Enhancing LPG adoption in Ghana (ELAG): a factorial cluster-randomized controlled trial to Enhance LPG Adoption & Sustained use

Daniel Carrión, Rebecca Dwommoh, Theresa Tawiah, Oscar Agyei, Francis Agbokey, Miecks Twumasi, Mohammed Mujtaba, Darby Jack, Kwaku Poku Asante, Daniel Carrión, Rebecca Dwommoh, Theresa Tawiah, Oscar Agyei, Francis Agbokey, Miecks Twumasi, Mohammed Mujtaba, Darby Jack, Kwaku Poku Asante

Abstract

Background: Three billion individuals worldwide rely on biomass fuel [dung, wood, crops] for cooking and heating. Further, health conditions resulting from household air pollution (HAP) are responsible for approximately 3.9 million premature deaths each year. Though transition away from traditional biomass stoves is projected curb the health effects of HAP by mitigating exposure, the benefits of newer clean cookstove technologies can only be fully realized if use of these new stoves is exclusive and sustained. However, the conditions under which individuals adopt and sustain use of clean cookstoves is not well understood.

Methods: The Enhancing LPG Adoption in Ghana (ELAG) study is a cluster-randomized controlled trial employing a factorial intervention design. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. This intervention seeks to align these five behavioral factors with clean cookstove adoption and sustained use. A second intervention is access-related and will improve LPG availability by offering a direct-delivery refueling service. These two interventions will be integrated via a factorial design whereby 27 communities are assigned to one of the following: the control arm, the educational intervention, the delivery, or a combined intervention. Intervention allocation is determined by a covariate-constrained randomization approach. After intervention, approximately 900 households' individual fuel use is tracked for 12 months via iButton stove use monitors. Analysis will include hierarchical linear models used to compare intervention households' fuel use to control households.

Discussion: Literature to-date demonstrates that recipients of improved cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can then lead to HAP-reductions and consequent improvements in public health.

Trial registration: NCT03352830 (November 24, 2017).

Keywords: Behavioral intervention; Biomass combustion; Clean cookstove adoption; Clean cookstoves; Household air pollution; Structural intervention; Sustained use.

Conflict of interest statement

Ethics approval and consent to participate

Individuals from the parent study, GRAPHS, will be directly contacted and asked to enroll in the current study. Participation will be confirmed through an informed consent process, which will be documented and consent can be revoked at any time. This study has received approval from the Institutional Review Board of Columbia University Medical Center and the Kintampo Heath Research Centre Institutional Ethics Committee. Additional approvals will be sought if there are unanticipated modifications to the protocol.

Competing interests

The authors declare that they do not have any competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Map of Kintampo, the study area
Fig. 2
Fig. 2
Power Calculations at .3 and .5 effect sizes
Fig. 3
Fig. 3
ELAG Study Flowchart

