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Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. Clinical Trials.gov NCT02239250.

To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours. A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time. All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate. In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group. Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.

Background Community-based programs aimed at improving cooking skills, cookingconfidence and individual eating behaviours have grown in number over thepast two decades. Whilst some evidence exists to support theireffectiveness, only small behavioural changes have been reported andlimitations in study design may have impacted on results. This paper describes the first evaluation of the Jamie Oliver Ministry ofFood Program (JMoF) Australia, in Ipswich, Queensland. JMoF Australia is acommunity-based cooking skills program open to the general public consistingof 1.5 hour classes weekly over a 10 week period, based on the program ofthe same name originating in the United Kingdom. Methods/Design A mixed methods study design is proposed. Given the programmaticimplementation of JMoF in Ipswich, the quantitative study is anon-randomised, pre-post design comparing participants undergoing theprogram with a wait-list control group. There will be two primary outcomemeasures: (i) change in cooking confidence (self-efficacy) and (ii) changein self-reported mean vegetable intake (serves per day). Secondary outcomemeasures will include change in individual cooking and eating behaviours andpsycho-social measures such as social connectedness and self-esteem.Repeated measures will be collected at baseline, program completion (10weeks) and 6 months follow up from program completion. A sample of 250participants per group will be recruited for the evaluation to detect a meanchange of 0.5 serves a day of vegetables at 80% power (0.5% significancelevel). Data analysis will assess the magnitude of change of these variablesboth within and between groups and use sub group analysis to explore therelationships between socio-demographic characteristics and outcomes. The qualitative study will be a longitudinal design consisting ofsemi-structured interviews with approximately 10-15 participants conductedat successive time points. An inductive thematic analysis will be conductedto explore social, attitudinal and behavioural changes experienced byprogram participants. Discussion This evaluation will contribute to the evidence of whether cooking programswork in terms of improving health and wellbeing and the underlyingmechanisms which may lead to positive behaviour change. Trial registration Australian and New Zealand Trial registration number: ACTRN12611001209987 .

Household air pollution from use of solid fuels is a major contributor to the national burden of disease in India. Currently available models of advanced combustion biomass cook-stoves (ACS) report significantly higher efficiencies and lower emissions in the laboratory when compared to traditional cook-stoves, but relatively little is known about household level exposure reductions, achieved under routine conditions of use. We report results from initial field assessments of six commercial ACS models from the states of Tamil Nadu and Uttar Pradesh in India. We monitored 72 households (divided into six arms to each receive an ACS model) for 24-h kitchen area concentrations of PM2.5 and CO before and (1–6 months) after installation of the new stove together with detailed information on fixed and time-varying household characteristics. Detailed surveys collected information on user perceptions regarding acceptability for routine use. While the median percent reductions in 24-h PM2.5 and CO concentrations ranged from 2 to 71% and 10–66%, respectively, concentrations consistently exceeded WHO air quality guideline values across all models raising questions regarding the health relevance of such reductions. Most models were perceived to be sub-optimally designed for routine use often resulting in inappropriate and inadequate levels of use. Household concentration reductions also run the risk of being compromised by high ambient backgrounds from community level solid–fuel use and contributions from surrounding fossil fuel sources. Results indicate that achieving health relevant exposure reductions in solid–fuel using households will require integration of emissions reductions with ease of use and adoption at community scale, in cook-stove technologies. Imminent efforts are also needed to accelerate the progress towards cleaner fuels.

Displacing the use of polluting and inefficient cookstoves in developing countries is necessary to achieve the potential health and environmental benefits sought through clean cooking solutions. Yet little quantitative context has been provided on how much displacement of traditional technologies is needed to achieve targets for household air pollutant concentrations or fuel savings. This paper provides instructive guidance on the usage of cooking technologies required to achieve health and environmental improvements. We evaluated different scenarios of displacement of traditional stoves with use of higher performing technologies. The air quality and fuel consumption impacts were estimated for these scenarios using a single-zone box model of indoor air quality and ratios of thermal efficiency. Stove performance and usage should be considered together, as lower performing stoves can result in similar or greater benefits than a higher performing stove if the lower performing stove has considerably higher displacement of the baseline stove. Based on the indoor air quality model, there are multiple performance-usage scenarios for achieving modest indoor air quality improvements. To meet World Health Organization guidance levels, however, three-stone fire and basic charcoal stove usage must be nearly eliminated to achieve the particulate matter target (< 1-3 hr/week), and substantially limited to meet the carbon monoxide guideline (< 7-9 hr/week). Moderate health gains may be achieved with various performance-usage scenarios. The greatest benefits are estimated to be achieved by near-complete displacement of traditional stoves with clean technologies, emphasizing the need to shift in the long term to near exclusive use of clean fuels and stoves. The performance-usage scenarios are also provided as a tool to guide technology selection and prioritize behavior change opportunities to maximize impact.

