title: A strategy to increase adoption of locally-produced, ceramic cookstoves in rural Kenyan households.
abstract: BACKGROUND
  Exposure to household air pollutants released during cooking has been linked to numerous adverse health outcomes among residents of rural areas in low-income countries. Improved cookstoves are one of few available interventions, but achieving equity in cookstove access has been challenging. Therefore, innovative approaches are needed. To evaluate a project designed to motivate adoption of locally-produced, ceramic cookstoves (upesi jiko) in an impoverished, rural African population, we assessed the perceived benefits of the cookstoves (in monetary and time-savings terms), the rate of cookstove adoption, and the equity of adoption.
  
  
  METHODS
  The project was conducted in 60 rural Kenyan villages in 2008 and 2009. Baseline (n = 1250) and follow-up (n = 293) surveys and a stove-tracking database were analyzed.
  
  
  RESULTS
  At baseline, nearly all respondents used wood (95%) and firepits (99%) for cooking; 98% desired smoke reductions. Households with upesi jiko subsequently spent <100 Kenyan Shillings/week on firewood more often (40%) than households without upesi jiko (20%) (p = 0.0002). There were no significant differences in the presence of children <2 years of age in households using upesi jiko (48%) or three-stone stoves (49%) (p = 0.88); children 2-5 years of age were less common in households using upesi jiko versus three-stone stoves (46% and 69%, respectively) (p = 0.0001). Vendors installed 1,124 upesi jiko in 757 multi-family households in 18 months; 68% of these transactions involved incentives for vendors and purchasers. Relatively few (<10%) upesi jiko were installed in households of women in the youngest age quartile (<22 years) or among households in the poorest quintile.
  
  
  CONCLUSIONS
  Our strategy of training of local vendors, appropriate incentives, and product integration effectively accelerated cookstove adoption into a large number of households. The strategy also created opportunities to reinforce health messages and promote cookstoves sales and installation. However, the project's overall success was diminished by inequitable and incomplete adoption by households with the lowest socioeconomic status and young children present. Additional evaluations of similar strategies will be needed to determine whether our strategy can be applied equitably elsewhere, and whether reductions in fuel use, household air pollution, and the incidence of respiratory diseases will follow adoption of improved cookstoves.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, 1600 Clifton Road, Atlanta, GA 30333, USA. bsilk@cdc.gov
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Silk
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sadumah
authors.forename: Minal K
authors.initials: MK
authors.lastname: Patel
authors.forename: Vincent
authors.initials: V
authors.lastname: Were
authors.forename: Bobbie
authors.initials: B
authors.lastname: Person
authors.forename: Julie
authors.initials: J
authors.lastname: Harris
authors.forename: Ronald
authors.initials: R
authors.lastname: Otieno
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nygren
authors.forename: Jennifer
authors.initials: J
authors.lastname: Loo
authors.forename: Alie
authors.initials: A
authors.lastname: Eleveld
authors.forename: Robert E
authors.initials: RE
authors.lastname: Quick
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000517:prevention & control*; D002516:Ceramics; D002675:Child, Preschool; D003296:Cooking / Q000295:instrumentation*; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D006794:Household Articles / Q000295:instrumentation* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007630:Kenya; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult