To reduce household air pollution exposure, consistent use of clean cooking fuels (e.g. liquefied petroleum gas (LPG)) is needed. While several studies have investigated determinants of LPG adoption cross-sectionally, few have explored factors associated with its use over time. Two surveys were administered to primary cooks in three peri-urban communities: Mbalmayo, Cameroon; Obuasi, Ghana and Eldoret, Kenya, with an approximate twomonth period in between surveys. Multivariable logistic regression models assessed predictors of continued primary LPG use. Within two months, 15% (n = 94) of 625 households cooking primarily with LPG ceased using it as their primary fuel. Additionally, 25% (n = 38) of 149 households using LPG as a secondary fuel stopped cooking with LPG altogether. In the multivariable model, primary cooks reporting constant availability of LPG at retailers had 1.34 times the odds (95% CI:1.07-1.70) of continued primary LPG use as those who found LPG refills to be unavailable once a month or more. Additionally, households with double (OR = 1.11, 95% CI: 1.03-1.20) or triple-burner LPG stoves (OR = 1.19, 95% CI: 1.10-1.30) had significantly higher odds of continuing to use LPG compared with those using a single-burner stove. Furthermore, households that used their stove seven days during the previous week had significantly higher odds (OR = 1.19, 95% CI: 1.10-1.30) of continued LPG use. Lastly, households in which the household head was unemployed had lower odds (OR = 0.94, 95% CI: 0.89-1.00) of continued primary LPG use. These findings underscore the importance of supply reliability and stove functionality as key determinants of continued clean fuel use, beyond initial adoption.

BACKGROUND:Relatively clean cooking fuels such as liquefied petroleum gas (LPG) emit less fine particulate matter (PM2·5) and carbon monoxide (CO) than polluting fuels (eg, wood, charcoal). Yet, some clean cooking interventions have not achieved substantial exposure reductions. This study evaluates determinants of between-community variability in exposures to household air pollution (HAP) across sub-Saharan Africa. METHODS:In this measurement study, we recruited households cooking primarily with LPG or exclusively with wood or charcoal in peri-urban Cameroon, Ghana, and Kenya from previously surveyed households. In 2019-20, we conducted monitoring of 24 h PM2·5 and CO kitchen concentrations (n=256) and female cook (n=248) and child (n=124) exposures. PM2·5 measurements used gravimetric and light scattering methods. Stove use monitoring and surveys on cooking characteristics and ambient air pollution exposure (eg, walking time to main road) were also administered. FINDINGS:The mean PM2·5 kitchen concentration was five times higher among households cooking with charcoal than those using LPG in the Kenyan community (297 μg/m3, 95% CI 216-406, vs 61 μg/m3, 49-76), but only 4 μg/m3 higher in the Ghanaian community (56 μg/m3, 45-70, vs 52 μg/m3, 40-68). The mean CO kitchen concentration in charcoal-using households was double the WHO guideline (6·11 parts per million [ppm]) in the Kenyan community (15·81 ppm, 95% CI 8·71-28·72), but below the guideline in the Ghanaian setting (1·77 ppm, 1·04-2·99). In all communities, mean PM2·5 cook exposures only met the WHO interim-1 target (35 μg/m3) among LPG users staying indoors and living more than 10 min walk from a road. INTERPRETATION:Community-level variation in the relative difference in HAP exposures between LPG and polluting cooking fuel users in peri-urban sub-Saharan Africa might be attributed to differences in ambient air pollution levels. Thus, mitigation of indoor and outdoor PM2·5 sources will probably be critical for obtaining significant exposure reductions in rapidly urbanising settings of sub-Saharan Africa. FUNDING:UK National Institute for Health and Care Research.

