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The disease burden related to air pollution from traditional solid-fuel cooking practices in low- and middle-income countries impacts millions of people globally. Although the use of liquefied petroleum gas (LPG) fuel for cooking can meaningfully reduce household air pollution concentrations, major barriers, including affordability and accessibility, have limited widespread adoption. Using a randomized controlled trial, our objective was to evaluate the association between the cost and use of LPG among 23 rural Rwandan households. We provided a 2-burner LPG stove with accessories and incorporated a "pay-as-you-go" (PAYG) LPG service model that included fuel delivery. PAYG services remove the large up-front cost of cylinder refills by integrating "smart meter" technology that allows participants to pay in incremental amounts, as needed. We assigned three randomized discounted prices for LPG to each household at ~4-week intervals over a 12-week period. We modeled the relationship between randomized PAYG LPG price and use (standardized to monthly periods), analyzing effect modification by relative household wealth. A 1000 Rwandan Franc (about 1 USD at the time of the study) increase in LPG price/kg was associated with a 4.1 kg/month decrease in use (95% confidence interval [CI]: -6.7, -1.6; n=69 observations). Wealth modified this association; we observed a 9.7 kg/month reduction (95% CI: -14.8, -4.5) among wealthier households and a 2.5 kg/month reduction (95% CI: -5.3, 0.3) among lower-wealth households (p-interaction=0.01). The difference in price sensitivity was driven by higher LPG use among wealthier households at more heavily discounted prices; from an 80% to 10% discount, wealthy households used 17.5 to 5.3 kg/month and less wealthy households used 6.2 to 3.1 kg/month. Our pilot-level experimental evidence of PAYG LPG in a rural low-resource setting suggests that further exploration of subsidized pricing varied by household wealth is needed to ensure future policy initiatives can achieve targets without exacerbating inequities., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Access to clean energy for cooking is central to achieving Sustainable Development Goal 7. Latest predictions suggest that this goal will not be met by 2030, with further setbacks due to the COVID-19 pandemic. We investigated the impacts of COVID-19 restrictions on household cooking fuel, practices and dietary behaviours in a peri-urban community in Central Cameroon. Using surveys (n = 333) and qualitative semi-structured interviews (n = 12), we found negative financial impacts and high levels of food insecurity, with 83 % and 56 % of households reporting reduced income and insufficient food, respectively. Households reduced food intake and cooking frequency and relied more heavily on local sources (e.g., farmland) to feed their families. Changes in primary cooking fuel were less pronounced and fuel choice was inherently linked to cooking behaviours, with some households utilising LPG more often for simple tasks, such as reheating food. Local systems were key in sustaining food and fuel access and households demonstrated resilience by employing numerous mechanisms to overcome challenges. Our findings underline the vulnerability of households in maintaining sufficient food intake and sustaining clean cooking, highlighting how policy needs to take a nuanced approach considering food-energy dynamics and strengthening local systems to ensure access to clean energy is resistant to system shocks., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: In 2007, the Indonesian Government instigated a national program to convert domestic kerosene users to liquefied petroleum gas (LPG) for cooking. This was primarily motivated by the rising cost of kerosene subsidies., Objective: To review the national conversion program and LPG scale up by evaluating its impacts, including assessing sustained changes in cooking behaviour and consequent reductions in exposure to household air pollution (HAP)., Methods and Data Sources: Searches of peer-review and grey literature in both English and Bahasa Indonesian were conducted and supplemented by interviews with key informants, data from the National Statistics Agency and results from household surveys. The data were extracted and analyzed using an Implementation Science approach., Results: The main kerosene to LPG conversion phase took place in highly populated kerosene dependent areas between 2007-2012 reaching over 50 million households, approximately two thirds of all households in Indonesia. Since then the drive to expand LPG use has continued at a slower pace, especially in more remote provinces where solid fuel is more widely used. Over 57 million LPG start up kits were distributed as of 2015. Beginning in 2018, the open subsidy for LPG is expected to be replaced by one targeted at lower income households. While the main conversion phase has been highlighted as an example of effective and impressively fast fuel switching at scale, the impact on domestic biomass use remains limited., Conclusions: Addressing HAP and the health impacts associated with kerosene and biomass use was never an objective of the program. Consequently, there is limited evidence of impact in this area, and in hindsight, missed opportunities in terms of influencing cooking behavior change among biomass users, who are more at risk.

