Despite decades of effort, around 2.8 billion people still rely on solid fuels to meet domestic energy needs. There is robust evidence this causes premature death and chronic disease, as well as wider economic, social, and environmental problems. Behavior change interventions are effective to reduce exposure to harm such as household air pollution, including those using health communications approaches. This article reports the findings of a project that reviewed the effectiveness of behavior change approaches in cleaner cooking interventions in resource-poor settings. The authors synthesized evidence of the use of behavior change techniques, along the cleaner cooking value chain, to bring positive health, economic, and environmental impacts. Forty-eight articles met the inclusion criteria, which documented 55 interventions carried out in 20 countries. The groupings of behavior change techniques most frequently used were shaping knowledge (n ¼ 47), rewards and threats (n ¼ 35), social support (n ¼ 35), and comparisons (n ¼ 16). A scorecard of behavior change effectiveness was developed to analyze a selection of case study interventions. Behavior change techniques have been used effectively as part of multilevel programs. Cooking demonstrations, the right product, and understanding of the barriers and benefits along the value chain have all played a role. Often absent are theories and models of behavior change adapted to the target audience and local context. Robust research methods are needed to track and evaluate behavior change and impact, not just technology disseminated. Behavior change approaches could then play a more prominent role as the ''special sauce'' in cleaner cooking interventions in resource poor settings.This article reports the findings of a review into the effectiveness of behavior change approaches in cleaner cooking interventions in resource-poor settings (Goodwin et al., 2014). The review produced evidence on the use of behavior change techniques (BCTs), a behavior change framework for clean cooking and a set of seven case studies, using a scorecard of effectiveness. The recommendations do not include an attempt to highlight or rank the most effective behavior change models or theories; rather, the review captures the key elements that make behavior change approaches more likely to succeed in ensuring the scale and sustainability of cleaner cooking interventions.
Globally, approximately 3 billion primarily cook using inefficient and poorly vented combustion devices, leading to unsafe levels of household air pollution (HAP) in and around the home. Such exposures contribute to nearly 4 million deaths annually (WHO 2018a, 2018b ). Characterizing the effectiveness of interventions for reducing HAP concentration and exposure is critical for informing policy and programmatic decision-making on which cooking solutions yield the greatest health benefits. This review synthesizes evidence of in-field measurements from four cleaner cooking technologies and three clean fuels, using field studies aimed at reducing HAP concentration and personal exposure to health damaging pollutants (particulate matter (PM2.5) and carbon monoxide (CO)). Fifty studies from Africa, Asia, South and Latin America, provided 168 estimates synthesized through meta-analysis. For PM2.5 kitchen concentrations, burning biomass more cleanly through improved combustion stoves (ICS) with (n = 29; 63% reduction) or without (n = 12; 52%) venting (through flue or chimney) and through forced-draft combustion (n = 9; 50%) was less effective than cooking with clean fuels including ethanol (n = 4; 83%), liquefied petroleum gas (LPG) (n = 11; 83%) and electricity (n = 6; 86%). Only studies of clean fuels consistently achieved post-intervention kitchen PM2.5 levels at or below the health-based WHO interim target level 1 (WHO-IT1) of 35 μg m−3. None of the advanced combustion stoves (gasifiers) achieved WHO-IT1, although no evidence was available for pellet fuelled stoves. For personal exposure to PM2.5, none of the ICS (n = 11) were close to WHO-IT1 whereas 75% (n = 6 of 8) of LPG interventions were at or below WHO-IT1. Similar patterns were observed for CO, although most post-intervention levels achieved the WHO 24 h guideline level. While clean cooking fuel interventions (LPG, electric) significantly reduce kitchen concentrations and personal exposure to PM2.5 in household settings, stove stacking and background levels of ambient air pollution, have likely prevented most clean fuel interventions from approaching WHO-IT1. In order to maximize health gains, a wholistic approach jointly targeting ambient and HAP should be followed in lower-and-middle income countries.
This paper presents results from eight field studies in Asia and Africa on the emissions performance of 16 stove/fuel combinations measured during normal cooking events in homes. Characterizing real-world emissions performance is important for understanding the climate and health implications of technologies being promoted as alternatives to displace baseline cooking stoves and fuels. Almost all of the stove interventions were measured to have substantial reductions in PM2.5 and CO emissions compared to their respective baseline technologies (reductions of 24–87% and 25–80%, for PM2.5 and CO emission rates, respectively), though comparison with performance guidance from the World Health Organization (WHO) and the International Organization for Standardization (ISO) suggests that further improvement for biomass stoves would help realize more health benefits. The emissions of LPG stoves were generally below the WHO interim PM2.5 emissions target (1.75 mg/min) though it was not clear how close they were to the most aspirational ISO (0.2 mg/min) or WHO (0.23 mg/min) targets as our limit of detection was 1.1 mg/min. Elemental and organic carbon emission factors and elemental-to-total carbon ratios (medians ranging from 0.11 to 0.42) were in line with previously reported field-based estimates for similar stove/fuel combinations. Two of the better performing forced draft stoves used with pellets—the Oorja (median ET/TC = 0.12) and Eco-Chula (median ET/TC = 0.42)—were at opposite ends of the range, indicating that important differences in combustion conditions can arise even between similar stove/fuel combinations. Field-based tests of stove performance also provide important feedback for laboratory test protocols. Comparison of these results to previously published water boiling test data from the laboratory reinforce the trend that stove performance is generally better during controlled laboratory conditions, with modified combustion efficiency (MCE) being consistently lower in the field for respective stove/fuel categories. New testing approaches, which operate stoves through a broader range of conditions, indicate potential for better MCE agreement than previous versions of water boiling tests. This improved agreement suggests that stove performance estimates from a new ISO laboratory testing protocol, including testing stoves across low, medium, and high firepower, may provide more representative estimates of real-world performance than previously used tests. More representative results from standardized laboratory testing should help push stove designs toward better real-world performance as well as provide a better indication of how the tested technologies will perform for the user.
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