity research, women's wellbeing is impacted by clean energy consumption in the household more than men's. Only in rural locations can clean household energy consumption significantly boost well-being; urban and suburban areas are unaffected. (3) In the mechanism analysis, health condition and depression played a mediating role on the impact of clean household energy consumption on well-being, and social contact played a moderating role on the impact of clean household energy consumption on well-being. The findings and policy recommendations in this paper are suggestive of how we can improve the well-being of residents in low- and middle-income countries and provide reference values for research in related fields around the world.

Assessing the Effects of Stove Use Patterns and Kitchen Chimneys on Indoor Air Quality during a Multiyear Cookstove Randomized Control Trial in Rural India

We conducted indoor air quality (IAQ) measurements during a multiyear cookstove randomized control trial in two rural areas in northern and southern India. A total of 1205 days of kitchen PM_2.5 were measured in control and intervention households during six ∼3 month long measurement periods across two study locations. Stoves used included traditional solid fuel (TSF), improved biomass, and liquefied petroleum gas (LPG) models. Intent-to-treat analysis indicates that the intervention reduced average 24 h PM_2.5 and black carbon in only one of the two follow-up measurement periods in both areas, suggesting mixed effectiveness. Average PM_2.5 levels were ∼50% lower in households with LPG (for exclusive LPG use: >75% lower) than in those without LPG. PM_2.5 was 66% lower in households making exclusive use of an improved chimney stove versus a traditional chimney stove and TSF-exclusive kitchens with a built-in chimney had ∼60% lower PM_2.5 than those without a chimney, indicating that kitchen ventilation can be as important as the stove technology in improving IAQ. Diurnal trends in real-time PM_2.5 indicate that kitchen chimneys were especially effective at reducing peak concentrations, which leads to decreases in daily PM_2.5 in these households. Our data demonstrate a clear hierarchy of IAQ improvement in real world, "stove-stacking" households, driven by different stove technologies and kitchen characteristics.

Ecohealth Villages: A Framework for an Ecosystem Approach to Health in Human Settlements

As life emerged on Earth, it began to affect its environments. It still does. The complex interactions between living things and their environments mediate the character of both. Today, this is apparent in the global impacts humans have made on ecosystems, with resultant reciprocal impacts on human health. This paper is concerned with that reciprocity, which may be considered as a link between ecosystems and human populations. We will distinguish an ecosystem approach to human health—or ecohealth—from One Health and planetary health perspectives. We will also propose a conceptual framework that can be used to distinguish human settlements as Ecohealth Villages. Broadly defined, an Ecohealth Village is a settlement that recognizes the interactions between healthy ecosystems and the health of people who live, work, learn, and play in it. The key principles of an Ecohealth Villages are as follows: community ownership, ecological restoration, sustainability, social and gender equity, integrated perspectives, and traditional practices and knowledge. Together, they support a holistic, ecosystem approach to health in human settlements, as demonstrated in case studies from Mexico and Aotearoa New Zealand.

Factors affecting access to clean cooking fuel among rural households in India during COVID-19 pandemic

This paper investigates the factors affecting access to clean cooking fuel among rural Indian households during the COVID-19 outbreak, based on World Bank's rural impact survey, covering 2731 rural households. Our analysis shows a significant decline in access to clean fuel among rural households from 35% in 2018 i.e. before COVID-19 to 19.7% during the COVID-19 pandemic. This implies that in order to meet their cooking needs, many rural households have switched from conventional fuels, which have numerous health and environmental concerns. The association between states and socio-demographic profiles of rural households with access to sources of cooking fuel shows a significant difference. The analysis results further indicate that socio-demographic characteristics and asset holdings of the rural households are the key factors that determine access to clean cooking fuel during COVID-19. Among the socio-demographic variables, age, gender, family size, social category, and income level are estimated to be significant factors that affect the access to clean fuel for cooking. Similarly, ownership of assets such as exclusive kitchen room, refrigerator, pressure cooker, television, and furniture are significant factors affecting access to clean cooking fuel among Indian rural households. Additionally, this study provides policy insights on developing mechanisms to ensure that rural households have an access to clean cooking fuel during crisis situations such as COVID-19.

Multinational prediction of household and personal exposure to fine particulate matter (PM2.5) in the PURE cohort study

INTRODUCTION

Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM_2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM_2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM_2.5 exposure models.

METHODS

The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM_2.5 kitchen concentrations (n = 2,365) and male and/or female PM_2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM_2.5 exposures.

RESULTS

The final models explained half (R² = 54%) of the variation in kitchen PM_2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R² = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM_2.5 kitchen concentrations. Average national PM_2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 μg/m³ (Chile); 55 μg/m³ (China)) and 12-fold among households primarily cooking with wood (36 μg/m³ (Chile)); 427 μg/m³ (Pakistan)). Average PM_2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM_2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile).

CONCLUSION

Using survey data to estimate PM_2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM_2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.

Will open waste burning become India's largest air pollution source?

