Opinion by Fogarty Director Dr Roger I Glass
Cooking the family meal poses an enormous health risk for women and children in the poorest parts of the world. Exposure to household air pollution is estimated to cause about 3 million premature deaths each year. Despite decades of many well-intentioned efforts and millions of dollars invested in clean cookstoves, it’s difficult to make meaningful progress, as many program implementers have discovered. Each low-resource setting has its own unique issues, fuel options, transportation logistics, maintenance requirements and so on. But, just as important, each culture, and perhaps even each household, has its own cooking tradition, preferences and ingrained behavior. As we all know, change is hard.
Since 2010, Fogarty and our NIH partners have been collaborating on global efforts to try to find new ways to solve this problem - to encourage the efficient uptake of clean fuels and cookstoves, and provide scientific evidence that they actually improve health. Neither has proved easily accomplished.
Photo by Andrew Propp for Fogarty
A new NIH-led study provides lessons learned on clean
We hope to add to the body of knowledge on the former with a new NIH-led publication that sheds some light on the various challenges and successes of clean cooking efforts in 13 countries across sub-Saharan Africa, Asia and Latin America. The
Clean Cooking Implementation Science Network (ISN), supported by NIH and partners, has
published an overview article and 11 case studies evaluating the status of implementation programs deploying a range of clean cooking solutions to meet household energy needs. These reports provide lessons learned that will inform others planning similar initiatives and provide advice for ongoing programs attempting to scale up their efforts.
The investigators used an established framework - known as Reach, Effectiveness, Adoption, Implementation, Maintenance, or RE-AIM - to examine various aspects of the projects. Five involve stoves powered by liquefied petroleum gas (LPG), two use ethanol, two use biogas digesters and stoves, and two focus on compressed biomass fuels consisting of pellets and briquettes. Each evaluation sheds light on best practices, as well as impediments to progress, which advance our understanding of the complexities of clean fuel implementation in various contexts and among different populations.
In addition, we’re excited NIH is proceeding with a major multi-country trial to determine if LPG stoves can be effectively adopted in low-resource settings and if they improve air quality sufficiently to provide measurable health benefits. The five-year, $30.5 million study is being funded by NIH, with support from the Bill and Melinda Gates Foundation. Trial sites include India, Rwanda, Guatemala and Peru. Pregnant women are being recruited at each location and they and their infants will be followed until the children are one year old. Mothers will be evaluated to see if they suffer hypertension during pregnancy, while children will be examined to determine birth weight, growth and development progress, incidence of pneumonia and other health measures.
Though our progress may be slow, we are confident the research we support is adding to the global body of knowledge that will eventually help us reach our goal - providing clean and safe cooking solutions to all households, no matter where they are located.