References

    1. Bonjour S, Adair-Rohani H, Wolf J, Bruce NG, Mehta S, Pruss-Ustun A, et al. Solid fuel use for household cooking: country and regional estimates for 1980-2010. Env Health Perspect. 2013;121:784–790. doi: 10.1289/ehp.1205987.
    1. Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102:843–851. doi: 10.1016/j.trstmh.2008.05.028.
    1. Smith KR, Bruce N, Balakrishnan K, Adair-Rohani H, Balmes J, Chafe Z, et al. Millions dead: how do we know and what does it mean? Methods used in the comparative risk assessment of household air pollution. Annu Rev Public Health. 2014;35:185–206. doi: 10.1146/annurev-publhealth-032013-182356.
    1. Streets DG, Bond TC, Carmichael GR, Fernandes SD, Fu Q, He D, et al. An inventory of gaseous and primary aerosol emissions in Asia in the year 2000. J Geophys Res Atmospheres. 2003;108(D21):n/a. doi: 10.1029/2002JD003093.
    1. Gustafsson Ö, Kruså M, Zencak Z, Sheesley RJ, Granat L, Engström E, et al. Brown clouds over South Asia: biomass or fossil fuel combustion? Science. 2009;323(5913):495. doi: 10.1126/science.1164857.
    1. Christian TJ. Trace gas and particle emissions from domestic and industrial biofuel use and garbage burning in Central Mexico. Atmospheric Chem Phys. 2010;10(2):565–584. doi: 10.5194/acp-10-565-2010.
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
    1. Kim Oanh NT, Reutergårdh LB, Dung NT. Emission of polycyclic aromatic hydrocarbons and particulate matter from domestic combustion of selected fuels. Environ Sci Technol. 1999;33(16):2703–2709. doi: 10.1021/es980853f.
    1. Mortimer K, Ndamala CB, Naunje AW, Malava J, Katundu C, Weston W, et al. A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi [the cooking and pneumonia study]: a cluster randomised controlled trial. Lancet. 2017;389(10065):167–175. doi: 10.1016/S0140-6736(16)32507-7.
    1. Smith KR, McCracken JP, Weber MW, Hubbard A, Jenny A, Thompson LM, et al. Effect of reduction in household air pollution on childhood pneumonia in Guatemala [RESPIRE]: a randomised controlled trial. Lancet. 2011;378:1717–1726. doi: 10.1016/S0140-6736(11)60921-5.
    1. Pope D, Bruce N, Dherani M, Jagoe K, Rehfuess E. Real-life effectiveness of ‘improved’stoves and clean fuels in reducing PM 2.5 and CO: systematic review and meta-analysis. Environ Int. 2017;101:7–18. doi: 10.1016/j.envint.2017.01.012.
    1. Masera OR, Saatkamp BD, Kammen DM. From linear fuel switching to multiple cooking strategies: a critique and alternative to the energy ladder model. World Dev. 2000;28:2083–2103. doi: 10.1016/S0305-750X(00)00076-0.
    1. Ruiz-Mercado I, Masera O, Zamora H, Smith KR. Adoption and sustained use of improved cookstoves. Energy Policy. 2011;39(12):7557–7566. doi: 10.1016/j.enpol.2011.03.028.
    1. Ruiz-Mercado I, Masera O. Patterns of stove use in the context of fuel–device stacking: rationale and implications. EcoHealth. 2015;12(1):42–56. doi: 10.1007/s10393-015-1009-4.
    1. Piedrahita R, Dickinson KL, Kanyomse E, Coffey E, Alirigia R, Hagar Y, et al. Assessment of cookstove stacking in northern Ghana using surveys and stove use monitors. Energy Sustain Dev. 2016;34:67–76. doi: 10.1016/j.esd.2016.07.007.
    1. Johnson MA, Chiang RA. Quantitative stove use and ventilation guidance for behavior change strategies. J Health Commun. 2015;20(Suppl 1):6–9. doi: 10.1080/10810730.2014.994246.
    1. Zhou Z, Dionisio KL, Arku RE, Quaye A, Hughes AF, Vallarino J, et al. Household and community poverty, biomass use, and air pollution in Accra, Ghana. Proc Natl Acad Sci. 2011;108(27):11028–11033. doi: 10.1073/pnas.1019183108.
    1. Zhou Z, Dionisio KL, Verissimo TG, Kerr AS, Coull B, Howie S, et al. Chemical characterization and source apportionment of household fine particulate matter in rural, peri-urban, and urban West Africa. Environ Sci Technol. 2014;48(2):1343–1351. doi: 10.1021/es404185m.
    1. Puzzolo E, Stanistreet D, Pope D, Bruce N, Rehfuess E. Factors influencing the large-scale uptake by households of cleaner and more efficient household energy technologies [Internet]. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2013. Available from: . Accessed 12 Nov 2013.
    1. 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. Environ Health Perspect. 2014;122(2):120–130.
