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Graham JP, Kaur M, Jeuland MA. Access to environmental health assets across wealth strata: Evidence from 41 low- and middle-income countries. PLoS One 2018; 13:e0207339. [PMID: 30444899 PMCID: PMC6239312 DOI: 10.1371/journal.pone.0207339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Low levels of household access to basic environmental health assets (EHAs)-including technologies such as clean cookstoves and bed nets or infrastructure such as piped water and electricity-in low- and middle-income countries (LMICs) are known to contribute significantly to the global burden of disease. This low access persists despite decades of promotion of many low-cost, life-saving technologies, and is particularly pronounced among poor households. This study aims to characterize variation in access to EHAs among LMIC households as a function of wealth, as defined by ownership of various assets. METHODS Demographic and Health Survey (DHS) data from 41 low- and middle-income countries were used to assess household-level access to the following EHAs: 1) improved water supply; 2) piped water supply; 3) improved sanitation; 4) modern cooking fuels; 5) electricity; and 6) bed nets. For comparison, we included access to mobile phones, which is considered a highly successful technology in terms of its penetration into poor households within LMICs. Ownership levels were compared across country-specific wealth quintiles constructed from household assets using bivariate analysis and multivariable linear regression models. RESULTS Access to EHAs was low among the households in the bottom three quintiles of wealth. Access to piped water, modern cooking fuels, electricity and improved sanitation, for example, were all below 50% for households in the bottom three wealth quintiles. Access to certain EHAs such as improved water supply and bed nets increased only slowly with concomitant increases in wealth, while gaps in access to other EHAs varied to a greater degree by wealth quintile. For example, disparities in access between the richest and poorest quintiles were greatest for electricity and improved sanitation. Rural households in all wealth quintiles had much lower levels of access to EHAs, except for bed nets, relative to urban households. CONCLUSIONS The findings of this study provide a basis for understanding how EHAs are distributed among poor households in LMICs, elucidate where inequalities in access are particularly pronounced, and point to a need for strategies that better reach the poor, if the global environmental burden of disease is to be reduced.
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Affiliation(s)
- Jay P. Graham
- Public Health Institute, Oakland, California, United States of America
| | - Maneet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Marc A. Jeuland
- Duke University, Durham, North Carolina, United States of America
- RWI-Leibniz Institute for Economic Research, Essen, Germany
- * E-mail:
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Jagger P, Jumbe C. Stoves or Sugar? Willingness to Adopt Improved Cookstoves in Malawi. ENERGY POLICY 2016; 92:409-419. [PMID: 27346912 PMCID: PMC4918052 DOI: 10.1016/j.enpol.2016.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Malawi has set a target of adoption of two million improved cookstoves (ICS) by 2020. Meeting this objective requires knowledge about determinants of adoption, particularly in rural areas where the cost of traditional cooking technologies and fuels are non-monetary, and where people have limited capacity to purchase an ICS. We conducted a discrete choice experiment with 383 households in rural Malawi asking them if they would chose a locally made ICS or a package of sugar and salt of roughly equal value. Six months later, we assessed adoption and stove use patterns. Sixty-six percent of households chose the ICS. We find that having a larger share of crop residues in household fuel supply, awareness of the environmental impacts of woodfuel reliance, time the primary cook devotes to collecting fuelwood, and peer effects at the village-level increase the odds of choosing the ICS. Having a large labor supply for fuelwood collection and experience with a non-traditional cooking technology decreased the odds of choosing the ICS. In a rapid assessment six months after stoves were distributed, we found 80% of households were still using the ICS, but not exclusively. Our findings suggest considerable potential for wide-scale adoption of ICS in Malawi.
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Affiliation(s)
- Pamela Jagger
- Department of Public Policy and Carolina Population Center, University of North Carolina at Chapel Hill, CB#8120, 211 West Cameron Avenue, Chapel Hill, NC, USA
| | - Charles Jumbe
- Center for Agricultural Research and Development, Lilongwe University of Agriculture and Natural Resources, P.O. Box 219, Lilongwe, Malawi
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User Perspectives of Characteristics of Improved Cookstoves from a Field Evaluation in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:167. [PMID: 26828505 PMCID: PMC4772187 DOI: 10.3390/ijerph13020167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
Over half of the world’s population uses biomass fuels; these households cook on open fires indoors, increasing their risk of adverse health effects due to household air pollution (HAP) from biomass combustion. This study evaluated six improved cookstoves (ICS) for effectiveness and acceptability in a rural community in Western Kenya. This paper describes women’s views on each ICS compared to the traditional three-stone fire. Views on stove characteristics, fuel consumption, health effects and acceptability were assessed through structured interviews and focus group discussions. Data were coded and analyzed using a thematic approach. In total, 262 interviews and 11 focus groups were conducted from 43 women. Overall, women preferred the ICS over the traditional three-stone fire for various reasons including ease of use, efficiency, fuel efficiency and perceived reduction in smoke and improved health. However, there were clear preferences for specific ICS with almost half of women preferring a Philips stove. Despite acceptance and use of ICS, women used multiple stoves to meet their daily needs. Qualitative studies are essential to field evaluations to provide insight into user perspectives and acceptability of ICS and to inform research and development of technologies that are both effective in reducing HAP and practical in use.