India struggles with frequent exceedances of the ambient air quality standard for particulate matter and benzene. In the past two decades, India has made considerable progress in tackling indoor air pollution, by phasing out kerosene lamps, and pushing biofuel using households towards Liquefied Petroleum Gas (LPG) usage. In this study, we use updated emission inventories and trends in residential fuel consumption, to explore changes in the contribution of different sectors towards India's largest air pollution problem. We find that residential fuel usage is still the largest air pollution source, and that the <10% households using cow dung as cooking fuel contribute ∼50% of the residential PM_2.5 emissions. However, if current trends persist, residential biofuel usage in India is likely to be phased out by 2035. India's renewable energy policies are likely to reduce emissions in the heat and electricity sector, and manufacturing industries, in the mid-term. PM_2.5 emissions from open waste burning, on the other hand, hardly changed in the decade from 2010 to 2020. We conclude that without strong policies to promote recycling and upcycling of non-biodegradable waste, and the conversion of biodegradable waste to biogas, open waste burning is likely to become India's largest source of air pollution by 2035. While our study is limited to India, our findings are of relevance for other countries in the global South suffering from similar waste management challenges.

LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial

The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM2.5 for 24 or 48 h using gravimetric-based PM2.5 samplers at baseline and two follow-ups over two months after delivery of an LPG cookstove and free fuel supply. Mixed models were used to estimate PM2.5 reductions. Median kitchen PM2.5 concentrations were 296 μg/m3 at baseline (interquartile range, IQR: 158-507), 24 μg/m3 at first follow-up (IQR: 18-37), and 23 μg/m3 at second follow-up (IQR: 14-37). Median personal exposures to PM2.5 were 134 μg/m3 at baseline (IQR: 71-224), 35 μg/m3 at first follow-up (IQR: 23-51), and 32 μg/m3 at second follow-up (IQR: 23-47). Overall, the LPG intervention was associated with a 92% (95% confidence interval (CI): 90-94%) reduction in kitchen PM2.5 concentrations and a 74% (95% CI: 70-79%) reduction in personal PM2.5 exposures. Results were similar for each site. CONCLUSIONS: The intervention was associated with substantial reductions in kitchen and personal PM2.5 overall and in all sites. Results suggest LPG interventions in these rural settings may lower exposures to the WHO annual interim target-1 of 35 μg/m3. The range of exposure contrasts falls on steep sections of estimated exposure-response curves for birthweight, blood pressure, and acute lower respiratory infections, implying potentially important health benefits when transitioning from solid fuels to LPG.

Gender and LPG use after government intervention in rural north India

Exposure to air pollution from cooking with solid fuels has important consequences for public health. This paper focuses on rural north India, where despite robust economic growth and government subsidies, the vast majority of households mainly use solid fuels. We draw on new qualitative and quantitative data collected in the context of a policy environment that dramatically expanded ownership of liquid petroleum gas (LPG) to examine why households are slow to adopt clean fuels in rural north India. We find that patriarchal gender norms and attitudes encourage the use of solid fuels in this region. North Indian society confers low status to women, promotes women's seclusion, and constrains women's engagement in economic activities outside of the home. These beliefs encourage women to preserve gas, promote women's work that facilitates the use of solid fuels, and hinder communication between the cook and the decision-maker regarding LPG refills. When rural north Indian households use gas, it is frequently to facilitate the adherence to norms of seclusion that prevent women from leaving the home to collect solid fuels. In addition to expanding access and improving economic conditions, future research and policy interventions should pay careful attention to the gender norms and attitudes that discourage the use of gas. Addressing these beliefs and norms is essential to sustained LPG use and health improvements.

Household cooking fuel estimates at global and country level for 1990 to 2030

Household air pollution generated from the use of polluting cooking fuels and technologies is a major source of disease and environmental degradation in low- and middle-income countries. Using a novel modelling approach, we provide detailed global, regional and country estimates of the percentages and populations mainly using 6 fuel categories (electricity, gaseous fuels, kerosene, biomass, charcoal, coal) and overall polluting/clean fuel use – from 1990-2020 and with urban/rural disaggregation. Here we show that 53% of the global population mainly used polluting cooking fuels in 1990, dropping to 36% in 2020. In urban areas, gaseous fuels currently dominate, with a growing reliance on electricity; in rural populations, high levels of biomass use persist alongside increasing use of gaseous fuels. Future projections of observed trends suggest 31% will still mainly use polluting fuels in 2030, including over 1 billion people in Sub-Saharan African by 2025.

Household air pollution derived from cooking fuels is a major source of health and environmental problems. Here, the authors provide detailed global, regional and country estimates of cooking fuel usage from 1990 to 2030 and project that 31% of people will still be mainly using polluting fuels in 2030.

Cause Analysis of the Large-Scale LPG Explosion Accident Based on Key Investigation Technology: A Case Study

Blending dimethyl ether (DME) into liquefied petroleum gas (LPG) has become a common phenomenon. On December 3, 2019, an LPG/DME explosion occurred in Beijing, resulting in 4 deaths and 10 injuries. To deeply investigate the cause and explosion process of the explosion accident, the accident investigation method combining on-site inspection, material evidence analysis, experimental verification, and logical reasoning was used. In addition, the location of the ignition point, the explosive substances, the cause of the gas leakage, the process and the distribution characteristics of the gas leakage, and the ignition process were successively reasoned and analyzed in detail. The results show that the LPG/DME-blended gas can effectively corrode silicone flange gaskets, forming laminar fractures and radial cracks on the gasket. As a result, the tensile strength of the gasket decreased. Under the action of the gas pressure inside the pipeline, the gasket was torn and a leakage hole was formed. The leaked combustible gas formed at least 305 m³ of the explosive gas mixture inside and outside the refrigerated storage. The investigation and research results have important scientific guiding significance for revealing the cause and preventing similar accidents.

