Household- and area-level characteristics appear to interact as determinants of cooking fuel choice. In all three countries, wealth and the educational attainment of women and men emerge as important; the nature of area-level factors varies between countries. In Benin, a two-level model with spatial community random effects best explains the data, pointing to an environmental explanation. In Ethiopia and Kenya, a three-level model with unstructured community and district random effects is selected, implying relatively autonomous economic and social areas.
Area-level heterogeneity, indicated by large median odds ratios, appears to be responsible for a greater share of variation in the data than household-level factors. This may be an indication that fuel choice is to a considerable extent supply-driven rather than demand-driven. Consequently, interventions to promote fuel switching will carefully need to assess supply-side limitations and devise appropriate policy and programmatic approaches to overcome them.
To our knowledge, this paper represents the first attempt to model the determinants of solid fuel use, highlighting socio-economic differences between households and, notably, the dramatic influence of contextual effects. It illustrates the potential that multilevel and spatial modelling approaches hold for understanding determinants of major public health problems in the developing world.