Approximately 3 billion people rely on solid fuels and kerosene for their cooking needs. Exposure to household air pollution from burning these fuels accounts for approximately 3 million premature deaths a year. Clean fuels - such as liquefied petroleum gas (LPG), ethanol, biogas, electricity, and certain compressed biomass fuels - have the potential to alleviate much of this health burden, but to achieve health impact, uptake of the interventions must be widespread and sustained. Many clean fuel intervention programs are being implemented in low- and middle-income settings around the world, but few of these efforts have been evaluated. The Clean Cooking Implementation Science Network supported by the NIH and partners developed a set of eleven case studies, describing: LPG scale-up initiatives in Cameroon, Ghana, Indonesia, and Peru; biogas programs in Cambodia and East Africa; compressed biomass projects in Rwanda and China; alcohol fuel programs in Ethiopia and Nigeria; and a case in Ecuador covering LPG and electric induction cooking. We used RE-AIM (reach, effectiveness, adoption, implementation, maintenance) - an implementation science framework designed to organize and integrate information important in the translation of research to practice - to coordinate and evaluate the case studies. Results of this project include the eleven case studies themselves, a dataset that summarizes the programs using the RE-AIM framework, and a general conceptual model to support future planning and evaluation of household energy programs. Among the emergent results is the fact that traditional cooking practices tend to persist for multiple reasons (e.g. due to fuel supply interruptions, availability of free solid fuel, or cultural preferences) even when access and affordability are increased. Recommendations for such programs going forward are to include household-level monitoring of stove use patterns and to actively incentivize transition to near-exclusive clean fuel use.
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