A Framework for Addressing the Twin Challenges of COVID-19 and Climate Change for Sustainable Agriculture and Food Security in South Asia

Climate change has begun to ravage agriculture and threaten food security in many parts of the world. The novel coronavirus pandemic (COVID-19) has further disrupted agricultural activities and supply chains and has become a serious threat for public health. Like in many developing countries, South Asian farmers are now facing the double challenge of addressing the impacts of a changing climate and managing the disruptions caused by COVID-19. Despite growing concern, there is limited understanding of how climate change, public health, and COVID-19 interact, and of the possible pathways to achieving a climate-friendly recovery from COVID-19 to achieve food and nutrition security. In view of this, this paper explores the multifaceted challenges that farmers are now facing in South Asia due to climate change and the disruption caused by COVID-19 from the agricultural and food security lens. The analysis reveals that the complex interactions of COVID-19 and climate change have impacted all dimensions of food security. These interlinkages demand an integrated approach in dealing with food, public health, and climate change to harness synergies and minimize trade-offs between food production, public health, and climate mitigation. I present a framework to address the immediate challenge of COVID-19 and the longer-term challenge of anthropogenic climate change. Key elements of the framework include the strengthening health sector response capacities, strengthening of local and regional food systems, making agriculture resilient to pandemics, adopting flexible and smart approaches—including the implementation of climate-smart agricultural interventions on different scales, promotion of appropriate research and innovation, and the integration of short-term support to address the challenges of COVID-19 to build long-term productivity, and resilience of food systems by investing on natural capital. This framework would enable policy makers to choose the appropriate policy responses at different scales, to address these twin challenges of COVID-19 and climate change.

Why energy access is not enough for choosing clean cooking fuels? Evidence from the multinomial logit model

The transition to sustainable energy requires an assessment of drivers of the use of clean and dirty fuels for cooking. Literature highlights the importance of access to clean fuel for switching from dirty fuels to clean fuels. Though access to cleaner fuels, such as electricity promotes clean fuel use, it does not necessarily lead to a complete transition to the use of clean fuels. Households continue using traditional fuels in addition to the clean fuels. The main objective of this paper is to explain the choice of dirty cooking fuels even when access to electricity is provided. We use nationally representative household survey data to study the household energy use decisions in three middle-income countries, namely, India, Kazakhstan, and the Kyrgyz Republic. The study discusses the role of access to natural gas, free fuel, convenience or multi-use of fuels featured by the heating system installed, built-in environment, and other socio-economic factors in household fuel choice for cooking. The results show that access to natural gas increases the likelihood of opting for clean fuel, while the availability of free fuel in rural areas and the coal-based heating system promote the use of solid fuels.

Firewood, forests, and fringe populations: Exploring the inequitable socioeconomic dimensions of Liquified Petroleum Gas (LPG) adoption in India

Liquified petroleum gas (LPG) is an important clean fuel alternative for households that rely on burning biomass for daily cooking needs. In India, Pradhan Mantri Ujjwala Yojana (PMUY) has provided poor households with LPG connections since 2016. We investigate cooking fuel use in households to determine the impact of the policy in the Central Indian Highlands Landscape (CIHL). The CIHL has a large population of marginalized social groups, including Indigenous, Scheduled Tribe, Schedule Caste, and Other Backward Caste people. We utilize survey data from 4,994 households within 500 villages living in forested regions collected in 2018 and a satellite-derived measure of forest availability to investigate the household and ecological determinants of LPG adoption and the timing of this adoption (pre- or post-2016). In addition, we document patterns of firewood collection and evaluate the extent to which households acquiring LPG change these activities. The probability of cooking with LPG was lowest for marginalized social groups. We observe that households recently adopting LPG, likely through PMUY, are poorer, more socially marginalized, less educated, and have more forest available nearby than their early-adopter counterparts. While 90% of LPG-using households continue to use firewood, households that have owned LPG for more years report spending less time collecting firewood, indicating a waning reliance on firewood over time. Policies targeting communities with marginalized social groups living near forests can further accelerate LPG adoption and displace firewood use. Despite overall growth in LPG use, disparities in access to clean cooking fuels remain between socioeconomic groups in India.

Enhancing LPG Adoption in Ghana (ELAG): A Trial Testing Policy-Relevant Interventions to Increase Sustained Use of Clean Fuels

Rural Ghanaians rely on solid biomass fuels for their cooking. National efforts to promote the Sustainable Development Goals include the Rural Liquefied Petroleum Gas Promotion Program (RLP), which freely distributes LPG stoves, but evaluations have demonstrated low sustained use among recipients. Our study objective was to assess if cheap and scalable add-on interventions could increase sustained use of LPG stoves under the RLP scheme. We replicated RLP conditions among participants in 27 communities in Kintampo, Ghana, but cluster-randomized them to four add-on interventions: a behavioral intervention, fuel delivery service, combined intervention, or control. We reported on the final 6 months of a 12-month follow-up for participants (n = 778). Results demonstrated increased use for each intervention, but magnitudes were small. The direct delivery intervention induced the largest increase: 280 min over 6 months (p < 0.001), ∼1.5 min per day. Self-reported refills (a secondary outcome), support increased use for the dual intervention arm (IRR = 2.2, p = 0.026). Past literature demonstrates that recipients of clean cookstoves rarely achieve sustained use of the technologies. While these results are statistically significant, we interpret them as null given the implied persistent reliance on solid fuels. Future research should investigate if fuel subsidies would increase sustained use since current LPG promotion activities do not.

