Multiple Non-communicable Diseases Research Articles

Drug prescription appropriateness in hospitalized older patients: 15-year results and lessons from a countrywide register.

The global increase of aging with the related increase of multiple noncommunicable diseases is inevitably accompanied by the associated issue of multimorbidity and polypharmacy. The latter is not without peculiar consequences on health, because it has been shown to be associated with drug-related adverse events, mainly due to poor prescription appropriateness and drug-drug interactions. To contribute to tackle this gigantic problem, a registry of drug dispensation in hospitalized older patient has been initiated in Italy in 2008. Through the last 15years, data on nearly 11,000 older people have been accrued during their hospital stay in internal medicine and geriatric wards. This review article summarizes the main findings obtained, and how these data contribute to tackle the issue of appropriateness of drug prescription and the need of deprescribing in hospitalized older people affected by the most common noncommunicable diseases.

Clustering of non-communicable disease risk factors among adolescents in urban and rural Rajasthan

Background: Non communicable diseases (NCDs) are primarily driven by the modifiable risk factors that often emerge during the childhood/adolescence and contribute towards majority of premature deaths during adulthood. This study aimed to assess the prevalence of multiple NCD risk factors and the associated factors among adolescents in urban and rural areas of Rajasthan. Methods: It was a community-based cross-sectional study conducted among 430 school going adolescents. A self-administered questionnaire adapted from STEPS survey format of the WHO and indian adolescent health questionnaire was used; anthropometric measurements were taken using standard procedure. Presence of two or more risk factors in one individual was considered as clustering of NCD risk factors. Results: Prevalence of two risk factors (Dyads) was 48.8% (urban) and 33% (rural), three or more risk factors were found in about 12.1% urban and 7.9% rural adolescents. For “Dyads”, males had OR 3.58 (95% CI 1.9- 6.4) and OR 4.1 (95% CI 2.6-7.9) in urban and rural areas, respectively. The risk of clustering was higher with increasing age [Dyad: OR 1.26 (CI 1.1-5.73) in urban, OR 2.2 (CI 1.56-3.7) in rural; ≥ 3 risk factors: OR 2.3 (CI 1.98-4.11) in urban, OR 1.52 (CI 1.21-4.9)]. Conclusions: Clustering of the risk factors was prevalent among urban as well as rural adolescents emphasizing the importance of developing primary prevention strategies which can be effective across all demographic and socioeconomic backgrounds.

DiseaseNet: a transfer learning approach to noncommunicable disease classification

As noncommunicable diseases (NCDs) pose a significant global health burden, identifying effective diagnostic and predictive markers for these diseases is of paramount importance. Epigenetic modifications, such as DNA methylation, have emerged as potential indicators for NCDs. These have previously been exploited in other contexts within the framework of neural network models that capture complex relationships within the data. Applications of neural networks have led to significant breakthroughs in various biological or biomedical fields but these have not yet been effectively applied to NCD modeling. This is, in part, due to limited datasets that are not amenable to building of robust neural network models. In this work, we leveraged a neural network trained on one class of NCDs, cancer, as the basis for a transfer learning approach to non-cancer NCD modeling. Our results demonstrate promising performance of the model in predicting three NCDs, namely, arthritis, asthma, and schizophrenia, for the respective blood samples, with an overall accuracy (f-measure) of 94.5%. Furthermore, a concept based explanation method called Testing with Concept Activation Vectors (TCAV) was used to investigate the importance of the sample sources and understand how future training datasets for multiple NCD models may be improved. Our findings highlight the effectiveness of transfer learning in developing accurate diagnostic and predictive models for NCDs.

Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol

IntroductionThe majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with...

Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018

Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources. Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis. In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC-0.1%, 95% CrI-1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively. The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC. National Natural Science Foundation of China.

Relationship of the SITLESS intervention on medication use in community-dwelling older adults: an exploratory study.

