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

ABSTRACT: 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.

SUBMITTER: Carrion D

PROVIDER: S-EPMC8580155 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThree billion individuals worldwide rely on biomass fuel [dung, wood, crops] for cooking and heating. Further, health conditions resulting from household air pollution (HAP) are responsible for approximately 3.9 million premature deaths each year. Though transition away from traditional biomass stoves is projected curb the health effects of HAP by mitigating exposure, the benefits of newer clean cookstove technologies can only be fully realized if use of these new stoves is exclusive and sustained. However, the conditions under which individuals adopt and sustain use of clean cookstoves is not well understood.MethodsThe Enhancing LPG Adoption in Ghana (ELAG) study is a cluster-randomized controlled trial employing a factorial intervention design. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. This intervention seeks to align these five behavioral factors with clean cookstove adoption and sustained use. A second intervention is access-related and will improve LPG availability by offering a direct-delivery refueling service. These two interventions will be integrated via a factorial design whereby 27 communities are assigned to one of the following: the control arm, the educational intervention, the delivery, or a combined intervention. Intervention allocation is determined by a covariate-constrained randomization approach. After intervention, approximately 900 households' individual fuel use is tracked for 12 months via iButton stove use monitors. Analysis will include hierarchical linear models used to compare intervention households' fuel use to control households.DiscussionLiterature to-date demonstrates that recipients of improved cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can then lead to HAP-reductions and consequent improvements in public health.Trial registrationNCT03352830 (November 24, 2017).

Project description:BackgroundThe Cameroon government has set a target that, by 2030, 58% of the population will be using Liquefied Petroleum Gas (LPG) as a cooking fuel, in comparison with less than 20% in 2014. The National LPG Master Plan (Master Plan) was developed for scaling up the LPG sector to achieve this target.ObjectivesThis study aimed to estimate the potential impacts of this planned LPG expansion (the Master Plan) on population health and climate change mitigation, assuming primary, sustained use of LPG for daily cooking.MethodsWe applied existing and developed new mathematical models to calculate the health and climate impacts of expanding LPG primary adoption for household cooking in Cameroon over two periods: a) short-term (2017-2030): Comparing the Master Plan 58% target with a counterfactual LPG adoption of 32% in 2030, in line with current trends; and b) long-term (2031-2100, climate modeling only), assuming Cameroon will become a mature and saturated LPG market by 2100 (73% adoption, based on Latin American countries). We compared this with a counterfactual adoption of 41% by 2100, in line with current trends.ResultsBy 2030, successful implementation of the Master Plan was estimated to avert about 28,000 (minimum=22,000, maximum=35,000) deaths and 770,000 (minimum=580,000 maximum=1 million) disability-adjusted life years. For the same period, we estimated reductions in pollutant emissions of more than a third in comparison with the counterfactual, leading to a global cooling of -0.1 milli °C in 2030. For 2100, a cooling impact from the Master Plan leading to market saturation (73%) was estimated to be -0.70 milli °C in comparison with to the counterfactual, with a range of -0.64 to -0.93 milli °C based on different fractions of nonrenewable biomass.DiscussionSuccessful implementation of the Master Plan could have significant positive impacts on population health in Cameroon with no adverse impacts on climate. https://doi.org/10.1289/EHP4899.

Project description:Each year up to 2.6 million people die prematurely from household air pollution (HAP) due to cooking with polluting fuels such as wood and charcoal, particularly in low and middle-income countries (LMICs). The World Health Organisation recommends scaling the adoption of clean fuels to improve maternal and child health. Liquefied Petroleum Gas (LPG) represents a scalable clean fuel that provides health and environmental benefits when used for household energy in LMICs. In Cameroon, over 70% of people rely on biomass for cooking, and the Government aims to increase LPG use from <20% to 58% by 2030. Supporting households make this transition requires involvement of multiple stakeholders and an understanding of perspectives from the community's perspective. We used visual participatory methods 'Photovoice' to explore households' perceptions of factors influencing the uptake of LPG for cooking in South-West Cameroon. Two groups of participants from rural (n = 7) and peri-urban (n = 8) areas photographed subjects they identified as preventing and facilitating LPG uptake in their communities. Subsequently, individual interviews (n = 15) and group discussions (n = 5) explored participants' reflections on the photographs. Thematic analysis was conducted using NVivo 10 software. The main barriers identified included difficulty in affording the initial LPG equipment and ongoing refills, scarcity of LPG retail shops and refills, and safety concerns. Facilitators included (i) increasing awareness of the benefits of LPG (e.g. health), (ii) increasing retail outlet density in rural areas, (iii) addressing safety concerns (e.g. replacing damaged cylinders), and (iv) reducing the price of LPG refills. Participants presented their photos at a public exhibition, which generated discussions with key stakeholders (e.g. government ministries) about how best to assist communities in this transition. Photovoice was found to be an innovative and effective approach for exploring how to advance equitable access to LPG from a community perspective and successfully engage with key stakeholders.

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

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