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019

BACKGROUND

The association of air pollution with multiple adverse health outcomes is becoming well established, but its negative economic impact is less well appreciated. It is important to elucidate this impact for the states of India.

METHODS

We estimated exposure to ambient particulate matter pollution, household air pollution, and ambient ozone pollution, and their attributable deaths and disability-adjusted life-years in every state of India as part of the Global Burden of Disease Study (GBD) 2019. We estimated the economic impact of air pollution as the cost of lost output due to premature deaths and morbidity attributable to air pollution for every state of India, using the cost-of-illness method.

FINDINGS

1·67 million (95% uncertainty interval 1·42-1·92) deaths were attributable to air pollution in India in 2019, accounting for 17·8% (15·8-19·5) of the total deaths in the country. The majority of these deaths were from ambient particulate matter pollution (0·98 million [0·77-1·19]) and household air pollution (0·61 million [0·39-0·86]). The death rate due to household air pollution decreased by 64·2% (52·2-74·2) from 1990 to 2019, while that due to ambient particulate matter pollution increased by 115·3% (28·3-344·4) and that due to ambient ozone pollution increased by 139·2% (96·5-195·8). Lost output from premature deaths and morbidity attributable to air pollution accounted for economic losses of US$28·8 billion (21·4-37·4) and $8·0 billion (5·9-10·3), respectively, in India in 2019. This total loss of $36·8 billion (27·4-47·7) was 1·36% of India's gross domestic product (GDP). The economic loss as a proportion of the state GDP varied 3·2 times between the states, ranging from 0·67% (0·47-0·91) to 2·15% (1·60-2·77), and was highest in the low per-capita GDP states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Chhattisgarh. Delhi had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, with 5·4 times variation across all states.

INTERPRETATION

The high burden of death and disease due to air pollution and its associated substantial adverse economic impact from loss of output could impede India's aspiration to be a $5 trillion economy by 2024. Successful reduction of air pollution in India through state-specific strategies would lead to substantial benefits for both the health of the population and the economy.

FUNDING

UN Environment Programme; Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder

In India, approximately 480,000 deaths occur annually from exposure to household air pollution from the use of biomass cooking fuels. Displacing biomass use with clean fuels, such as liquefied petroleum gas (LPG), can help reduce these deaths. Through government initiatives, most Indian households now own an LPG stove and one LPG cylinder. Many households, however, continue to regularly use indoor biomass-fueled mud stoves (chulhas) alongside LPG. Focusing on this population in rural Maharashtra, India, this study (N = 186) tests the effects of conditioning a sales offer for a spare LPG cylinder on a reversible commitment requiring initially disabling indoor chulhas. We find that almost all relevant households (>98%) were willing to accept this commitment. Indoor chulha use decreased by 90% (95% CI = 80% to 101%) when the sales offer included the commitment, compared to a 23% decrease (95% CI = 14% to 32%) without it. For both treatment groups, we find that 80% purchased the spare cylinder at the end of the study.

Exploring the impact of a liquefied petroleum gas intervention on time use in rural Peru: A mixed methods study on perceptions, use, and implications of time savings

BACKGROUND

Efforts to promote clean cooking through adoption of clean-burning fuels such as liquefied petroleum gas (LPG) are often based on the idea that near-exclusive use of LPG could lead to health improvements. However, benefits beyond health, such as time savings, could be more tangible and meaningful to LPG users.

OBJECTIVES

This study investigated the effect of an LPG intervention on time spent cooking and collecting fuel, using objective measures of stove temperatures combined with self-reports under conditions of near-exclusive LPG use. We also investigated the perceived value of any time savings and potential economic and quality of life implications.

METHODS

We analyzed data from the Cardiopulmonary outcomes and Household Air Pollution trial in Puno, Peru, a randomized controlled trial with 180 participants assessing exposure and health impacts of an LPG stove, fuel, and behavioral intervention. Surveys conducted with 90 intervention women receiving free LPG and 90 control women cooking primarily with biomass assessed time spent cooking and collecting biomass fuel and use of time savings. Cooking time was objectively measured with temperature sensors on all stoves. Qualitative interviews explored perceptions and use of time savings in more depth.

RESULTS

Intervention women spent 3.2 fewer hours cooking and 1.9 fewer hours collecting fuel per week compared to control women, but cooked on average 1.0 more meals per day. Participants perceived time saved from LPG positively, reporting more time for household chores, leisure activities, and activities with income-generating potential such as caring for animals and working in fields.

DISCUSSION

This paper suggests that the benefits of LPG extend beyond health and the environment. LPG use could also lead to economic and quality of life gains, through increased time for work, rest, and consumption of hot meals, and reduced arduous biomass fuel collection.

