General Characteristics of Peri-Urban and Rural Households
A total of 1577 households completed the surveys (1334 from peri-urban Limbe (88.9% of households sampled) and 243 from rural Buea [from approximately 500 households located in the survey communities—48.6%]). The mean age of the household head was younger in peri-urban Limbe than in rural Buea (42.2 years (sd = 12.9) vs 51.8 years (sd = 16.9), respectively, p < 0.0005) with a lower proportion of female heads (23 vs 29%; p = 0.037)—Table 1. In addition, a significantly higher proportion of respondents from peri-urban households than from rural households reported having education beyond primary school level (62.7 vs 37%; p < 0.0005), being married (60.2 vs 46.1%; < 0.0005), having piped water (51.8 vs 30.5%; p < 0.0005) and having a flushing toilet (50 vs 16.1%; p < 0.0005). Peri-urban households reported having a higher number of residents within each house (mean = 5.1 vs 4.6; p = 0.005) translates into a higher number of people per room, as an indicator of crowding (mean = 2.2 vs 1.3; p < 0.0005).
Table 1 General Characteristics of Survey Populations.
Respondents from peri-urban communities were more likely to rent property than those from rural communities (50.5 vs 11.1%; p < 0.0005). Wealth ownership also differed between the two contexts with peri-urban households being more likely to have occupations that paid a cash income (75.3 vs 42.4%; p < 0.0005) and reporting higher monthly household incomes above the WHO poverty threshold of 25 k CFA (90.7 vs 74.1%; p < 0.0005) and above the average monthly national Cameroon household income of 50 k CFA (59.8 vs 34.4%; p < 0.0005). In addition, peri-urban households were significantly more likely to own assets such as electricity, mobile phones, televisions and a car (p < 0.0005).
Fuel Use and Cooking Patterns for Peri-Urban and Rural Households
The two most dominant primary fuel groups were wood (40.7%) and LPG (51.1%) with other fuels such as sawdust, kerosene and charcoal typically being used as secondary fuels (Table 2). All houses reporting LPG as a fuel indicated using the standard size 12.5-kg cylinder for cooking, typically obtained at the regulated refill price of 6500 CFA (USD 12), although price increases were reported in relation to transport costs and restricted supply.
Table 2 Primary and Secondary Fuels Use for Cooking (Including Stove and Location of Cooking), and Lighting Stratified by Rural and Peri-Urban Contexts.
In rural communities, the majority of households reported wood (mostly gathered for free) as their primary fuel (80.7% compared to 33.4% of peri-urban homes), whereas peri-urban homes were more likely to report LPG as their primary fuel (57.8 vs 15.6%; p < 0.0005). In peri-urban homes, kerosene (3%), charcoal (2.6%) and sawdust (2.6%) were reported by some households as a primary fuel—very few rural households reported primary use of these fuels. The majority of rural households did not use a secondary fuel at home (51.5%), whereas 81.1% of peri-urban households reported using a secondary fuel. These included a mixture of LPG (21.1%), kerosene (10.6%), charcoal (20%) and wood (26.3%) with limited use of sawdust (2.2%). To understand the extent of fuel stacking (mixed use of LPG with other fuels), exclusivity of LPG use for cooking was defined as (1) primary use of LPG with no secondary fuel or (2) LPG use reported as both primary and secondary fuels. Of the 1116 households that reported using LPG as a fuel for cooking, only 130 (11.6%) reported using it exclusively. In rural households, where only 30% reported some use of LPG as a cooking fuel, only 3 (1.2%) reported exclusive use of LPG. For peri-urban households, only 127 (9.5%) reported exclusive use of LPG with by far the majority of LPG users (916; 87.8%) ‘stacking’ fuels (using biomass and LPG). A greater proportion of peri-urban households reported cooking indoors (59.5 vs 22.4%; p < 0.0005) with the majority having a separate kitchen within the home (73.2%). Rural households were more likely to cook outside in a separate building used as an enclosed kitchen, located near the main house (74.3 vs 31.3%; p < 0.0005). The majority of households in both rural communities (91.4%) and peri-urban households (99.3%) reported use of electricity for lighting.