Introduction:Liquefied petroleum gas (LPG) is a clean cooking fuel that emits less household air pollution (HAP) than polluting cooking fuels (e.g. charcoal, wood). While switching from polluting fuels to LPG can reduce HAP and improve health, the impact of 'stacking' (concurrent use of polluting fuels and LPG) on adverse health symptoms (e.g. headaches, eye irritation, cough) among female cooks is uncertain. Methods:Survey data from the CLEAN-Air(Africa) study was collected on cooking patterns and health symptoms over the last 12 months (cough, wheezing, chest tightness, shortness of breath, eye irritation, headaches) from approximately 400 female primary cooks in each of three peri‑urban communities in sub-Saharan Africa: Mbalmayo, Cameroon; Obuasi, Ghana; and Eldoret, Kenya. Random effects Poisson regression, adjusted for socioeconomic and health-related covariates, assessed the relationship between primary and secondary cooking fuel type and self-reported health symptoms. Results:Among 1,147 participants, 10 % (n = 118) exclusively cooked with LPG, 45 % (n = 509) stacked LPG and polluting fuels and 45 % (n = 520) exclusively cooked with polluting fuels. Female cooks stacking LPG and polluting fuels had significantly higher odds of shortness of breath (OR 2.16, 95 %CI:1.04-4.48) compared with those exclusively using LPG. In two communities, headache prevalence was 30 % higher among women stacking LPG with polluting fuels (Mbalmayo:82 %; Eldoret:65 %) compared with those exclusively using LPG (Mbalmayo:53 %; Eldoret:33 %). Women stacking LPG and polluting fuels (OR 2.45, 95 %CI:1.29-4.67) had significantly higher odds of eye irritation than women cooking exclusively with LPG. Second-hand smoke exposure was significantly associated with higher odds of chest tightness (OR 1.92, 95 % CI:1.19-3.11), wheezing (OR 1.76, 95 % CI:1.06-2.91) and cough (OR 1.78, 95 %CI:1.13-2.80). Conclusions:In peri‑urban sub-Saharan Africa, women exclusively cooking with LPG had lower odds of several health symptoms than those stacking LPG and polluting fuels. Promoting a complete transition to LPG in these communities may likely generate short-term health benefits for primary cooks.

BACKGROUND AND AIM: Cleaner cooking fuels like liquefied petroleum gas (LPG) emit less fine particulate matter (PM2.5) and carbon monoxide (CO) than polluting fuels (e.g. wood, charcoal). Yet, some clean cooking interventions have not achieved substantial exposure reductions. METHOD: The CLEAN-Air(Africa) study measured 24-hour PM2.5 and CO kitchen concentrations (n=262), female cook (n=223) and child (n=119) exposures in peri-urban Kenya, Ghana and Cameroon among households cooking primarily with LPG, wood or charcoal. Stove use monitoring was used to derive mean 'cooking' and 'non-cooking' PM2.5 and CO levels. RESULTS: The mean 24-hour PM2.5 kitchen concentration among households cooking with charcoal (317 μg/m3) was quintuple that among households using LPG (61 μg/m3) in Kenya, but only 2 μg/m3 higher in Ghana (56 versus 54 μg/m3, respectively). The mean CO kitchen concentration in households cooking with charcoal was twice the WHO guideline (7 ppm) in Kenya (15.81 ppm) but below the guideline in Ghana (1.77 ppm). The mean PM2.5 kitchen concentration among households using wood in Cameroon was four times higher while cooking (811 μg/m3) than not cooking (202 μg/m3). Among households using charcoal in Ghana, the mean PM2.5 kitchen concentration was lower when cooking (42 μg/m3) than not cooking (67 μg/m3). Mean PM2.5 cook exposures only met the WHO interim-1 target (35 μg/m3) among LPG users staying indoors and living 10 minutes from a road. CONCLUSIONS: Clean cooking interventions should be prioritized in certain sub-Saharan African communities to increase the likelihood of PM2.5 exposure reductions and associated health benefits.