Solid fuel users' perceptions of household solid fuel use in low- and middle-income countries: A scoping review

Almost half of the global population is exposed to household air pollution (HAP) from the burning of biomass fuels primarily for cooking, and this has been linked with considerable mortality and morbidity. While alternative cooking technologies exist, sustained adoption of these is piecemeal, indicating that there is insufficient knowledge of understandings of HAP within target communities. To identify potential gaps in the literature, a scoping review was conducted focused on solid fuel users' perceptions of HAP and solid fuel use in low- and middle-income countries. From the initial 14,877 search returns, 56 were included for final analysis. An international multi-disciplinary workshop was convened to develop the research question; six key domains: health; family and community life; home, space, place and roles; cooking and cultural practices, environment; and policy and practice development, were also identified using a Social Ecological Model framework. The review showed a series of disconnects across the domains which highlighted the limited research on perceptions of HAP in the literature. Reviewed studies showed that participants emphasized short-term health impacts of HAP as opposed to longer-term health benefits of interventions and prioritized household security over improved ventilation. There was also a socio-demographic gendered disconnect as although women and children generally have most exposure to HAP, their decision-making power about use of solid fuels is often limited. In the domain of policy and practice, the review identified the importance of community norms and cultural traditions (including taste). Research in this domain, and within the environment domain is however limited and merits further attention. We suggest that interventions need to be locally situated and community-led and a deeper understanding of perceptions of HAP could be obtained using participatory and innovative research methods. Bridging the disconnects and gaps identified in this review is essential if the global disease burden associated with HAP is to be reduced.

Use of liquefied petroleum gas in Puno, Peru: Fuel needs under conditions of free fuel and near-exclusive use

Reducing the burden of household air pollution could be achieved with exclusive adoption of cleaner fuels such as liquefied petroleum gas (LPG). However, we lack understanding of how much LPG is required to support exclusive use and how household characteristics affect this quantity. This paper used data from 90 participants in the Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial in Puno, Peru who received free LPG deliveries for one year. Households with a mean of four members that cooked nearly exclusively (>98%) with LPG used an average of 19.1 kg (95% CI 18.5 to 19.6) of LPG per month for tasks similar to those done with the traditional biomass stove. LPG use per month was 0.5 kg higher for each additional pig or dog owned (p=0.003), 0.7 kg higher for each additional household member (p<0.001), 0.3 kg higher for households in the second-lowest compared to the lowest wealth quintile (p=0.01), and 1.1 kg higher if the household had previously received subsidized LPG (p=0.05). LPG use per month was 1.1 kg lower during the rainy season (p<0.001) and 1.7 kg lower during the planting season (p<0.001) compared to the cold and harvest seasons, despite the fact that LPG was not typically used for space heating. LPG use decreased by 0.05 kg per month over the course of one year after receiving the LPG stove (p=0.02). These results suggest that achieving exclusive LPG use in Puno, Peru requires that rural residents have affordable access to an average of two 10 kg LPG tanks per month. Conducting similar investigations in other countries could help policymakers set and target LPG subsidies to ensure that households have access to enough LPG to achieve exclusive LPG use and the potential health benefits.

Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

INTRODUCTION

Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda.

METHODS

Using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial.

RESULTS

We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits.

CONCLUSION

Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.

TRIAL REGISTRATION NUMBER

NCT02944682, Pre-results.

Using longitudinal survey and sensor data to understand the social and ecological determinants of clean fuels use and discontinuance in rural Ghana

Efforts to reduce the health and ecological burdens of household biomass combustion are underway in Ghana, principally by promoting clean cookstoves and fuels. Recent studies have focused on the sustained use of clean cookstoves, but sometimes household adopt a new cookstove and then end use of that stove. In this study, we introduce a novel framework for understanding and encouraging household transitions to cleaner cooking: clean fuel discontinuance. We leveraged data from the Ghana Randomized Air Pollution and Health Study (GRAPHS) (N = 1412) where pregnant women received either improved biomass (BioLite) or dual burner LPG stoves for free. LPG users were given free LPG refills during GRAPHS. Weekly questionnaires were administered. Stove use monitors tracked a sub-cohort (n = 220) 6 months before and after the fuel subsidy. We examined social and ecological determinants of stove use and discontinuance. Overall intervention stove use adherence was high throughout GRAPHS, with self-reported use at 69% and 86% of participant-weeks for BioLite and LPG arms respectively. Participants used intervention stoves less for meals requiring vigorous stirring. Burns from intervention stoves decreased use among BioLite (RR: 0.96, p = 0.009), but not LPG users. Device breakage was mentioned as an impediment in 18% of free-text responses for LPG users and 1% for BioLite. Tree canopy within a spatial buffer-a plausible proxy for biomass fuels access-was the only variable explaining LPG discontinued stove use in adjusted Cox time-to-event analyses (HR = -0.56, p < 0.001). Future studies should consider the stove use discontinuance framework.