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Rehfuess EA, Puzzolo E, Stanistreet D, Pope D, Bruce NG. Enablers and barriers to large-scale uptake of improved solid fuel stoves: a systematic review. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:120-30. [PMID: 24300100 PMCID: PMC3914867 DOI: 10.1289/ehp.1306639] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 12/03/2013] [Indexed: 05/19/2023]
Abstract
BACKGROUND Globally, 2.8 billion people rely on household solid fuels. Reducing the resulting adverse health, environmental, and development consequences will involve transitioning through a mix of clean fuels and improved solid fuel stoves (IS) of demonstrable effectiveness. To date, achieving uptake of IS has presented significant challenges. OBJECTIVES We performed a systematic review of factors that enable or limit large-scale uptake of IS in low- and middle-income countries. METHODS We conducted systematic searches through multidisciplinary databases, specialist websites, and consulting experts. The review drew on qualitative, quantitative, and case studies and used standardized methods for screening, data extraction, critical appraisal, and synthesis. We summarized our findings as "factors" relating to one of seven domains-fuel and technology characteristics; household and setting characteristics; knowledge and perceptions; finance, tax, and subsidy aspects; market development; regulation, legislation, and standards; programmatic and policy mechanisms-and also recorded issues that impacted equity. RESULTS We identified 31 factors influencing uptake from 57 studies conducted in Asia, Africa, and Latin America. All domains matter. Although factors such as offering technologies that meet household needs and save fuel, user training and support, effective financing, and facilitative government action appear to be critical, none guarantee success: All factors can be influential, depending on context. The nature of available evidence did not permit further prioritization. CONCLUSIONS Achieving adoption and sustained use of IS at a large scale requires that all factors, spanning household/community and program/societal levels, be assessed and supported by policy. We propose a planning tool that would aid this process and suggest further research to incorporate an evaluation of effectiveness.
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Affiliation(s)
- Eva A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
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Martin SL, Arney JK, Mueller LM, Kumakech E, Walugembe F, Mugisha E. Using formative research to design a behavior change strategy to increase the use of improved cookstoves in peri-urban Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6920-38. [PMID: 24336020 PMCID: PMC3881149 DOI: 10.3390/ijerph10126920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/29/2013] [Accepted: 11/30/2013] [Indexed: 01/19/2023]
Abstract
Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used to identify behavioral determinants related to the acquisition and use of improved cookstoves in peri-urban Uganda. Results were used to design a behavior change strategy for the introduction of a locally-fabricated top-lit updraft gasifier (TLUD) stove in Wakiso district. A theoretical framework—opportunity, ability, and motivation—was used to guide the research and behavior change strategy development. Participants consistently cited financial considerations as the most influential factor related to improved cookstove acquisition and use. In contrast, participants did not prioritize the potential health benefits of improved cookstoves. The theoretical framework, research methodology, and behavior change strategy design process can be useful for program planners and researchers interested in identifying behavioral determinants and designing and evaluating improved cookstove interventions.
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Affiliation(s)
- Stephanie L. Martin
- PATH, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC 20001, USA; E-Mails: (J.K.A.); (L.M.M.)
- Division of Nutritional Sciences, Cornell University, 118 Savage Hall, Ithaca, NY 14853, USA; E-Mail:
| | - Jennifer K. Arney
- PATH, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC 20001, USA; E-Mails: (J.K.A.); (L.M.M.)
| | - Lisa M. Mueller
- PATH, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC 20001, USA; E-Mails: (J.K.A.); (L.M.M.)
| | - Edward Kumakech
- PATH, P.O. Box 24578, Kampala, Uganda; E-Mails: (E.K.); (F.W.)
| | - Fiona Walugembe
- PATH, P.O. Box 24578, Kampala, Uganda; E-Mails: (E.K.); (F.W.)