Sedentary behavior (SB) and physical activity (PA) interventions in older adults can improve health outcomes. Problems related with aging include prevalent comorbidity, multiple non-communicable diseases, complaints, and resulting polypharmacy. This manuscript examines the relationship between an intervention aiming at reducing SB on medication patterns. This manuscript presents a local sub-analysis of the SITLESS trial data on medication use. SITLESS was an exercise referral scheme (ERS) enhanced by self-management strategies (SMS) to reduce SB in community-dwelling older adults. We analyzed data from the ERS + SMS, ERS and usual care (UC) groups. Patient medication records were available at baseline and at the end of the intervention (4-month period) and were analyzed to explore the effect of SITLESS on medication patterns of use. A sample of 75 participants was analyzed, mostly older overweight women with poor body composition scores and mobility limitations. There was a significant reduction of 1.6 medicines (SD = 2.7) in the ERS group (p < 0.01), but not in the UC or ERS + SMS groups. Differences were more evident in medicines used for short periods of time. The findings suggest that an exercise-based program enhanced by SMS to reduce SB might influence medication use for acute conditions but there is a need to further investigate effects on long-term medicine use in older adults.

Study protocol for development and validation of a single tool to assess risks of stroke, diabetes mellitus, myocardial infarction and dementia: DemNCD-Risk

IntroductionCurrent efforts to reduce dementia focus on prevention and risk reduction by targeting modifiable risk factors. As dementia and cardiometabolic non-communicable diseases (NCDs) share risk factors, a single risk-estimating tool...

Advances in the Administration of Vitamin D Analogues to Support Bone Health and Treat Chronic Diseases.

Vitamin D (VD) exerts a wide variety of biological actions in addition to its well-known roles in calcium homeostasis. Nutritional VD deficiency induces rachitic abnormalities in growing children and osteomalacia in adults, and it has been proposed to underlie the onset and development of multiple non-communicable chronic diseases. Therefore, the administration of VD or synthetic VD analogues represents a promising therapeutic strategy; indeed, VD and a VD agonist have shown clinical promise in mitigating osteoporosis and symptoms of insufficient calcium intake. However, even though high doses of VD analogues have shown pre-clinical efficacy against several diseases, including cancers, they have not yet had wide-spread clinical success. This difference may be due to limitation of clinical doses in light of the inherent calcemic action of VD. An approach to overcome this problem involves the development of VD analogues with lower calcemic activity, which could be administered in high doses to attenuate the onset and progress of disease. In a similar strategy, selective estrogen receptor modulators have had success as anti-osteoporosis drugs, and they have shown benefit for other estrogen target organs by serving as partial antagonists or agonists of estrogen receptor α. It is thus conceivable to generate synthetic partial antagonists or agonists for the VD receptor (VDR) that would exert beneficial effects on bone and other VD target organs. In this review, we discuss the molecular basis of the development of such synthetic VDR ligands from the viewpoint of roles of VDR in gene regulation.

Changes in Kidney Function Among Malaysian Adolescents and Its Determinants

The health and wellbeing of adolescents are often neglected, including the knowledge of chronic kidney disease (CKD), especially in its early stages. A total of 607 adolescents were recruited from the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study, a prospective cohort study conducted from March 2012 to May 2016 that explored the noncommunicable diseases (NCDs) risk factors among 13 to 17 years old students in 3 states of Peninsular Malaysia. Students who participated in all 3 data collection periods in 2012, 2014, and 2016 with kidney function assessment across all 3-time points were included in the current study. The students' estimated glomerular filtration rate (eGFR) was calculated from isotope-dilution mass spectrometry-traceable Schwartz's equation and categorized based on Kidney Disease: Improving Global Outcomes (KDIGO) classification. Changes in kidney function were examined, and the longitudinal relationship between eGFR and multiple NCD risk factors was analyzed using the generalized estimating equation (GEE). The prevalence of decreased eGFR (60-89 ml/min per 1.73 m2) among the students increased from 6.1% (2012) to 30.0% (2014) and 40.2% (2016). Based on the GEE, the student's eGFR decreased over time, with a steeper decline during early to midadolescence. Males and rural students had lower eGFR compared to their counterparts. Students who are morbidly obese had lower eGFR than those with normal body mass index (BMI). Protein consumption also has a potential moderating effect on eGFR in adolescents. Kidney function changes can be detected as early as adolescence and are likely attributable to multiple NCD risk factors. Therefore, more comprehensive prevention efforts from various stakeholders are needed to identify health issues like CKD.

Polypharmacy and cognition in older women: less is more?