Drivers of the Adoption and Exclusive Use of Clean Fuel for Cooking in Sub-Saharan Africa: Learnings and Policy Considerations from Cameroon

Household air pollution (HAP) caused by the combustion of solid fuels for cooking and heating is responsible for almost 5% of the global burden of disease. In response, the World Health Organisation (WHO) has recommended the urgent need to scale the adoption of clean fuels, such as liquefied petroleum gas (LPG), in low and middle-income countries (LMICs). To understand the drivers of the adoption and exclusive use of LPG for cooking, we analysed representative survey data from 3343 peri-urban and rural households in Southwest Cameroon. Surveys used standardised tools to collect information on fuel use, socio-demographic and household characteristics and use of LPG for clean cooking. Most households reported LPG to be clean (95%) and efficient (88%), but many also perceived it to be expensive (69%) and unsafe (64%). Positive perceptions about LPG's safety (OR = 2.49, 95% CI = 2.04, 3.05), cooking speed (OR = 4.31, 95% CI = 2.62, 7.10), affordability (OR = 1.7, 95% CI = 1.38, 2.09), availability (OR = 2.17, 95% CI = 1.72, 2.73), and its ability to cook most dishes (OR = 3.79, 95% CI = 2.87, 5.01), were significantly associated with exclusive LPG use. Socio-economic status (higher education) and household wealth (higher income) were also associated with a greater likelihood of LPG adoption. Effective strategies to raise awareness around safe use of LPG and interventions to address financial barriers are needed to scale wider adoption and sustained use of LPG for clean cooking, displacing reliance on polluting solid fuels.

Beyond cost: Exploring fuel choices and the socio-cultural dynamics of liquefied petroleum gas stove adoption in Peru

Reducing the burden of household air pollution requires that cleaner fuels such as liquefied petroleum gas (LPG) be used nearly exclusively. However, exclusive adoption has been challenging in low- and middle-income countries. Previous studies have found that economic, social, and cultural barriers often impede adoption. We conducted in-depth qualitative interviews with 22 participants in a research trial where LPG was provided for free in Puno, Peru. We aimed to determine whether social and cultural barriers to LPG use persisted when monetary costs to the household were removed, and what factors influenced exclusive adoption of LPG in a cost-free context. Facilitators of LPG use included: support from study staff, family support, time savings, previous experience with LPG, stove design, ability to use existing pots, smoke reductions, desire for cleanliness, removal of traditional stoves, and perceptions of luck. Barriers to LPG use included: fears of LPG, problems with LPG brands, delays in obtaining LPG refills, social pressure, perceived incompatibility of traditional dishes, perceived inability to use clay pots, separate kitchens for LPG and traditional stoves, designated pots for use on the traditional stove, and lack of heat. However, these barriers did not prevent participants from using LPG nearly exclusively. Results suggest that social and cultural barriers to exclusive LPG use can be overcome when LPG stoves and fuel are provided for free and supplemented with behavioral support. Governments should evaluate the economic feasibility and sustainability of LPG subsidization, considering the potential benefits of exclusive LPG use.

Affordability, Accessibility, and Awareness in the Adoption of Liquefied Petroleum Gas: A Case-Control Study in Rural India

Interventions in the clean cooking sector have focused on improved biomass stoves in a bid to address household air pollution (HAP) in low- and middle-income countries. These initiatives have not delivered adequate health and environmental benefits owing to the less than optimal performance of improved biomass stoves. There is an urgency to transition communities to cleaner cooking systems such as liquefied petroleum gas (LPG) to reduce the prevalence of HAP. Adoption of LPG also has challenges. This case-control cross-sectional study with 510 households examines how affordability, accessibility, and awareness (3As) are associated with LPG adoption in rural poor households of Andhra Pradesh, a state of India. Using binomial logistic regression analyses, the study examines the association of 3As with LPG adoption, adjusting for demographic predictors. Results show disparities in LPG adoption owing to affordability, accessibility, and awareness. Household income is positively associated with LPG adoption. Easy availability of biomass deters households from adopting LPG. Concerns for LPG safety reduces likelihood of LPG adoption. On the other hand, attending awareness campaigns on clean cooking benefits is strongly associated with LPG adoption. Awareness drives, primarily targeted marketing campaigns, could help expand LPG coverage among poorer households. This paper offers insights into the determinants of clean fuel adoption with implications for resource-poor settings across the world to advance energy justice and address energy poverty.

The drivers of sustained use of liquified petroleum gas in India

Ninety-five per cent of Indian households now have access to liquified petroleum gas (LPG), with 80 million acquiring it under the Pradhan Mantri Ujjwala Yojana (PMUY) since 2016. Still, having a connection is not enough to eliminate household air pollution. Studying panel data from rural households in six major states from 2014-2015 and 2018, we assess the determinants of cooking energy transition from solid fuels to LPG. We find that PMUY beneficiaries have much lower odds of using LPG as the primary or exclusive fuel compared with general customers, irrespective of their economic status. Village-level penetration of LPG as a primary fuel and the years of LPG use positively influence its sustained use, while ease of access to freely available biomass and reliance on uncertain and irregular income sources hinder LPG use. The findings highlight the need to interlace cooking fuel policies with rural development, to enable a complete transition towards cleaner cooking fuels.

