Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

On Behalf Of The Prospective Urban Rural Epidemiology Study, Matthew Shupler, Perry Hystad, Paul Gustafson, Sumathy Rangarajan, Maha Mushtaha, K. G. Jayachtria, Prem K. Mony, Deepa Mohan, Parthiban Kumar, Lakshmi Pvm, Vivek Sagar, Rajeev Gupta, Indu Mohan, Sanjeev Nair, Ravi Prasad Varma, Wei Li, Bo Hu, Kai You, Tatenda NcubeBrian Ncube, Jephat Chifamba, Nicola West, Karen Yeates, Romaina Iqbal, Rehman Khawaja, Rita Yusuf, Afreen Khan, Pamela Seron, Fernando Lanas, Patricio Lopez-Jaramillo, Paul A. Camacho, Thandi Puoane, Salim Yusuf, Michael Brauer

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Introduction. Switching from polluting (e.g. wood, crop waste, coal) to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods. We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (∼2005-2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households (12 369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3109) switched between different polluting fuels, 10% (1164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17 830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005 and 2015) were the strongest predictors of polluting-to-clean fuel switching. Conclusions. The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.

Original languageEnglish
Article number085006
JournalEnvironmental Research Letters
Issue number8
Publication statusPublished - 29 Jul 2019


  • clean cooking
  • household air pollution
  • multilevel modeling
  • primary cooking fuel switching


Dive into the research topics of 'Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study'. Together they form a unique fingerprint.

Cite this