At present, two-thirds of all community-dwelling adults develop multiple non-communicable diseases in their lifetime, with women at nearly double the risk of multimorbidity involving psychiatric conditions than men. This high burden of somatic-psychiatric multimorbidity among women necessitates frequent and simultaneous use of drugs according to various disease-specific guidelines. This do not necessarily imply overtreatment as co-occurring diseases may warrant treatment by multiple drugs, yet when inappropriate, polypharmacy turns to be particularly detrimental to cognitive health among older women.

A VALIDATION STUDY OF THE ADOLESCENT SMOKING QUESTIONNAIRE (ASQ) AMONG ADOLESCENTS IN PADANG, INDONESIA

Smoking is one of the world's most severe threats to public health that contributes to multiple non-communicable diseases. There is widespread use of tobacco among adolescents where the establishment of smoking behavior occurs during adolescence. Due to the high prevalence of smoking in Indonesia, it is essential to identify the associated risk factors for smoking behavior among adolescents, especially in West Sumatra. Thus, this study aims to determine the validity and reliability of the Adolescent Smoking Questionnaire (ASQ) that consisted of associated factors on smoking behavior among adolescents in Padang, Indonesia. This cross-sectional study was conducted among 172 respondents aged 13-15 from high schools in rural and urban areas, Padang City. The questionnaire consisted of sociodemographic information, knowledge of smoking, attitude toward smoking, social influence on smoking, and psychological factor. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed using STATA software Version 14. The EFA resulted in the production of 4 domains with 47 items. The CFA produced 46 items, and the model fit the data well, with CFI and TLI above 0.90 and RMSEA less than 0.08. All items also had factor loadings greater than 0.50. The Cronbach's alpha showed a good internal consistency since all domains had values greater than 0.7. The EFA and CFA analysis of ASQ showed a valid and reliable instrument for measuring adolescent smoking behaviors' associated factors.

Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study.

Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States. All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression. The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010). The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.

Healthcare-seeking experiences of older citizens in Bangladesh: A qualitative study.

Despite improvements in many health indicators in the last few decades, providing access to affordable and quality healthcare for older citizen remains a considerable challenge in Bangladesh. This study aimed to understand individuals 'experiences regarding their healthcare-seeking, treatment cost, accessibility and coping mechanisms for the promotion of appropriate strategies to enhance the quality of life of the older citizens of Bangladesh.A qualitative descriptive approach was used in this study. A total of 27 In-Depth Interviews (IDIs) were conducted in a district in Bangladesh with older people between January and February 2020, where gender distribution was equal. Face-to-face interviews were conducted by trained and experienced interviewers regarding healthcare-seeking and accessibility, affordability, and healthcare coping strategy. Thematic analysis was conducted to analyse the data. It was found that the health condition of the older population is not satisfactory. Most of them had been suffering from several diseases such as benign tumor, chronic kidney disease, body aches, gastric ulcers for a longer period of time. The majority of the participants were suffering from multiple non-communicable diseases while diabetes and hypertension were the foremost of all diseases. This study provides insight into the challenges of managing healthcare services for older citizens in Bangladesh. Healthcare facilities were available, but high out-of-pocket payments, lack of caregivers, and time distance created a barrier to the service provision. The findings indicated that geriatric care policymakers and service providers should prioritize the older-friendly health infrastructures with affordable cost of treatment for the betterment of the health status of older citizens in Bangladesh.

The Health-Seeking Behavior of the Elderly with Non-Communicable Diseases in Coastal Areas of Vietnam

This study aimed to analyze the utilization of health care facilities and the health-seeking behavior of elderly people with non-communicable diseases and find the factors that affect them. A cross-sectional study was conducted in seven coastal areas of the Thua Thien Hue province, Vietnam, using a sample of 370 elderly people aged over 60 years. Chi-square and multiple logistic regression analyses were used to examine the factors associated with the utilization of health care services. The participants' average age was 69.70 (SD), and 18% of them reported having ≥ two non-communicable diseases (NCDs). The results of the study showed that 69.8% of the total participants exhibited health-seeking behaviors. The findings also revealed that elderly people living alone, and those with an average or above-average income, had higher utilization of health care services. Participants with multiple NCDs exhibited more health-seeking behaviors than those with only one (OR: 9.24, 95% CI: 2.66-32.15, p = <0.001). The presence of health insurance and the need for health care counseling were also relevant ([OR: 4.16, 95% CI: 1.30-13.31, p = 0.016], [OR: 3.91, 95% CI: 2.04-7.49, p < 0.001], respectively). Health-seeking behavior is one of the most important positive implications for the aged population, as it encompasses one's physical, mental, and psychological wellbeing. Future studies can aim at gaining an in-depth understanding of the same results, helping improve the health-seeking behavior of elderly people, and enhancing their quality of life.