OBJECTIVES:Attempts to reduce health inequities in England frequently prioritise some equity dimensions over others. Intersectionality highlights how different dimensions of inequity interconnect and are underpinned by historic and institutionalised power imbalances. We aimed to explore whether intersectionality could help us shed light on young adults' understanding of health inequities. STUDY DESIGN:The study incorporatedqualitative thematic analysis of primary data. METHODS:Online focus groups with young adults (n = 25) aged 18-30 living in three English regions (Greater London; South Yorkshire/Midlands; North-East England) between July 2020 and March 2021. Online semistructured interviews (n = 2) and text-based communication was conducted for participants unable to attend online groups. RESULTS:Young adults described experiencing discrimination, privilege, and power imbalances driving health inequity and suggested ways to address this. Forms of inequity included cumulative, within group, interacting, and the experience of privilege alongside marginalisation. Young adults described discrimination occurring in settings relevant to social determinants of health and said it adversely affected health and well-being. CONCLUSION:Intersectionality, with its focus on discrimination and identity, can help public health stakeholders engage with young adults on health equity. An upstream approach to improving health equity should consider multiple and intersecting forms of discrimination along with their cultural and institutional drivers.

Polluting fuels such as biomass and kerosene are used for cooking by approximately 85% of the population in sub-Saharan Africa (SSA) despite the well-known associated negative health effects. Many governments across SSA are aiming to scale up the use of liquefied petroleum gas (LPG), a cleaner-burning fuel in terms of black carbon and fine particulate matter emissions, to promote public health and protect the environment by reducing deforestation. In Kenya, the government has been promoting rapid scale-up of LPG as a household fuel by zero rating it. A census survey was administered to over 2000 households in a peri-urban and rural sub-county of Uasin Gishu County to determine cooking characteristics and factors associated with the primary cooking fuel (biomass versus LPG). We found that the majority 72% (n = 1619) of the households mainly use biomass as a primary fuel (86% wood, 12% charcoal, 1.5% wood chips, and 1% kerosene) while about 28% (n = 629) use clean fuels (86.8% LPG, 12.9% biogas/solar, and 0.3% electricity). Peri-urban residents had up to 2.5 times increased odds of using LPG compared to those in the rural sub-county. Supply factors such as easy access to refills affect the number of days the LPG is used per week. Urbanization at sub-county leads to increases in use of LPG for cooking, irrespective of household-level SES. The Government is encouraged to enact policies that would increase the availability of LPG refills to rural communities hence reducing the time and transportation costs that are likely to affect access with consequent low usage.

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action.This paper addresses these developments, and specifically engages with the contested notion of 'allyship'. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation.White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity.The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings.

Community-centered approaches can be effective ways to engage communities and improve their health and well-being. The Grange is a community-led, multifaceted, and dynamic intervention incorporating a community hub and garden, that took place in a small area of the North-West of England, characterized by high levels of deprivation and poor health. Activities have been defined, developed, and supported by residents to meet locally defined needs. This study used photovoice methods to explore residents' perceptions and experiences of this community-led intervention and any perceived impact on health, well-being, and community inclusion. Through photographs, semistructured interviews, a focus group discussion, and an exhibition, this study engaged intensively and creatively with a group of six residents. They identified positive and negative aspects related to The Grange and suggested recommendations that were directly communicated to policy makers during the photo-exhibition event. Participants reflected on various activities such as the community garden and the community shop. They also reflected on contextual factors and suggested that the culture of inclusivity and friendships associated with The Grange were more important to them than specific activities. This study demonstrated the value of using photovoice to (a) explore residents' perceptions of community led interventions; and (b) meaningfully engage residents living in areas with high levels of deprivation. Public health practitioners should consider the use of photovoice (a) in the evaluation of health interventions that take place in a complex and changing context, and (b) as a powerful tool to engage with members of the community, especially traditionally disadvantaged groups, to ensure that engagement about health, well-being, and social inclusion is meaningful.

