Impacts of a sustained, large-scale liquefied petroleum gas (LPG) cooking intervention in the Rohingya refugee camp on time use, household air pollution, and health

Background: Humanitarian organizations typically provide refugees with shelter and food, but not cooking fuel. Many refugees harvest firewood for cooking, consuming considerable time and resulting in indoor and ambient air pollution. To address these issues, humanitarian agencies began distributing liquefied petroleum gas (LPG) for cooking to all ~200,000 Rohingya refugee households.

Methods: We assessed households that were about to receive LPG (n=600) or had been receiving LPG for at least 12 months (n=600) at baseline, then 12 and 32 months after baseline. We conducted a difference-in-difference analysis to quantify the impact of free LPG distribution time use, expenditures, physical and mental health, and estimated averted deaths due to reduced exposure to air pollution.

Results: Free LPG distribution allowed households to reallocate time from gathering firewood to caring for others and leisure time and to increase food expenditures. Time-weighted exposure to PM2.5 fell by 195 ug/m3, averting an estimated 215 [95% confidence interval: 175, 263] deaths and 6608 [5340, 8870] disability-adjusted life years lost. There was a 10·0 percentage point (pp) [-17·4pp, -2·7pp] decrease in reported clinic visits for children’s breathing problems, a 7·4pp [-14·6pp, -0·003pp] reduction in reported child severe asthma, and a 9·8pp [1·1pp, 19·8pp] reduction in the prevalence of caregivers at-risk for depression.

Implications: Sustained, large-scale distribution of LPG in a humanitarian setting reduced exposure to PM2.5 and promoted well-being. Provision of free LPG in other humanitarian contexts could similarly foster better physical and mental health amongst displaced people.