Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial
Energy poverty is prevalent in resource-limited settings, leading households to use inefficient fuels and appliances that contribute to household air pollution. Randomized controlled trials of household energy interventions in low and middle income countries have largely focused on cooking services....
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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IOP Publishing
2021-01-01
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| Series: | Environmental Research Letters |
| Subjects: | |
| Online Access: | https://doi.org/10.1088/1748-9326/ac3f05 |
| _version_ | 1827869562841858048 |
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| author | Radhika Sundararajan Helen D’Couto Joseph Mugerwa Mellon Tayebwa Nicholas L Lam Eli S Wallach Matthew O Wiens Matthew Ponticiello Debbi Stanistreet Alexander C Tsai Jose Vallarino Joseph G Allen Daniel Muyanja Mark G Shrime Edwin Nuwagira Peggy S Lai |
| author_facet | Radhika Sundararajan Helen D’Couto Joseph Mugerwa Mellon Tayebwa Nicholas L Lam Eli S Wallach Matthew O Wiens Matthew Ponticiello Debbi Stanistreet Alexander C Tsai Jose Vallarino Joseph G Allen Daniel Muyanja Mark G Shrime Edwin Nuwagira Peggy S Lai |
| author_sort | Radhika Sundararajan |
| collection | DOAJ |
| description | Energy poverty is prevalent in resource-limited settings, leading households to use inefficient fuels and appliances that contribute to household air pollution. Randomized controlled trials of household energy interventions in low and middle income countries have largely focused on cooking services. Less is known about the adoption and impact of clean lighting interventions. We conducted an explanatory sequential mixed methods study as part of a randomized controlled trial of home solar lighting systems in rural Uganda in order to identify contextual factors determining the use and impact of the solar lighting intervention. We used sensors to track usage, longitudinally assessed household lighting expenditures and health-related quality of life, and performed cost-effectiveness analyses. Qualitative interviews were conducted with all 80 trial participants and coded using reflexive thematic analysis. Uptake of the intervention solar lighting system was high with daily use averaging 8.23 ± 5.30 h d ^−1 . The intervention solar lighting system increased the EQ5D index by 0.025 (95% CI 0.002–0.048) and led to an average monthly change in household lighting costs by −1.28 (−2.52, −0.85) US dollars, with higher savings in users of fuel-based lighting. The incremental cost-effectiveness ratio for the solar lighting intervention was $2025.72 US dollars per quality adjusted life year gained making the intervention cost-effective when benchmarked against the gross domestic product per capita in Uganda. Thematic analysis of qualitative data from individual interviews showed that solar lighting was transformative and associated with numerous benefits that fit within a social determinants of health (SDOH) framework. The benefits included improved household finances, improved educational performance of children, increased household safety, improved family and community cohesion, and improved perceived household health. Our findings suggest that household solar lighting interventions may be a cost-effective approach to improve health-related quality of life by addressing SDOH. |
| first_indexed | 2024-03-12T15:47:00Z |
| format | Article |
| id | doaj.art-687c30904fc74670b24a507043c9ee7a |
| institution | Directory Open Access Journal |
| issn | 1748-9326 |
| language | English |
| last_indexed | 2024-03-12T15:47:00Z |
| publishDate | 2021-01-01 |
| publisher | IOP Publishing |
| record_format | Article |
| series | Environmental Research Letters |
| spelling | doaj.art-687c30904fc74670b24a507043c9ee7a2023-08-09T15:24:14ZengIOP PublishingEnvironmental Research Letters1748-93262021-01-0117101500210.1088/1748-9326/ac3f05Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trialRadhika Sundararajan0https://orcid.org/0000-0002-8451-2243Helen D’Couto1Joseph Mugerwa2Mellon Tayebwa3Nicholas L Lam4Eli S Wallach5https://orcid.org/0000-0003-2458-2466Matthew O Wiens6https://orcid.org/0000-0002-3287-5181Matthew Ponticiello7Debbi Stanistreet8https://orcid.org/0000-0003-3738-1727Alexander C Tsai9https://orcid.org/0000-0001-6397-7917Jose Vallarino10Joseph G Allen11Daniel Muyanja12Mark G Shrime13https://orcid.org/0000-0002-3546-9867Edwin Nuwagira14Peggy S Lai15https://orcid.org/0000-0001-9501-8606Department of Emergency Medicine, Weill Cornell Medicine , 525 East 68th Street, New York, NY 10065, United States of America; Weill Cornell Center for Global Health , 402 East 67th Street, New York, NY 10065, United States of AmericaDivision of Pulmonary and Critical Care Medicine, Massachusetts General Hospital , Bulfinch 148, 55 Fruit Street, Boston, MA 02114, United States of AmericaMbarara University of Science and Technology , PO Box 1410, Mbarara, UgandaMbarara University of Science and Technology , PO Box 1410, Mbarara, UgandaSchatz Energy Research Center, Humboldt State University , 1 Harpst Street, Arcata, CA, United States of AmericaSchatz Energy Research Center, Humboldt State University , 1 Harpst Street, Arcata, CA, United States of AmericaMbarara University of Science and Technology , PO Box 1410, Mbarara, Uganda; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia , 2329 West Mall, Vancouver, British Columbia, CanadaWeill Cornell Center for Global Health , 402 East 67th Street, New York, NY 10065, United States of AmericaRoyal College of Surgeons in Ireland , 123 Saint Stephen’s Green, Dublin, IrelandCenter for Global Health and Mongan Institute, Massachusetts General Hospital , 125 Nashua Street, Boston, MA, 02114, United States of AmericaDepartment of Environmental Health, Harvard T.H. Chan School of Public Health , 677 Huntington Avenue, Boston, MA 02115, United States of AmericaDepartment of Environmental Health, Harvard T.H. Chan School of Public Health , 677 Huntington Avenue, Boston, MA 02115, United States of AmericaMbarara University of Science and Technology , PO Box 1410, Mbarara, UgandaRoyal College of Surgeons in Ireland , 123 Saint Stephen’s Green, Dublin, IrelandMbarara University of Science and Technology , PO Box 1410, Mbarara, UgandaDivision of Pulmonary and Critical Care Medicine, Massachusetts General Hospital , Bulfinch 148, 55 Fruit Street, Boston, MA 02114, United States of America; Center for Global Health and Mongan Institute, Massachusetts General Hospital , 125 Nashua Street, Boston, MA, 02114, United States of America; Department of Environmental Health, Harvard T.H. Chan School of Public Health , 677 Huntington Avenue, Boston, MA 02115, United States of AmericaEnergy poverty is prevalent in resource-limited settings, leading households to use inefficient fuels and appliances that contribute to household air pollution. Randomized controlled trials of household energy interventions in low and middle income countries have largely focused on cooking services. Less is known about the adoption and impact of clean lighting interventions. We conducted an explanatory sequential mixed methods study as part of a randomized controlled trial of home solar lighting systems in rural Uganda in order to identify contextual factors determining the use and impact of the solar lighting intervention. We used sensors to track usage, longitudinally assessed household lighting expenditures and health-related quality of life, and performed cost-effectiveness analyses. Qualitative interviews were conducted with all 80 trial participants and coded using reflexive thematic analysis. Uptake of the intervention solar lighting system was high with daily use averaging 8.23 ± 5.30 h d ^−1 . The intervention solar lighting system increased the EQ5D index by 0.025 (95% CI 0.002–0.048) and led to an average monthly change in household lighting costs by −1.28 (−2.52, −0.85) US dollars, with higher savings in users of fuel-based lighting. The incremental cost-effectiveness ratio for the solar lighting intervention was $2025.72 US dollars per quality adjusted life year gained making the intervention cost-effective when benchmarked against the gross domestic product per capita in Uganda. Thematic analysis of qualitative data from individual interviews showed that solar lighting was transformative and associated with numerous benefits that fit within a social determinants of health (SDOH) framework. The benefits included improved household finances, improved educational performance of children, increased household safety, improved family and community cohesion, and improved perceived household health. Our findings suggest that household solar lighting interventions may be a cost-effective approach to improve health-related quality of life by addressing SDOH.https://doi.org/10.1088/1748-9326/ac3f05social determinants of healthglobal healthmixed methodssolar lightingrandomized controlled trialcost effectiveness |
| spellingShingle | Radhika Sundararajan Helen D’Couto Joseph Mugerwa Mellon Tayebwa Nicholas L Lam Eli S Wallach Matthew O Wiens Matthew Ponticiello Debbi Stanistreet Alexander C Tsai Jose Vallarino Joseph G Allen Daniel Muyanja Mark G Shrime Edwin Nuwagira Peggy S Lai Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial Environmental Research Letters social determinants of health global health mixed methods solar lighting randomized controlled trial cost effectiveness |
| title | Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial |
| title_full | Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial |
| title_fullStr | Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial |
| title_full_unstemmed | Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial |
| title_short | Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial |
| title_sort | use cost effectiveness and end user perspectives of a home solar lighting intervention in rural uganda a mixed methods randomized controlled trial |
| topic | social determinants of health global health mixed methods solar lighting randomized controlled trial cost effectiveness |
| url | https://doi.org/10.1088/1748-9326/ac3f05 |
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