Household air pollution (HAP) caused by the combustion of solid fuels for cooking and heating is responsible for almost 5% of the global burden of disease. In response, the World Health Organisation (WHO) has recommended the urgent need to scale the adoption of clean fuels, such as liquefied petroleum gas (LPG), in low and middle-income countries (LMICs). To understand the drivers of the adoption and exclusive use of LPG for cooking, we analysed representative survey data from 3343 peri-urban and rural households in Southwest Cameroon. Surveys used standardised tools to collect information on fuel use, socio-demographic and household characteristics and use of LPG for clean cooking. Most households reported LPG to be clean (95%) and efficient (88%), but many also perceived it to be expensive (69%) and unsafe (64%). Positive perceptions about LPG’s safety (OR = 2.49, 95% CI = 2.04, 3.05), cooking speed (OR = 4.31, 95% CI = 2.62, 7.10), affordability (OR = 1.7, 95% CI = 1.38, 2.09), availability (OR = 2.17, 95% CI = 1.72, 2.73), and its ability to cook most dishes (OR = 3.79, 95% CI = 2.87, 5.01), were significantly associated with exclusive LPG use. Socio-economic status (higher education) and household wealth (higher income) were also associated with a greater likelihood of LPG adoption. Effective strategies to raise awareness around safe use of LPG and interventions to address financial barriers are needed to scale wider adoption and sustained use of LPG for clean cooking, displacing reliance on polluting solid fuels.

The World Health Organisation (WHO) Global Age-Friendly Cities (AFC) Guide classifies key characteristics of an AFC according to eight domains. Whilst much age-friendly practice and research have focused on domains of the physical environment, those related to the social environment have received less attention. Using a Photovoice methodology within a Community-Based Participatory Research approach, our study draws on photographs, interviews and focus groups among 26 older Liverpool residents (60+ years) to explore how the city promotes respect and social inclusion (a core WHO AFC domain). Being involved in this photovoice study allowed older adults across four contrasting neighbourhoods to communicate their perspectives directly to Liverpool's policymakers, service providers and third sector organisations. This paper provides novel insights into how: (i) respect and social inclusion are shaped by aspects of both physical and social environment, and (ii) the accessibility, affordability and sociability of physical spaces and wider social processes (e.g., neighbourhood fragmentation) contributed to or hindered participants' health, wellbeing, intergenerational relationships and feelings of inclusion and connection. Our findings suggest that respect and social inclusion are relevant across all eight domains of the WHO AFC Guide. It is core to an AFC and should be reflected in both city-based policies and evaluations.

Background Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Conduct a systematic review to determine the extent and nature of UK qualitative evidence on gastrointestinal infections; 2. Use meta-ethnography to examine the influences of the differing social contexts in which people live. Methods MEDLINE, Scopus, Web of science, CINAHL and JSTOR were searched for UK qualitative studies engaging with the risk, diagnosis, management or consequences of gastrointestinal infections from 1980 to July 2019. Five reviewers were involved in applying inclusion and exclusion criteria, extracting and synthesising data (PROSPERO CRD 42017055157). Results Searches identified 4080 studies, 18 met the inclusion criteria. The majority (n = 16) contained data relating to the risk of gastrointestinal infection and these made up the main synthesis. The tenets of meta-ethnography were used to glean new understandings of the role of social and environmental contexts in shaping the risk of gastrointestinal infection, specifically with respect to foodborne GI illness. Three main explanations concerning risk emerged from the data: explanations of risk in the community were underpinned by understandings of ‘bugs’, dirt and where food comes from; risks were negotiated in households alongside diverse processes of decision making around food; and resources available to households shaped food practices. Conclusion This systematic review highlights the scarcity of UK qualitative evidence examining gastrointestinal infections. Apart from risk, questions around diagnosis, management and consequences of illness were largely untouched. No studies investigated patterning by socio-economic status. Nevertheless, the meta-ethnography yielded wider contextual theories and explanations as to why people might not follow food hygiene guidance, giving pointers to the types of qualitative enquiry needed to develop more effective interventions.

