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.

Camille Raynes-Greenow,Jasmin Khan,Sajia Islam,Fariha Tasnim,Sk Masum Billah,Monjura Khatun Nisha,Jonathan Thornburg,And Ashraful Alam

doi:10.3390/ijerph17030848

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.

Highlights

Household air pollution is one of the major contributors to the global burden of morbidity and mortality [1], and women and children experience the greatest exposure burden, the impact on perinatal mortality has not been accurately defined [2]
All households had not cooked or used liquid petroleum gas (LPG) previously, but all were aware of LPG, and their perception was that it was superior cooking compared to traditional stoves
We learned many valuable lessons and established the feasibility of conducting a large-scale trial of LPG for pregnant women in rural Bangladesh taking into account local issues and cultural cooking practices

Summary

Introduction

Household air pollution is one of the major contributors to the global burden of morbidity and mortality [1], and women and children experience the greatest exposure burden, the impact on perinatal mortality (stillbirth >28 weeks and early neonatal death ≤ 7 days after birth) has not been accurately defined [2]. In South Asia, both the reliance on polluting fuels that cause household air pollution and perinatal mortality is high, and this, coupled with the accumulating evidence of the effect of exposure to household air pollution and perinatal outcomes, suggest that further research is needed [2,3]. A 2014 systematic review and meta-analysis of stillbirth with polluting fuels reported a summary odds effect of 1.29 (95% CI: 1.18, 1.41) [4], which is slightly lower than the previous estimates from an earlier systematic review (OR: 1.51, 95% CI: 1.23, 1.85) [2]. In both reviews, the same four studies were.

Objectives

Methods

Results

Discussion

Conclusion