Everybody Stacks: Lessons from household energy case studies to inform design principles for clean energy transitions

Stove stacking (concurrent use of multiple stoves and/or fuels) is a poorly quantified practice in regions where efforts to transition household energy to cleaner stoves/or fuels are on-going. Using biomass-burning stoves alongside clean stoves undermines health and environmental goals. This review synthesizes stove stacking data gathered from eleven case studies of clean cooking programs in low/middle-income country settings. Analyzed data are from ministry and program records, research studies, and informant interviews. Thematic analysis identify key drivers of stove stacking behavior in each setting. Significant (28%-100%) stacking with traditional cooking methods was observed in all cases. Reason for traditional fuel use includes: costs of clean fuel; mismatches between cooking technologies and household needs; and unreliable fuel supply. National household surveys often focus on 'primary' cookstoves and miss stove stacking data. Thus more attention should be paid to discontinuation of traditional stove use, not solely adoption of cleaner stoves/fuels. Future energy policies and programs should acknowledge the realities of stacking and incorporate strategies at the design stage to transition away from polluting stoves/fuels. Seven principles for clean cooking system program design and policy are presented, focused on a shift toward "cleaner stacking" that could yield household air pollution reductions approaching WHO targets.

The Role of Education and Attitudes in Cooking Fuel Choice: Evidence from two states in India

Widespread adoption of clean cooking fuels is a necessary step toward reducing household air pollution and improving population health. Here we use large-scale surveys (10,000 households) from two Indian states, Kerala and Rajasthan, to examine how education and attitudes toward cooking associate with the adoption of liquefied petroleum gas (LPG), India's most popular clean cooking fuel. We report three main results. First, education is a strong predictor of LPG adoption. Second, perceptions that LPG is good and affordable and progressive health-related perceptions are associated with LPG ownership. Third, and surprisingly, education does not predict positive attitudes toward clean cooking fuels. These results suggest that education leads to LPG adoption, but not through attitudinal changes. Further research should examine the mediators of the observed robust education-adoption association.

A Feasibility Study Assessing Acceptability and Supply Issues of Distributing LPG Cookstoves and Gas Cylinders to Pregnant Women Living in Rural Bangladesh for Poriborton: The CHANge Trial

Our aim was to develop a protocol for a cluster randomised controlled trial to assess the impact of liquid petroleum gas (LPG) cooking compared to usual cooking on perinatal mortality in pregnant women in rural Bangladesh. We, therefore, aimed to assess the feasibility of the planned trial and the barriers/facilitators of distributing LPG to rural households. We conducted a feasibility study in rural Bangladesh using an iterative design. We included pregnant women, their families, and local LPG stakeholders. We distributed LPG to households for 3 months (3 cylinders) and assessed process issues, acceptability, and cooking/food behaviours. We interviewed LPG stakeholders, and conducted focus groups and in-depth interviews with the users. The initial distribution and uptake of LPG were hampered by process issues, most of these were due to the nonestablished supply chain in the study area. LPG cooking was very acceptable and all users reported a preference for continued use, fuel-sparing was heavily practiced. Safety concerns were an initial issue. LPG stakeholders reported that LPG demand differed by season. This study demonstrated the feasibility of our planned trial and the need for safety messages. These results are relevant beyond our trial, including for programs of LPG fuel promotion.

Household fuel mixes in peri-urban and rural Ecuador: Explaining the context of LPG, patterns of continued firewood use, and the challenges of induction cooking

Nationwide transitions from cooking with solid fuels to clean fuels promise substantial health, climate, and environmental benefits. For decades, Ecuador has invested heavily in consumption subsidies for liquified petroleum gas (LPG), a leading clean fuel. With the goal of understanding household energy use in a context where LPG is ubiquitous and cheap, we administered 808 household surveys in peri-urban and rural communities in Coastal and Andean Ecuadorian provinces. We assess cooking fuel patterns after long-term LPG access and the reach of induction stoves promoted through a recent government program. Nearly all participants reported using LPG for more than a decade and frequent, convenient access to highly subsidized LPG. Nonetheless, half of rural households and 20% of peri-urban households rely on firewood to meet specific household energy needs, like space heating or heating water for bathing. Induction was rare and many induction owners reported zero use because the required equipment had never been installed by electricity companies, their stove had broken, or due to fears of high electricity costs. Our discussion is instructive for other countries because of Ecuador's long-standing clean fuel policies, robust LPG market and standardized cylinder recirculation model, and promotion of induction stoves.

Supply Considerations for Scaling Up Clean Cooking Fuels for Household Energy in Low- and Middle-Income Countries

Promoting access to clean household cooking energy is an important subject for policy making in low- and middle-income countries, in light of urgent and global efforts to achieve universal energy access by 2030 (Sustainable Development Goal 7). In 2014, the World Health Organization issued "Guidelines for Indoor Air Quality: Household Fuel Combustion", which recommended a shift to cleaner fuels rather than promotion of technologies that more efficiently combust solid fuels. This study fills an important gap in the literature on transitions to household use of clean cooking energy by reviewing supply chain considerations for clean fuel options in low- and middle-income countries. For the purpose of this study, we consider electricity, liquefied petroleum gas (LPG), alcohol fuels, biogas, and compressed biomass pellets burned in high performing gasifier stoves to be clean fuel options. Each of the clean fuels reviewed in this study, as well as the supply of electricity, presents both constraints and opportunities for enhanced production, supply, delivery, and long-term sustainability and scalability in resource-poor settings. These options are reviewed and discussed together with policy and regulatory considerations to help in making these fuel and energy choices available and affordable. Our hope is that researchers, government officials and policy makers, and development agencies and investors will be aided by our comparative analysis of these clean household energy choices.