PDS 64: Health impact assessment and environmental justice, Johan Friso Foyer, Floor 1, August 26, 2019, 1:30 PM - 3:00 PM Background: Purchasing start-up equipment for cooking with LPG represents a key barrier to adoption in resource-poor settings. To address this barrier, a micro-finance package for LPG (double burner, cylinder and accessories) was introduced in Cameroon, and offered to 150 households on a first-come, first served basis, repayable over 6 months at no interest. We evaluated the perceived impact on LPG adoption by a peri-urban community in South-West Cameroon. Methods: One to 2 months after receiving the equipment, semi-structured interviews (SSIs) were conducted with 10 purposively selected participants: 5 households that took the loan (beneficiaries) and 5 households that had not taken the loan (non-beneficiaries), investigating the decision-making process surrounding the loan and cooking practices. After 6 months, we conducted SSIs with 10 additional beneficiaries, exploring experiences of loan repayments and how LPG use impacted on daily life. To generate discussion around the micro-loan and cooking patterns, we conducted a focus group with participants (n=8) sampled from the above groups. Transcripts were analysed thematically. Results: Beneficiaries reported that the loan allowed them to purchase the start-up equipment, which they would not have been able to afford otherwise. Monthly payments made the loan more affordable to beneficiaries and attractive to non-beneficiaries. Beneficiaries described that cooking with LPG improved their lives, through reduced smoke, better health and time savings. They reported cooking most dishes with LPG almost daily, including traditional meals, and LPG use increased during the rainy season. Conserving LPG was the main reason for continued use of biomass. Although 94% of beneficiaries (n=141) repaid the loan, some struggled to pay on time. Suggestions for improvement included a three/four-burner stove to accommodate multiple dishes. Conclusions: Through qualitative methods, we gained unique insights into the facilitators/inhibitors surrounding the loan, and benefits of LPG. Findings are informing further LPG microloan initiatives across Cameroon.

Approximately four million people die each year in low- and middle-income countries from household air pollution (HAP) due to inefficient cooking with solid fuels. Liquid Petroleum Gas (LPG) offers a clean energy option in the transition towards renewable energy. This qualitative study explored lay knowledge of barriers and facilitators to scaling up clean fuels in Cameroon, informed by Quinn et al.'s Logic Model. The model has five domains and we focused on the user and community needs domain, reporting the findings of 28 semi-structured interviews (SSIs) and four focus group discussions (FGDs) that explored the reasons behind fuel use choices. The findings suggest that affordability, safety, convenience, and awareness of health issues are all important influences on decision making to the adoption and sustained use of LPG, with affordability being the most critical issue. We also found the ability of clean fuels to meet cooking needs to be central to decision-making, rather than an aspect of convenience, as the logic model suggests. Local communities provide important insights into the barriers and facilitators to using clean fuels. We adapt Quinn et al.'s logic model accordingly, giving more weight to lay knowledge so that it is better positioned to inform policy development.

S02: Harmonizing insights from intervention studies, contextual information and resource availability to develop policy advocacy for clean cooking and domestic fuel adoption in Africa, Room 417, Floor 4, August 27, 2019, 10:30 AM - 12:00 PM Background: In Sub-Saharan Africa, most cooking is undertaken using biomass fuels, posing significant health and environmental risks and inhibiting economic development, especially for biomass collectors unable to participate in the cash economy. In 2016, exposure to household air pollution (HAP) associated with solid fuel use resulted in an estimated 520,000 premature deaths (7% of total) in the region. Biomass burning also contributes to climate change, deforestation and perpetuating the poverty cycle particularly for women and children who share the majority of domestic responsibilities. Switching to clean burning fuels is recommended by the World Health Organization to reduce exposure to HAP and tackle climate change. Aims: Identify policy and intervention strategies to support more equitable and large-scale uptake of clean fuels across the population to inform national policy; estimate the health and climate impacts of scaled clean fuel adoption in line with government targets; develop capacity through health systems strengthening; facilitate public-policy exchange as research is undertaken alongside national policy implementation. Methods: The CLEAN-AIR(Africa) Global Health Research Group funded by the UK National Institute for Health Research is working directly with Cameroon, Ghana and Kenya government ministries who have made ambitious commitments to scale-up population access to Liquefied Petroleum gas (LPG) for the majority. Survey, quasi-experimental, ethnographic and qualitative methodologies will evaluate the anticipated reduction in personal exposures to HAP, explore factors influencing fuel stacking and clean fuel uptake and evaluate interventions that could facilitate more equitable adoption and sustained use of clean fuel (e.g. microfinance, pay-as-you cook). Anticipated outcomes: Through a multi-disciplinary program of research, capacity building and public, policy and stakeholder engagement, CLEAN-AIR (Africa) will work across health, energy and education sectors to deliver (i) impactful policy-relevant research, and (ii) develop bespoke training modules for health practitioners on the health impacts of HAP and prevention strategies to protect vulnerable groups.