Approximately 3 billion people, most of whom live in Asia, Africa, and the Americas, rely on solid fuels (i.e. wood, crop wastes, dung, charcoal) and kerosene for their cooking needs. Exposure to household air pollution from burning these fuels is estimated to account for approximately 3 million premature deaths a year. Cleaner fuels - such as liquefied petroleum gas, biogas, electricity, and certain compressed biomass fuels - have the potential to alleviate much of this significant health burden. A wide variety of clean cooking intervention programs are being implemented around the world, but very few of these efforts have been analyzed to enable global learning. The Clean Cooking Implementation Science Network (ISN), supported by the U.S. National Institutes of Health (NIH) and partners, identified the need to augment the publicly available literature concerning what has worked well and in what context. The ISN has supported the development of a systematic set of case studies, contained in this Special Issue, examining clean cooking program rollouts in a variety of low- and middle-income settings around the world. We used the RE-AIM (reach, effectiveness, adaptation, implementation, maintenance) framework to coordinate and evaluate the case studies. This paper describes the clean cooking case studies project, introduces the individual studies contained herein, and proposes a general conceptual model to support future planning and evaluation of household energy programs.

Introduction: Over 80% of rural households in Peru use solid fuels as their primary source of domestic energy, which contributes to several health problems. In 2016, 6.7 million Peruvians were living in rural areas. The Fondo de Inclusión Social Energético (FISE) LPG Promotion Program, which began in 2012 and is housed under the Ministry of Energy and Mining, is a government-sponsored initiative aimed at reducing use of solid fuels by increasing access to clean fuel for cooking to poor Peruvian households., Methods: We conducted a mixed methods study incorporating data from publicly available records and reports, a community survey of 375 households in Puno (the province with the largest number of FISE beneficiary households), and in-depth interviews with community members and key stakeholders. We used the Reach, Effectiveness - Adoption, Implementation, Maintenance (RE-AIM) framework to guide our data collection and analysis efforts. In a sample of 95 households, we also measured 48-hour area concentrations and personal exposures to fine particulate matter (PM 2.5 )., Results: The FISE LPG promotion program has achieved high geographical reach; the program is currently serving households in 100% of districts in Peru. Households with access to electricity may be participating at a higher level than households without electricity because the program is implemented primarily by electricity distributors. In a sample of 95 households, FISE beneficiaries experienced a reduction in kitchen concentrations of PM 2.5 ; however, there were no differences in personal exposures, and both kitchen and personal exposures were above the WHO intermediate target for indoor air quality. Among the 375 households surveyed, stove stacking with biomass fuels was reported in more than 95% of both beneficiary and non-beneficiary households, with fewer than 5% reporting exclusive use. In-depth interviews suggest that the complexity of enrollment process and access to LPG distribution points may be key barriers to participating in FISE., Conclusion: The FISE LPG Program has achieved high reach and its targeted subsidy and surcharge-based financing structure represent a potentially feasible and sustainable model for other government programs. However, the prevalence of stove stacking among FISE beneficiaries remains high. There is a need for improved communication channels between program implementers and beneficiaries. FISE should also consider expanding the mobile LPG network and community delivery service to reduce physical barriers and indirect costs of LPG acquisition. Finally, increasing the value of LPG vouchers to completely cover one or two tanks a month, or alternatively, introducing behavior change strategies to reduce monthly LPG usage, may facilitate the transition to exclusive LPG use., Competing Interests: DECLARATIONS OF INTEREST: None.

In 2016, the government of Cameroon, a central African country heavily reliant on wood fuel for cooking, published a Masterplan for increasing primary use of LPG from 20% to 58% of households by 2035. Developed via a multi-sectoral committee with support from the Global LPG Partnership, the plan envisages a 400 million Euro investment program to 2030, focused on increasing LPG cylinder numbers, key infrastructure, and enhanced regulation. This case study describes the Masterplan process and investment proposals and draws on community studies and stakeholder interviews to identify factors likely to impact on the planned expansion of LPG use.