Factors Associated with LPG Use in Peri-Urban and Rural Households
Associations between demographic, household and wealth characteristics with ‘any’ use of LPG for rural households (Table 3) and with ‘any’ use and ‘exclusive’ use of LPG for peri-urban households (Table 4) were assessed. For rural households, age, sex and marital status were not associated with LPG use; however, households with a head who had secondary education (OR = 3.33; 95% CI = 1.76, 6.30) and a university education (OR = 6.84; 95% CI = 2.82, 16.62) were significantly more likely to use LPG than those who had not received a secondary education. Whilst the number of people resident in the household did not affect likelihood of LPG use, access to mains water (OR = 4.04; 95% CI = 2.24, 7.28) and household sanitation (OR = 14.95; 95% CI = 6.4, 34.9) were strongly associated with an increased likelihood of using LPG. Household wealth was also strongly associated with LPG use in rural households. Households with incomes above the national average for Cameroon (50 k CFA) were significantly more likely to use LPG, than those with the highest incomes (100 + CFA) being the most likely to report using LPG (OR = 4.68; 95% CI = 1.64, 13.4). In addition, ownership of assets including a mobile phone, car and electricity were also positively associated with LPG use (p < 0.05). Conversely, ownership of the house was negatively associated with LPG use, owners being almost 50% less likely to report using LPG (OR = 0.51; 95% CI = 0.30, 0.91). After adjustment through multivariable analysis (Table 5), education, access to piped water, access to sanitation, ownership of a television and car ownership were found to be independently associated with any LPG use.
Table 3 Association of Household and Individual Characteristics with ‘Any’ LPG Use in Rural Communities.
Table 4 Association of Household and Individual Characteristics with ‘Any’ and ‘Exclusive’ LPG Use in Peri-Urban Communities.
Table 5 Independent Association Between Household and Individual Characteristics with ‘Any’ LPG Use in Rural Communities*.
For the peri-urban setting, the household heads of an older age (46+ years) were significantly less likely to report using any LPG than younger ages (18–35 years)—OR = 0.42; 95% CI = 0.38, 0.58 (Table 4)—the association was more pronounced for exclusive use of LPG (OR = 0.12; 95% CI = 0.07, 0.23). Although not associated with any use of LPG, respondents who indicated being married or in a partnership were significantly less likely to report exclusive use of LPG (OR = 0.47; 95% CI = 0.33, 0.69). As with the rural setting, increasing level of education and having access to mains water and household sanitation were also significantly associated with the likelihood of using LPG and also, for the peri-urban community, with exclusive use of LPG (p < 0.05, after Bonferroni correction). Households identified as having the highest person-to-room ratio (crowding indicator) were significantly less likely to report using any LPG (OR = 0.55; 95% CI = 0.40, 0.74) and exclusive use of LPG (OR = 0.21, 0.13, 0.35). Whilst, similar to rural households, indicators of household wealth (being paid exclusively in cash, higher income bracket and ownership of a mobile phone, a car and a television) were significantly associated with any LPG use (p < 0.05, after Bonferroni correction). Only the method of receiving income (in cash rather than kind) was associated with an increased likelihood of exclusive use (OR = 2.10; 95% CI = 1.26, 3.52).
Multivariable analysis of peri-urban homes identified a number of factors independently associated with both ‘any’ and ‘exclusive use’ of LPG use (Table 6). Increasing level of education, younger age, access to piped water and household sanitation, payment in cash rather than kind, a higher level of income and ownership of a television were all significantly (p < 0.05) and independently associated with any LPG use. For exclusive use of LPG, increasing education, younger age, being single, having a less crowded household and being paid in cash all demonstrated significant independent associations.
Table 6 Independent Associations Between Household and Individual Characteristics with ‘Any’ and ‘Exclusive’ LPG Use in Peri-Urban Communities*.