| | - Emmanuel Mugisha
- PATH, P.O. Box 24578, Kampala, Uganda; E-Mails: (E.K.); (F.W.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-256-414-335-504; Fax: +1-256-414-335-588
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Foote EM, Gieraltowski L, Ayers T, Sadumah I, Faith SH, Silk BJ, Cohen AL, Were V, Hughes JM, Quick RE. Impact of locally-produced, ceramic cookstoves on respiratory disease in children in rural western Kenya. Am J Trop Med Hyg 2012; 88:132-7. [PMID: 23243108 DOI: 10.4269/ajtmh.2012.12-0496] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Household air pollution is a risk factor for pneumonia, the leading cause of death among children < 5 years of age. From 2008 to 2010, a Kenyan organization sold ≈ 2,500 ceramic cookstoves (upesi jiko) that produce less visible household smoke than 3-stone firepits. During a year-long observational study, we made 25 biweekly visits to 200 homes to determine stove use and observe signs of acute respiratory infection in children < 3 years of age. Reported stove use included 3-stone firepit only (81.8%), upesi jiko only (15.7%), and both (2.3%). Lower, but not statistically significant, percentages of children in upesi jiko-using households than 3-stone firepit-using households had observed cough (1.3% versus 2.9%, rate ratio [RR] 0.48, 95% confidence interval [CI]: 0.22-1.03), pneumonia (0.9% versus 1.7%, RR 0.60, 95% CI: 0.24-1.48), and severe pneumonia (0.3% versus 0.6%, RR 0.66, 95% CI: 0.17-2.62). Upesi jiko use did not result in significantly lower pneumonia rates. Further research on the health impact of improved cookstoves is warranted.
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Affiliation(s)
- Eric M Foote
- Emory University School of Medicine, Atlanta, Georgia, USA.
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Person B, Loo JD, Owuor M, Ogange L, Jefferds MED, Cohen AL. "It is good for my family's health and cooks food in a way that my heart loves": qualitative findings and implications for scaling up an improved cookstove project in rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1566-80. [PMID: 22754457 PMCID: PMC3386572 DOI: 10.3390/ijerph9051566] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 01/15/2023]
Abstract
The use of indoor, three-stone fire pits in resource–poor countries is a substantial burden on human health and the environment. We conducted a pilot intervention promoting the purchase and use of an improved cookstove in rural Kenya. The goals of this qualitative inquiry were to understand the motivation to purchase and use; perceived benefits and challenges of cookstove use; and the most influential promotion activities for scaling up future cookstove promotion. Purposive sampling was used to recruit 10 cookstove promoters and 30 cookstove purchasers in the Luo community. Qualitative semi-structured interviews were transcribed and a thematic analysis conducted. Women reported the need for less firewood, fuel cost savings, reduced smoke, improved cooking efficiency, reduced eye irritation, lung congestion and coughing as major benefits of the cookstove. Cost appeared to be a barrier to wider adoption. The most persuasive promotion strategies were interpersonal communication through social networks and cooking demonstrations. Despite this cost barrier, many women still considered the improved cookstove to be a great asset within their household. This inquiry provided important guidance for future cookstove implementation projects.
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Affiliation(s)
- Bobbie Person
- Office of the Director, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention,1600 Clifton Road, Atlanta, GA 30333, USA
- Author to whom correspondence should be addressed; ; Tel.: +1-404-639-2114; Fax: +1-404-639-2128
| | - Jennifer D. Loo
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,1600 Clifton Road, Atlanta, GA 30333, USA; (J.D.L.); (A.L.C.)
| | - Mercy Owuor
- Kenya Medical Research Institute, Box 1578, Kisumu, Kenya; (M.O.); (L.O.)
| | - Lorraine Ogange
- Kenya Medical Research Institute, Box 1578, Kisumu, Kenya; (M.O.); (L.O.)
| | - Maria Elena D. Jefferds
- International Micronutrient Malnutrition Prevention and Control Program, Divisions of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention,1600 Clifton Road, Atlanta, GA 30333, USA;
| | - Adam L. Cohen
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,1600 Clifton Road, Atlanta, GA 30333, USA; (J.D.L.); (A.L.C.)
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"It is good for my family's health and cooks food in a way that my heart loves": qualitative findings and implications for scaling up an improved cookstove project in rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012. [PMID: 22754457 DOI: 10.3390/ijerph9051566ijerph-09-01566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of indoor, three-stone fire pits in resource-poor countries is a substantial burden on human health and the environment. We conducted a pilot intervention promoting the purchase and use of an improved cookstove in rural Kenya. The goals of this qualitative inquiry were to understand the motivation to purchase and use; perceived benefits and challenges of cookstove use; and the most influential promotion activities for scaling up future cookstove promotion. Purposive sampling was used to recruit 10 cookstove promoters and 30 cookstove purchasers in the Luo community. Qualitative semi-structured interviews were transcribed and a thematic analysis conducted. Women reported the need for less firewood, fuel cost savings, reduced smoke, improved cooking efficiency, reduced eye irritation, lung congestion and coughing as major benefits of the cookstove. Cost appeared to be a barrier to wider adoption. The most persuasive promotion strategies were interpersonal communication through social networks and cooking demonstrations. Despite this cost barrier, many women still considered the improved cookstove to be a great asset within their household. This inquiry provided important guidance for future cookstove implementation projects.
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