A Feasibility Study Assessing Acceptability and Supply Issues of Distributing LPG Cookstoves and Gas Cylinders to Pregnant Women Living in Rural Bangladesh for Poriborton: The CHANge Trial

Abstract

Our aim was to develop a protocol for a cluster randomised controlled trial to assess the impact of liquid petroleum gas (LPG) cooking compared to usual cooking on perinatal mortality in pregnant women in rural Bangladesh. We, therefore, aimed to assess the feasibility of the planned trial and the barriers/facilitators of distributing LPG to rural households. We conducted a feasibility study in rural Bangladesh using an iterative design. We included pregnant women, their families, and local LPG stakeholders. We distributed LPG to households for 3 months (3 cylinders) and assessed process issues, acceptability, and cooking/food behaviours. We interviewed LPG stakeholders, and conducted focus groups and in-depth interviews with the users. The initial distribution and uptake of LPG were hampered by process issues, most of these were due to the non-established supply chain in the study area. LPG cooking was very acceptable and all users reported a preference for continued use, fuel-sparing was heavily practiced. Safety concerns were an initial issue. LPG stakeholders reported that LPG demand differed by season. This study demonstrated the feasibility of our planned trial and the need for safety messages. These results are relevant beyond our trial, including for programs of LPG fuel promotion.

Pregnant Women’s Exposure to Household Air Pollution in Rural Bangladesh: A Feasibility Study for Poriborton: The CHANge Trial

“…Bangladesh experiences cooler temperatures in November and December, which increases traditional fuel use to heat the participant’s homes, especially evident since 29 of the 30 participants kept their traditional stoves in a separate kitchen [ 45 ]. Our survey data determined stove stacking was common as participants tried to conserve their LPG fuel for cooking and use traditional fuels for other activities such as heating [ 30 ]. Anecdotal evidence also suggests study participants used household products that produce significant amounts of PM 2.5 , especially black carbon, during the winter.…”

“…The Poriborton: The CHANge Trial feasibility study is described in Raynes-Greenow (2020) [ 30 ]. To briefly summarize, pregnant women’s exposure to HAP before and during LPG stove distribution were measured.…”

“…Important social implications must be considered before deciding whether the widespread adoption of LPG stoves is the most viable and sustainable option for improving air quality. The impact of a clean cooking intervention on HAP exposure reduction and associated improved health outcomes depends on behavior change that leads to sustained LPG stove adoption [ 30 , 31 , 32 ]. Cultural cooking practices, willingness to pay, fuel accessibility, economic factors associated with fuel costs and stove maintenance, and inadequate estimates of HAP reduction can adversely impact any clean cooking intervention [ 33 , 34 , 35 , 36 , 37 , 38 ].…”

Protocol for a cluster randomised controlled trial of LPG cookstoves compared to usual cooking practices to reduce perinatal mortality and morbidity in rural Bangladesh called Poriborton: the CHANge trial

“…Before finalising the trial design, we conducted a single-arm non-randomised feasibility study of LPG stove and cylinder distribution [ 30 ]. The findings from this study had multiple outcomes that identified issues and improved processes for conducting our trial: firstly, the development of a locally appropriate LPG cylinder supply chain in the study area, and secondly, the development of content relevant for our initial behaviour change communication such as benefits of clean cooking, practical suggestions for modifying cooking behaviours, and the important role of mothers-in-law and husbands in decision-making about cooking and fuel practices [ 30 ]. Lastly, we confirmed culturally appropriate approaches for measuring personal exposure to household air pollution and produced representative data that confirmed the LPG intervention did reduce exposure to cooking fuel emissions [ 31 ].…”

Exposure contrasts associated with a liquefied petroleum gas (LPG) intervention at potential field sites for the multi-country household air pollution intervention network (HAPIN) trial in India: results from pilot phase activities in rural Tamil Nadu

“…the “plancha” improved cookstove), establishing the potential for exposure reduction, and validating measurements of exposure for carbon monoxide. Most other HAP RCTs provide relatively limited information on potential for exposure contrast at putative trial sites, instead using considerations of high HAP levels at baseline, local logistics, stove or fuel distribution feasibility, and institutional support as the primary reasons for site selection [ 15 , 24 , 36 ].…”