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(1) Background: Water and solid fuel collection and transport are domestic duties for millions of households across the globe. People in areas with limited or no access to safely managed sources of water and household energy must fetch these resources on a frequent basis. The health, gender, and economic impacts associated with water and solid fuel collection labor have not been systematically reviewed. (2) Methods: Studies were identified through database searches and included using a list of inclusion and exclusion criteria. Studies were summarized and grouped into one of eight thematic categories. (4) Conclusions: The findings suggest that a diverse and heavy health burden is associated with water and solid fuel collection and transport. The literature also suggests that the provision of safely managed and accessible water and improved fuel options can mitigate these negative outcomes. Filling research gaps and utilizing results to guide policy and funding would likely be an effective way to ensure low- and middle-income countries are not left behind as the world strives to meet the sustainable development goals.

Background: Globally, an estimated 3.6 billion people rely on solid fuels for cooking over open fires or in simple cookstoves. Universal access to clean cooking fuels and technology by 2030 is a United Nations&rsquo, Sustainable Development Goal. Methods: The Mediae Company created a home makeover television and radio show, Shamba Chef, designed to promote modern, cleaner, safer cooking methods and improved nutrition in Kenya, which reached 5 million homes in late 2017. This was accompanied by a mobile phone platform called iChef. Researchers evaluated the effects of Shamba Chef on cookstove purchase, use, and attitudes, beliefs, and intentions. Results: The study revealed dose&ndash, response effects of Shamba Chef exposure on several key outcomes. Exposure to the program was associated with an awareness of improved biomass stoves (OR 4.4, 95% CI 2.8 to 6.9), and aspirations to own an improved biomass stove (OR 2.0, 95% CI 1.4 to 2.9). Receiving information about modern stoves from two or more sources generated greater awareness of liquefied petroleum gas (LPG) stoves (OR 2.0, 95% CI 1.3 to 3.1). The qualitative study revealed that Shamba Chef explained how the stoves worked, communicated their benefits, and encouraged participants to trust and purchase those cookstoves. Conclusion: Shamba Chef was successful in influencing determinants of cookstove purchase and use, and there is evidence from the qualitative study that it influenced the purchase and use of improved biomass stoves.

A recently completed randomized controlled study in Nigeria that transitioned pregnant women from traditional fuels to ethanol in their cook stoves demonstrated improved pregnancy outcomes in mothers and children. We subsequently conducted a pilot study of 30 households in Lagos, Nigeria, to determine the acceptability of blended ethanol/methanol as cooking fuel and willingness to pay for the Clean Cook stove. A third of the pilot participants expressed a willingness to purchase the stove for the minimum price of 42 USD or more. Fuel sales data suggest sustained, but non-exclusive, use of the CleanCook stove. These results will influence the final design and implementation of a planned 2500 stove commercial pilot that is scheduled to start in Nigeria in August 2018.

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.

It is estimated that women in Sub-Saharan Africa spend three times longer than men on unpaid work, such as household chores and caregiving. ‘Time poverty’ restricts women's involvement in paid work, as well as educational, political, and social activities, thereby perpetuating gender inequality, economic poverty, and a persistent drudgery trap. A significant time burden for women living in communities dependent on biomass fuel and traditional cookstoves arises from the procurement and preparation of fuel, as well as from long hours cooking on inefficient, polluting stoves. We used a mixed methods study in 55 households in rural Kenya to explore the impact of introducing a more efficient biomass cooking technology on time use and quality. Quantitative survey, stove use monitors (SUMs), and qualitative research methods were used before and after households were given new wood burning stoves.

This study looked at the effects of select behavior change interventions on the purchase and the correct and consistent use of a locally fabricated top-lit updraft (TLUD) stove in Uganda. Behavior change interventions included training of community sales agents and village health team volunteers on household air pollution and correct use, referral of interested community members to sales agents, community cooking demonstrations, information flyers, and direct sales of TLUDs and processed wood. Qualitative and quantitative research methods shaped interventions and were used to understand attitudes and practices related to TLUD stove acquisition and use. Results showed that TLUDs were appreciated because they use wood efficiently, cook quickly, reduce smoke, and produce charcoal. However, the substantial purchase price barrier, combined with the cost of processed wood, effectively eliminated the cost savings from its significant fuel efficiency. This made it difficult for the TLUD to be a meaningful part of most households' cooking practices.

Nearly three billion people worldwide burn solid fuels and kerosene in open fires and inefficient stoves to cook, light, and heat their homes. Cleaner-burning stoves reduce emissions and can have positive health, climate, and women’s empowerment benefits. This article reports on the protocol and baseline data from the evaluation of four behavior change communication (BCC) campaigns carried out in lower to middle income countries aimed at promoting the sale and use of cleaner-burning stoves. Interventions implemented in Bangladesh, Kenya, and Nigeria are using a range of BCC methods including mass media, digital media, outdoor advertising, and inter-personal communication. The mixed methods evaluation comprises three large-scale surveys: one pre-BCC and two follow-ups, along with smaller scale assessments of stove uptake and patterns of use. Baseline results revealed varying levels of awareness of previous promotions and positive attitudes and beliefs about modern (i.e., relatively clean-burning) cookstoves. Differences in cookstove preferences and behaviors by gender, socio-demographics, media use, and country/region were observed that may affect outcomes. Across all three countries, cost (lack of funds) a key perceived barrier to buying a cleaner-burning stove. Future multivariate analyses will examine potential dose-response effects of BCC on cookstove uptake and patterns of use. BCC campaigns have the potential to promote modern cookstoves at scale. More research on campaign effectiveness is needed, and on how to optimize messages and channels. This evaluation builds on a limited evidence base in the field.

In the developing world, indoor air pollution (IAP) created from solid fuel used in traditional biomass cook stoves is a leading contributor of poor respiratory health, global burden of disease, and greenhouse pollutant emissions. In the present study, we piloted an experimental cross-sectional monitoring and evaluation design with 30 households in rural Lijiang and Deqin counties in northwest Yunnan province, China. This approach offers the ability to examine the effectiveness of improved cook stove (ICS) programs with a much smaller sample size than the typical population based pre- and post-intervention study that requires a large sample representative of the population. Continuous PM2.5 was measured with the UCB (currently known as UCB-PATS) and the TSI DustTrak and continuous CO was measured with the HOBO CO logger. Using the traditional method of cooking and heating, mean 24-h PM2.5 and CO concentrations in the kitchen were measured in the range of 0.15–0.71 mg m−3 for PM2.5 and 3.0–11 ppm for CO. These concentrations were compared to using a combination of improved stoves in the kitchen where PM2.5 and CO concentrations were measured in the range of 0.08–0.18 mg m−3 for PM2.5 and 0.7–5.5 ppm for CO. These concentrations yielded statistically significant reduction in IAP when replacing the traditional fireplace or traditional stove with an improved stove combination. Finally, we show a strong correlation between CO and PM2.5 (R2 = 0.72–0.76). The combination of this experimental design along with the monitoring and evaluation protocol presented here may provide a robust framework to rapidly assess the effectiveness of ICS interventions in progress.