Morbidity and risk factors for multiple noncommunicable diseases in Northern China: a cross-sectional survey.

This study aimed to determine the morbidity and comorbidity of glucolipid metabolic multiple noncommunicable diseases in a Chinese natural population and associated risk factors. A cross-sectional survey with randomized sampling was conducted on a typical sample of 4,002 residents (aged 26-76 years) in the Pinggu District of Beijing. They were subjected to a questionnaire survey, physical examination, and laboratory examination to collect data. Multivariable analysis was used to establish the association between various risk factors and multiple noncommunicable diseases. The overall prevalence rate of chronic glucolipid metabolic noncommunicable diseases was 84.28%. The most common type of noncommunicable diseases was dyslipidemia, abdominal obesity, hypertension, obesity, and type 2 diabetes. The prevalence rate of multiple noncommunicable diseases was 79.60%. Participants with dyslipidemia were at higher risk for underlying chronic diseases. Younger men and women after menopause were more likely to have multiple noncommunicable diseases compared to their older and younger counterparts, respectively. The results of multivariate logistic regression indicated that age above 50, male sex, high household income, low education level, and harmful alcohol consumption were independent risk factors for multiple noncommunicable diseases. The prevalence of chronic glucolipid metabolic noncommunicable diseases in Pinggu was higher than at the national level. Men with multiple noncommunicable diseases were younger, while women after menopause were more likely to suffer from multiple noncommunicable diseases and the prevalence rate was higher than in men. Intervention programs that aim to target risk factors by sex and region-specific are urgently needed.

The global agenda on obesity: what does this mean for Singapore?

The global agenda on obesity: what does this mean for Singapore?

Perceived Experience of Old Adult Patients with Services provided in the Tertiary Level Hospitals in Kathmandu: A Cross-Sectional study

Introduction: Most old adults are vulnerable to multiple non-communicable diseases and need extensive care, treatment and support for a good quality of life. The main objective of this study was to identify the old adult patient’s perceived experience with the care provided in the tertiary level hospitals under the Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. Methods: The cross-sectional study was conducted among 404 old adult patients admitted with non-communicable diseases in two tertiary levels University Hospitals in Kathmandu, Nepal. An interview schedule was conducted with hospitalized old adult patients to collect data using a consecutive sampling technique. Results: Most participants [208 (51.5%)] were from the age group of 60 to 69 years with a mean age (± SD) of 71.1 (± 9.7) years. One-fourth [103 (25.5%)] of them were financially independent. Two hundred thirty-three (57.7%) were admitted with a single diagnosis. Two hundred forty (59.4%) participants bore their hospital expenses with out-of-pocket payment, and 40.6% were covered by a third party payment. The majority of them (86.1%) had the experience of finding approachable health personnel in the hospital whereas 82.7% felt that the cost of treatment was higher than expected. 80.4% perceived that access to the hospital service (e.g. getting the outpatient tickets) was user-friendly. However, only 10.9% experienced follow-up visits user friendly. Conclusions: The hospitals where this research was done have a relatively high standard of care for old adult patients. Old adult-friendly health policy, physical environments of the hospital, and advocacy for them should further be considered in the tertiary level hospitals for the benefit of old adult patients.

Noncommunicable Disease Profiles of Bangladeshi Immigrants Aged &gt;55 Years Living in Toronto: Access to Health Workshop and Needed Supports for Management