    1. Lewis JJ, Pattanayak SK. Who adopts improved fuels and cookstoves? A systematic review. Environ Health Perspect. 2012;120(5):637. doi: 10.1289/ehp.1104194.
    1. Jeuland M, Pattanayak SK, Bluffstone R. The economics of household air pollution. Annu Rev Resour Econ. 2015;7(1):81–108. doi: 10.1146/annurev-resource-100814-125048.
    1. Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public Health. 2016;136:109–116. doi: 10.1016/j.puhe.2016.03.030.
    1. Petty RE, Brinol P. Attitude change. Adv Soc Psychol State Sci. 2010:217–59.
    1. Contzen N, Mosler HJ. The RANAS approach to systematic behavior change. Methodological Fact Sheet 1 [Internet]. Dübendorf, Switzerland: Eawag; 2015. Available from: . Accessed 13 June 2017.
    1. Stanistreet D, Hyseni L, Bashin M, Sadumah I, Pope D, Sage M, et al. The role of mixed methods in improved cookstove research. J Health Commun. 2015;20(Suppl 1):84–93. doi: 10.1080/10810730.2014.999896.
    1. Bhojvaid V, Jeuland M, Kar A, Lewis JJ, Pattanayak SK, Ramanathan N, et al. How do people in rural India perceive improved stoves and clean fuel? Evidence from Uttar Pradesh and Uttarakhand. Int J Environ Res Public Health. 2014;11(2):1341–1358. doi: 10.3390/ijerph110201341.
    1. Hankey S, Sullivan K, Kinnick A, Koskey A, Grande K, Davidson JH, et al. Using objective measures of stove use and indoor air quality to evaluate a cookstove intervention in rural Uganda. Energy Sustain Dev. 2015;25:67–74. doi: 10.1016/j.esd.2014.12.007.
    1. Alem Y, Beyene AD, Köhlin G, Mekonnen A. Modeling household cooking fuel choice: a panel multinomial logit approach. Energy Econ. 2016;59:129–137. doi: 10.1016/j.eneco.2016.06.025.
    1. Jeuland M, Pattanayak SK, Soo T, Sheng J. Preference Heterogeneity and Adoption of Environmental Health Improvements: Evidence from a Cookstove Promotion Experiment [Internet]. Rochester, NY: Social Science Research Network; 2014. Available from: . Accessed 21 Jan 2017.
    1. Beltramo T, Blalock G, Levine DI, Simons AM. Does peer use influence adoption of efficient Cookstoves? Evidence from a randomized controlled trial in Uganda. J Health Commun. 2015;20(sup1):55–66. doi: 10.1080/10810730.2014.994244.
    1. Bensch G, Peters J. A Recipe for Success? Randomized Free Distribution of Improved Cooking Stoves in Senegal, Ruhr Economic Papers, No. 325, ISBN 978-3-86788-374-0, RWI, Essen; 2012. .
    1. Pine K, Edwards R, Masera O, Schilmann A, Marrón-Mares A, Riojas-Rodríguez H. Adoption and use of improved biomass stoves in Rural Mexico. Energy for sustainable development 2011;15(2):176–183.
    1. Gordon J, Hyman J. The stoves are also stacked: evaluating the energy ladder, cookstove swap-out programs and social adoption preferences in the cookstove literature. J Environ Invest. 2012;3(1):17.
    1. Beyond Distribution: Ensuring and Evaluating the Adoption of Clean Cooking and Its Benefits [Internet]. Lima, Peru: Global Alliance for Clean Cookstoves; 2015. Available from: . Accessed 9 July 2015.
    1. International Energy Agency, Organisation for Economic Co-operation and Development World energy outlook 2016. Paris: OECD/IEA; 2016.
    1. Mosler H-J. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res. 2012;22:431–449. doi: 10.1080/09603123.2011.650156.
    1. Jack DW, Asante KP, Wylie BJ, Chillrud SN, Whyatt RM, Quinn AK, et al. Ghana randomized air pollution and health study [GRAPHS]: study protocol for a randomized controlled trial. Trials. 2015;16(1)
    1. Ghana Statistical Service. Population and Housing Census: Final Results [Internet]; 2010. Available from: . Accessed 13 Nov 2017.
    1. GhanaWeb. Ghana: Geography, Location, weather etc [Internet]. Available from: . Accessed 12 June 2017.
    1. Van Vliet ED, Asante K, Jack DW, Kinney PL, Whyatt RM, Chillrud SN, et al. Personal exposures to fine particulate matter and black carbon in households cooking with biomass fuels in rural Ghana. Environ Res. 2013;127:40–48. doi: 10.1016/j.envres.2013.08.009.
    1. Carrión D, Asante KP, Dwomah R, Mujtaba M, Taiwah T, Jack DW. Predictors of clean Cookstove use in a rural Ghanaian cohort. Manuscript in preparation; 2018.
    1. Scherbaum CA, Ferreter JM. Estimating statistical power and required sample sizes for organizational research using multilevel modeling. Organ Res Methods. 2009;12:347–367. doi: 10.1177/1094428107308906.