Each year up to 2.6 million people die prematurely from household air pollution (HAP) due to cooking with polluting fuels such as wood and charcoal, particularly in low and middle-income countries (LMICs). The World Health Organisation recommends scaling the adoption of clean fuels to improve maternal and child health. Liquefied Petroleum Gas (LPG) represents a scalable clean fuel that provides health and environmental benefits when used for household energy in LMICs. In Cameroon, over 70% of people rely on biomass for cooking, and the Government aims to increase LPG use from < 20% to 58% by 2030. Supporting households make this transition requires involvement of multiple stakeholders and an understanding of perspectives from the community's perspective. We used visual participatory methods `Photovoice' to explore households' perceptions of factors influencing the uptake of LPG for cooking in South-West Cameroon. Two groups of participants from rural (n = 7) and peri-urban (n = 8) areas photographed subjects they identified as preventing and facilitating LPG uptake in their communities. Subsequently, individual interviews (n = 15) and group discussions (n = 5) explored participants' reflections on the photographs. Thematic analysis was conducted using NVivo 10 software. The main barriers identified included difficulty in affording the initial LPG equipment and ongoing refills, scarcity of LPG retail shops and refills, and safety concerns. Facilitators included (i) increasing awareness of the benefits of LPG (e.g. health), (ii) increasing retail outlet density in rural areas, (iii) addressing safety concerns (e.g. replacing damaged cylinders), and (iv) reducing the price of LPG refills. Participants presented their photos at a public exhibition, which generated discussions with key stakeholders (e.g. government ministries) about how best to assist communities in this transition. Photovoice was found to be an innovative and effective approach for exploring how to advance equitable access to LPG from a community perspective and successfully engage with key stakeholders.

Background: Most households in Cameroon rely on solid fuel for cooking. The government haslaunched a Master Plan to increase LPG use from <20% to 58% by 2035 to address deforestationand energy security issues. To understand how to support communities transition from solid fuelto LPG, LACE surveys assessed household characteristics and perceptions of LPG in different fuelusing groups.Methods: After rapid census, 320 households from rural and peri-urban communities in SWCameroon were randomly selected into 4 fuel-use groups: exclusive LPG (n=51), primary LPG(n=52), mixed LPG and biomass (n=113) and exclusive wood (n=104). Surveys collectedinformation on (i) household characteristics and fuel use practices, (iii) perceptions of LPG and (iv)experience of health issues and burns.Results: Amongst LPG users, distance from retailer (refills) impacted on more exclusive use (travel> 5km: 15% of LPG exclusive/ primary users vs 24% of LPG mixed). Greater income, education anda younger age were associated with increasing LPG use (p<0.05). Perceptions of LPG as a cookingfuel differed by amount of LPG use. 85% of LPG exclusive users reported LPG could be used formost foods compared to 40% of wood exclusive users (p<0.05). Increasing LPG use was associatedwith increased reporting of LPG as a clean and fast fuel and cost was less of an issue. In all groups,LPG was perceived as potentially dangerous (>75% reporting). The occurrence of cough andphlegm was low in all groups, whilst a higher proportion of exclusive wood users reported soreeyes (60% vs 29% (LPG exclusive) p<0.005) and burns (23% vs 10% p=0.007) .Conclusion: Potential barriers to adoption and more exclusive use of LPG include its perceivedability to cook most foods, perceptions over its safety and distance from retail outlets. Householdincome is a strong indicator of usage. Education strategies (health and safety) and financialsupport mechanisms (e.g. microfinance) could help scaling LPG adoption