Objectives: The study explored the profiles of noncommunicable diseases (NCDs) of South Asian Bangladeshi immigrants aged &gt; 55, access to health workshops about NCDs for self-care, and the types of support they needed to control and manage their NCDs.&#x0D; Methods: The study was cross-sectional. The participants were Bangladeshi immigrants aged &gt; 55 living in Toronto. They attended an ethnic community organization for services from January to March 2020, and the study included participants from them (purposively). Pretested structured and semi-structured questionnaires were applied to collect the information. The study used chi-square and logistic regression for data analysis. &#x0D; Results: The study included 191 participants; among the participants, males and females were 44.0% (84) and 56.0% (107), respectively, more than half of them (53.4%, 102) were aged &gt; 60 years, and the majority (69.6%, 133) lived in Canada for more than five years. The frequently mentioned NCDs by gender perspective were diabetes (male vs. female: 51.2% vs. 57.9%), high blood pressure (male vs. female: 48.8% vs. 54.2%), and high cholesterol (male vs. female: 33.3% vs. 36.4%). They also mentioned arthritis/chronic joint pain (22.0%, 44), anxiety and depression (16.2%, 31), and heart disease (15.2%, 29). Females, compared to males, were more likely to have multiple NCDs, AOR= 1.62, 95% CI: 0.86, 3.04. Also, the participants aged &gt; 60 years were 2.53 times more likely to have multiple NCDs than those who were &lt; 60 years (95% CI: 1.34, 4.77), and the participants who arrived in Canada in five years were more likely to have multiple NCDs, AOR=1.42, 95% CI: 0.72, 2.83) compared to the group more than five years. Furthermore, 51.8% (99) of participants had no access to health workshops/ health information about NCDs for self-management. Most needed caregiver support from family members (59.7%, 114) to manage NCDs. Also, they required accompaniment support to go to health care providers (40.3%, 77), needed a doctor's cooperation (34.0%, 65), prescription management support (28.3%, 54), and home support (26.7%, 51) for managing the diseases. &#x0D; Conclusion: The profile of NCDs of Bangladeshi immigrants aged &gt; 55 years were high blood pressure, diabetes, and high cholesterol. Gender and sociodemographic variables changed the profile of NCDs in Bangladeshi immigrants. Participants needed better health information access and family care support to manage NCDs. Local ethnic community services can design a community-based health, home, and caregiver support approach to address the NCDs of Bangladeshi immigrants.

HUMAN AGING INTERVENTIONS

Abstract Biological aging is the greatest risk factor for multiple non-communicable diseases affecting multiple organ systems. Evidence from animal studies suggest that the rate of biological aging is modifiable and that slowing the rate of biological aging may decrease the incidence of age-related morbidity and mortality. Based on these findings, several approaches are currently being studied to slow the rate of biological aging in humans. This symposium features internationally renowned aging research scientists whose work focuses on clinical interventions to modify biological aging in humans. We will hear from Rajagopal Sekhar from the Baylor College of Medicine who will present his research on “Improving oxidative stress, mitochondrial dysfunction, inflammaging, aging hallmarks and muscle strength in older adults: the novel role of GlyNAC and the 'Power of 3'”; Jamie Justice from the Wake Forest School of Medicine will present her work on “Response to dietary restriction interventions in older adults: biomarkers of cellular senescence and biological aging”; Reem Waziry from the Columbia University Mailman School of Public Health will present her work “Does Caloric Restriction Slow the Process of Biological Aging in Non-Obese Healthy Adults? Evidence from the CALERIE™ Trial”; and Daniel Parker from the Duke University School of Medicine will present his work “Does APOE genotype moderate the impact of diet modification and exercise training on age-related outcomes?”. Attendees will learn about recent advances in interventions targeting human aging.

A review on household air pollution and biomass use over Kenya

Household air pollution (HAP) causes multiple noncommunicable diseases, such as pneumonia, stroke, and ischemic heart disease, and is responsible for over 3.8 million deaths globally per year. Kenya has a high rate of HAP, mainly caused by solid fuels. This review assesses its effect and identifies factors that could improve policy in Kenya. A systematic review approach is used, mainly considering 88 research articles on the Web of Science, published from 1951 to 2022. We excluded studies on HAP caused by other forms of fuel, subjective study types, and studies focusing on animals. The results show that rural settings and urban slums have more HAP, ventilation is an important factor, HAP is high in the evening, and children and women health is significantly affected. There is a need for interventions to reduce the use of biomass fuels in Kenya. The interventions include improved access to efficient cookstoves with ventilation, community health awareness about ventilation, housing rules for better ventilation in rural and urban areas, and NGO partnership for improving access to improved cookstoves in rural areas. The government’s role includes subsidizing the supply and cost of renewable energy and adopting energy policies that encourage populations to switch to more efficient cookstoves, cleaner energy, and modern biofuels.