The widespread adoption and sustained use of modern cookstoves has the potential to reduce harmful effects to climate, health, and the well-being of approximately one-third of the world’s population that currently rely on biomass fuel for cooking and heating. In an effort to understand and develop cleaner burning and more efficient cookstoves, 15 stove design and fuel/loading combinations were evaluated in the laboratory using the International Workshop Agreement’s five-tiered (0–4) rating system for fuel use and emissions. The designs evaluated include rocket-type combustion chamber models including reduced firepower, sunken pots, and chimneys (three stoves); gasifier-type combustion chambers using prepared fuels in the form of wood pellets (four stoves); forced draft stoves with a small electric fan (five stoves); and a single insulated charcoal stove with preheated secondary air. It was found that a charcoal burning stove was the only stove to meet all the Tier 4 levels of performance. Achieving over 40% thermal efficiency at high power was made possible by reducing firepower and gaps around the pot, although batch-fed stoves generally do not “turn down” for optimal low power performance. While all stoves met Tier 4 for carbon monoxide, only stoves equipped with electrical fans reduced respirable particulate matter to Tier 4 levels. Finally, stoves with chimneys and integrated pots were fuel efficient and virtually eliminated indoor emissions. It is hoped that these design techniques will be useful in further development and evolution of high-performance cookstove designs.

Zeenah Haddad and colleagues call for an expansion of data on household energy use routinely collected through national surveys to gauge the health effects by gender

Objective: The ready-meal market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills has been observed. Ready meals are often rich in energy, fat and sugar and lack vegetables; however, studies investigating associations between ready-meal consumption, overweight and cooking skills are lacking. The present study examines whether demographic factors, overweight, beliefs about the nutritional value and taste of ready meals and cooking skills are associated with ready-meal consumption. Design: Cross-sectional survey. Setting: Ready-meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals and demographic variables were assessed with self-administered questionnaires. Data were analysed with one-way ANOVA and multiple regression analysis. Subjects: A total of 1017 adults from the German-speaking part of Switzerland. Results: Men reported being more positive about ready meals and having fewer cooking skills compared with women. Overweight adults (BMI.25 kg/m2) were more positive about nutrients and vitamins in ready meals compared with normal-weight adults. Ready-meal consumption was associated with cooking skills (b= -0-192), age (b= -0-228), overweight (b=0-129), nutritional value (b= -0-131), taste (b= -0-126), working status (b=0-096) and gender (b=0-084). Conclusions: Cooking skills were identified as a strong predictor of ready-meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future. Next, the study provided evidence for an association between ready-meal consumption and overweight. Further research should examine the importance of ready meals for the overweight epidemic.

This study was performed in order to assess technological characteristics, proximate composition, fatty acids profile, and microbiological safety of sous-vide processed salmon in comparison with steaming and roasting. The cooking loss was lower in the sous-vide method (6.3–9.1%) than in conventional methods (11.6–16.2%). The preparation of salmon using sous-vide was more time- and energy-consuming than steaming. The dry matter content of the salmon fillets was higher in conventionally processed samples than sous-vide due to the evaporation of water, and it was connected with total protein (r = 0.85) and lipid content (r = 0.73). Analysis of the fatty acids profile only revealed significant differences in six fatty acids. All of the heat treatment methods ensured microbiological safety with regard to coagulase-positive Staphylococcus, E. coli, Listeria monocytogenes, and Salmonella spp. However, in sous-vide (57 °C, 20 min) and steamed samples after storage Enterobacteriaceae bacteria (<104) was detected. Summing up, high parameters of sous-vide salmon cooking, when considering both technological parameters, nutritional value, and microbiological status should be recommended.

We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22-December 4, 2018. Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.