Background: Cameroon relies on biomass fuel (mainly wood) for cooking, (88% rural population), with important health, deforestation and climatic consequences. The Government aims to increase Liquified Petroleum Gas (LPG) use from < 20% to 58% of the population by 2035 and developed a Masterplan (2016) to achieve this goal via a multi-sectoral committee (ministries, national agencies, private sector and the Global LPG Partnership). An Investment Committee was established to oversee implementation. Objectives: To document and evaluate the Cameroon national process for LPG scale-up. Methods: The RE-AIM framework structured data collection and reporting: secondary data (socio-economic development, energy situation, policy); Masterplan documentation; LPG market expert and national stakeholder interviews; and LPG Adoption in Cameroon Evaluation (LACE) study data (community data on fuel use, stacking, barriers to LPG use, microloan schemes, impacts on particulate air pollution (PM2.5) and health). A logic model compared Masterplan proposals with issues reported by users and stakeholders. Findings: Masterplan recommended: €400 million investment to 2030 to increase LPG cylinders by 7 million, infrastructure developments (storage, transport, distribution and retail facilities), enhanced market regulation, national harmonisation of refill price and cylinder import tax reductions. The LACE studies highlighted user concerns about costs, safety, access, supply and cooking traditional foods. Stakeholders proposed increasing microfinance initiatives, LPG promotion, user support and health system engagement to promote clean fuels. Conclusions: The Masterplan has the potential to address problems of LPG access and supply and improve industry safety. Microfinance is supported and new pricing arrangements may lower cylinder deposit costs. Users' concerns (affordability, access, safety, traditional cooking) need consideration. Programme monitoring and evaluation is recommended.

IntroductionCameroon has begun implementation of a national liquified petroleum gas (LPG) Master Plan to increase use of LPG from <20% to 58% of the population by 2030 to address the environmental and health impacts of reliance on solid fuel for domestic energy. The LPG Adoption in Cameroon Evaluation (LACE) studies assessed the potential impacts of replacing traditional solid cooking fuel with LPG on household air pollution (HAP) and personal exposures.MethodsSamples of households (exclusive wood fuel (n=61) and primary LPG fuel (n=67)) from peri-urban and rural households in South West Cameroon were identified from LACE census surveys. PM2.5 was measured over a 48-hr period using the RTI MicroPEM for kitchens (n=55; n=67), women cooks (n=61; n=67) and children (n=56; n=60). Stove-use-monitoring data, demographic and health surveys, and time activity diaries were collected alongside the exposure measurements.ResultsKitchen PM2.5 concentrations were significantly lower in households using LPG as their primary fuel compared to those using wood (geometric mean (GM) 23.7 vs 391.5 µg/m3 p<0.0005). In addition, exposures in women (GM=14.5 vs 52.3 µg/m3 p<0.0005) and children (GM=11.6 vs 29.9 µg/m3 p<0.0005) were significantly lower in LPG households. Exclusive use of LPG was associated with the lowest levels of PM2.5 for kitchens (exclusive =18.5 vs mixed=28.7 µg/m3), women (exclusive=13.3 vs mixed=15.9 µg/m3) and children (exclusive=11.1 vs mixed=12.0 µg/m3).ConclusionWe measured significant reductions in mean PM2.5 kitchen concentrations and personal exposure levels in households primarily using LPG when compared to those exclusively burning wood. Mean kitchen and personal PM2.5 concentrations were lower than the annual WHO interim-target 1 guideline level of 35 µg/m3. These results show that a targeted effort to promote clean fuel adoption on a national level has the potential to significantly decrease HAP exposures of the most vulnerable populations.

In 2016, the government of Cameroon, a central African country heavily reliant on wood fuel for cooking, published a Masterplan for increasing primary use of LPG from 20% to 58% of households by 2035. Developed via a multi-sectoral committee with support from the Global LPG Partnership, the plan envisages a 400 million Euro investment program to 2030, focused on increasing LPG cylinder numbers, key infrastructure, and enhanced regulation. This case study describes the Masterplan process and investment proposals and draws on community studies and stakeholder interviews to identify factors likely to impact on the planned expansion of LPG use.

Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature.