Effects of an intervention for a liquefied petroleum gas cook-stove with free fuel on food insecurity and dietary diversity among women and infants: a multi-country randomized controlled trial

Food insecurity and energy insecurity are critical global health issues, with implications for dietary diversity and infant feeding practices. This study evaluated the effects of an intervention for a liquefied petroleum gas (LPG) cook-stove and for free fuel on food security and dietary diversity among women and infants in four diverse settings. The Household Air Pollution Intervention Network (HAPIN) study is a randomized controlled trial that enrolled 800 pregnant women each in Guatemala, Peru, India, and Rwanda. Participants (N = 3195) were randomly assigned to intervention or control groups, with intervention households receiving an LPG cook-stove and free fuel for 18 months. We measured household food insecurity using the Food Insecurity Experience Scale and dietary diversity for women and infants using the Minimum Dietary Diversity – Women and WHO infant and young child feeding questionnaires, respectively. We conducted an intention-to-treat analysis to evaluate the effect of the intervention on each outcome. At baseline, 27.4% of households were mildly food insecure, 15.6% were moderately or severely food insecure, and 26.8% of women achieved minimum dietary diversity. At end-line, the intervention significantly reduced moderate or severe food insecurity (RR: 0.75, 95% CI: 0.58–0.97) and improved dietary diversity among our analytic sample of 2868 women (RR: 1.16, 95% CI: 1.01–1.33) and 2836 infants aged 12 months (RR: 1.07, 95% CI: 1.002–1.15). Our findings suggest that interventions that increase energy security can be nutrition-sensitive and contribute to improved food and nutrition security.