In-Field Emission Measurements from Biogas and Liquified Petroleum Gas (LPG) Stoves

Household air pollution from solid fuel cooking causes millions of deaths each year and contributes to climate change. These emissions can be reduced if households transition to cleaner cooking fuels such as LPG or biogas, yet emission measurements during actual use are limited. Six LPG and 57 biogas cooking event emissions were measured during typical cooking practices in Nepal. Emission factors are reported for elemental carbon (EC), organic carbon (OC), particulate matter (PM 2.5 ), and carbon monoxide (CO) and compared to measurements from wood stoves in the same households. Biogas cooking emission factors were 7.4 ± 10.9 mg MJ − 1 for PM 2.5 and 0.2 ± 0.3 mg MJ − 1 for EC on a fuel energy basis, and were not significantly different from LPG stoves (9.5 ± 6.8 mg MJ − 1 for PM 2.5 and 0.3 ± 0.3 mg MJ − 1 for EC, p > 0.05). Wood stoves emitted 50 times more PM 2.5 than biogas on a fuel energy basis and 230 times more EC. EC emissions were about 3% of total particle emissions from biogas and LPG stoves. Most PM 2.5 emissions from gas stoves were attributed to food frying and stove ignition (90%), not the gas fuel (10%), implying that there is a limit to emission reductions that can be achieved with improved fuels.

Understanding Household Energy Transitions: From Evaluating Single Cookstoves to “Clean Stacking” Alternatives

The pervasiveness of “stacking” between traditional and clean fuels/stoves is moving the household clean cooking research and policy agenda from programs that are centered on one-fuel or stove, to multi-clean fuel/device interventions that could result in a more effective displacement of traditional biomass stoves. However, there is little recognition and knowledge of the benefits realistic clean-stacking cooking solutions can have on indoor air quality and health. In this paper, particulate matter (PM2.5) and carbon monoxide (CO) concentration levels that are associated with stove-stacking options (Patsari-U-shaped open fire (U-type), Patsari-liquefied petroleum gas (LPG) stove, U-type-LPG, and Patsari-U-type-LPG) common within rural Mexico were evaluated while using a controlled cooking cycle (CCC) from the Purepecha Highlands, which mimics the most common dishes prepared daily within the region as well as their sequential arrangement. The results confirms that the WHO Interim Target-1 (IT1) of 35 μg/m3 for PM2.5 is exceeded whenever woodburning open fires are part of the stacking combination (Patsari-U-type 107 ± 9 μg/m3, U-type-LPG 131 ± 55 μg/m3 and Patsari-U-type-LPG 107 ± 22 μg/m3). However, well-designed and properly operated woodburning chimney stoves, such as the Patsari can meet the IT1, either used exclusively (21 ± 8 μg/m3) or as a “clean stacking” option with LPG (24 ± 5 μg/m3). Given stove stacking patterns, evaluating the health and environmental consequences of stove transitions while assuming the total replacement of traditional fires by clean cooking options will lead to misplaced expectations, and programs should evaluate more realistic “clean-stacking” options.

Linkages between Respiratory Symptoms in Women and Biofuel Use: Regional Case Study of Rajasthan, India

Women in low and middle-income countries predominantly use biofuel for cooking, resulting in potential adverse health outcomes. In India, it is estimated that about 40% of total primary energy consumption is in the domestic sector with biofuels alone accounting for about 75% of domestic energy consumption. This study assesses linkages between wood consumption and perceptions of women's health, combining results from a rapid assessment of eight rural districts in Rajasthan with a regression analysis of data from Rajasthan State (sample size 41,965 women) from the Demographic and Health Survey 7 dataset (2015-2016). The results of the rapid survey indicate that women who cook with biofuels perceive adverse health outcomes. Educational level, income, and age have an impact on fuel consumption and clean fuel purchased. The regression model drawing upon data on women at a regional level in Rajasthan yielded significant results suggesting a strong association between fuel type and symptoms of respiratory infection controlling for age and education. This research is timely as it provides valuable evidence for India's Ujjawala Scheme which has the mandate of providing LPG connections to women from below the poverty line.

The Gendered Nature of Liquefied Petroleum Gas Stove Adoption and Use in Rural India

Clean cooking fuels promise substantial health benefits for rural households, but almost three billion people continue to rely on traditional biomass for their cooking needs. We explore the role of gender in the adoption of LPG, a clean cooking fuel, in rural India. Given that women are responsible for most households' cooking needs, we propose that gender inequality is an obstacle to LPG adoption because men may fail to appreciate the full benefits of clean cooking fuels. Using data for 8,563 households from the ACCESS survey, we demonstrate that households where women participant in decison-making are more likely to adopt LPG for cooking than households in which a man is the sole decision-maker. We extend our analytic framework to evaluate the relationship between household characteristics and LPG and firewood use. Access and cylinder costs were both negatively associated with LPG use and while LPG adoption reduced firewood use, fuel stacking remains the norm in study households. This study has implications for future policy designs to increase LPG adoption and use to obtain the multiple benefits of cleaner cooking.