    1. Mosler HJ, Contzen N. Systematic behavior change in water, sanitation and hygiene. A practical guide using the RANAS approach. ESI 3.1: Catalog of behavior change techniques (BCTs) [Internet]. Dübendorf, Switzerland: Eawag; 2016. Available from: . Accessed 13 June 2017.
    1. Mosler HJ, Contzen N. Systematic behavior change in water, sanitation and hygiene. A practical guide using the RANAS approach [Internet]. Dübendorf, Switzerland: Eawag; 2016. Available from: . Accessed 13 June 2017.
    1. Sovacool BK, Drupady IM, ebrary Inc . Energy access, poverty, and development the governance of small-scale renewable energy in developing Asia. Surrey: Ashgate; 2012.
    1. Otoo M. NPA Launches National Consumer Week Celebration [Internet]. 10 November 2014, Modern Ghana. Available from: . Accessed 13 June 2017.
    1. Simon GL, Bailis R, Baumgartner J, Hyman J, Laurent A. Current debates and future research needs in the clean cookstove sector. Energy Sustain Dev. 2014;20:49–57. doi: 10.1016/j.esd.2014.02.006.
    1. Smith KR, Dutta K. Cooking with gas. Energy Sustain Dev. 2011;15(2):115–116. doi: 10.1016/j.esd.2011.05.001.
    1. Hollada J, Williams NK, Miele HC, Danz D, Harvey AS, Checkley W. Perceptions of improved biomass and liquefied petroleum gas stoves in Puno, Peru: implications for promoting sustained and exclusive adoption of clean cooking technologies. Int J Environ Res Public Health 2017;14[2].
    1. World LPG Association. Accelerating the LPG Transition: Global Lessons from Innovative Business and Distribution Models [Internet]; 2015. Available from: . Accessed 13 June 2017.
    1. ENERGIA International. Reaching the last mile in the extremely energy poor Asia-Pacific [Internet]; 2017. Available from: . Accessed 13 June 2017.
    1. Accenture Development Partnerships. Global Alliance for Clean Cookstoves: Brazil Feasibility Study [Internet]; 2011. Available from: . Accessed 13 June 2017.
    1. Iacus SM, King G, Porro G, Katz JN. Causal inference without balance checking: coarsened exact matching. Polit Anal. 2012:1–24.
    1. Ivers NM, Halperin IJ, Barnsley J, Grimshaw JM, Shah BR, Tu K, et al. Allocation techniques for balance at baseline in cluster randomized trials: a methodological review. Trials. 2012;13:120. doi: 10.1186/1745-6215-13-120.
    1. Moulton LH. Covariate-based constrained randomization of group-randomized trials. Clin Trials. 2004;1(3):297–305. doi: 10.1191/1740774504cn024oa.
    1. Lorenz E, Gabrysch S. Covariate-constrained randomization routine for achieving baseline balance in cluster-randomized trials. Stata Journal. 2017;17(2):503–10.
    1. Miller G, Mobarak AM. Gender differences in preferences, intra-household externalities, and low demand for improved cookstoves. National Bureau of Economic Research; 2013. Available from: . Accessed 11 Apr 2016.
    1. Pachauri S, Rao ND. Gender impacts and determinants of energy poverty: are we asking the right questions? Curr Opin Environ Sustain. 2013;5(2):205–215. doi: 10.1016/j.cosust.2013.04.006.
    1. Doss C. Intrahousehold bargaining and resource allocation in developing countries. World Bank Res Obs. 2013;28(1):52–78. doi: 10.1093/wbro/lkt001.
    1. Tolhurst R, Amekudzi YP, Nyonator FK, Squire SB, Theobald S. “He will ask why the child gets sick so often”: the gendered dynamics of intra-household bargaining over healthcare for children with fever in the Volta region of Ghana. Soc Sci Med. 2008;66(5):1106–1117. doi: 10.1016/j.socscimed.2007.11.032.
    1. Mani A. Mine, yours or ours? The efficiency of household investment decisions: an experimental approach. 2011.
    1. Hoel JB. Heterogeneous households: a within-subject test of asymmetric information between spouses in Kenya. J Econ Behav Organ. 2015;118:123–135. doi: 10.1016/j.jebo.2015.02.016.
    1. Ruiz-Mercado I, Canuz E, Smith KR. Temperature dataloggers as stove use monitors [SUMs]: field methods and signal analysis. Biomass Bioenergy. 2012;47:459–468. doi: 10.1016/j.biombioe.2012.09.003.
    1. Rosenbaum J, Derby E, Dutta K. Understanding consumer preference and willingness to pay for improved cookstoves in Bangladesh. J Health Commun. 2015;20(sup1):20–27. doi: 10.1080/10810730.2014.989345.
    1. Ezzati M, Baumgartner JC. Household energy and health: where next for research and practice?. The Lancet. 2017;389(10065):130–2.

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