Self-adopted 'natural users' of liquid petroleum gas for household cooking by pregnant women in rural Bangladesh: characteristics of high use and opportunities for intervention

The use of clean fuel such as liquid petroleum gas (LPG) is globally recommended for household cooking to reduce exposure to household air pollution and its adverse health consequences. Adoption of LPG in resource-poor settings such as South Asia is low and driven by many factors. In Bangladesh, more than 90% of the rural population relies on biomass fuels for cooking. Identifying factors among households that self-adopt LPG, i.e. 'natural users' may provide insight into how LPG programs could be modified to improve the adoption of clean fuels. We aimed to assess factors that drive LPG adoption and use in a rural setting amongst natural users of LPG in Bangladesh. We conducted a household survey of natural users of LPG who were pregnant and were identified by a census listing of households in 63 villages of five unions of Tangail district. Of 337 existing pregnant natural users, we could complete interview of 299 women using a structured questionnaire which included socio-demographic, kitchen structure, cooking behaviours and potential factors related to LPG use. Nearly all natural users had multiple cookstoves, and 85% reported using LPG as an alternative fuel to their main cooking and fuel (traditional cooking with biomass fuels). Factors related to high use of LPG (defined as at least 50% of all cooking time in previous 24 h) included households in second wealth quintile, (adjusted Prevalence Ratio, aPR 3.03; 95% CI:1.15–8.00), middle wealth quintile, (aPR 2.72; 95% CI:1.01–7.30) and highest wealth quintile (aPR2.71;95% CI: 1.02–7.28. Health issues also influenced LPG use; if LPG was described as alleviating breathing problems (aPR 1.65; 95% CI: 1.08–2.52), there was more LPG use. Adoption of LPG stove as a backup option for emergency purpose cooking reduced greater use of LPG (aPR 0.59; 95% CI: 0.39–0.91). High use of LPG was associated with LPG cooking being reported as easy to use (aPR 4.13; 95% CI: 1.95–8.73). Women's perception that LPG alleviated breathing difficulties was associated with high-use of LPG cooking, as was household wealth and ease of use. Women who reported to use LPG only for emergency purposes were less likely to be high users. Clean fuel programs as well as being financially supportive could be modified to include a trial period so that the experience of LPG would further support clean cooking adoption. (paper)