Primary cook dietary diversity and cooking fuel use in Cambodia: A cross-sectional study Open Access

Abstract

Background: Dietary diversity is a key indicator of diet quality and micronutrient adequacy, especially in low- and middle-income countries. However, there is limited evidence on the association between household cooking fuel use and dietary diversity, especially in Cambodia. In addition, socioeconomic factors may also influence dietary diversity, but their relative contribution in this context remains unclear.

Methods: We conducted a cross-sectional analysis using baseline data from the Applied Implementation Research for Clean Cooking in Cambodia (AIR-C3) study, including 2,622 primary cooks from peri-urban areas of Kampong Speu and Kandal provinces, Cambodia. Dietary diversity was assessed using a 24-hour recall to calculate the Dietary Diversity Score (DDS; range 0-10) and Minimum Dietary Diversity (MDD; ≥5 food groups). Multivariable linear regression (for DDS) and modified Poisson regression (for MDD) with robust standard errors clustered at the village level were used to examine associations between dietary diversity and cooking fuel use patterns and other determinants.

Results: Dietary diversity was moderate (mean DDS: 5.36), with 63.6% of primary cooks achieving MDD, although gaps remained in the consumption of nutrient-rich foods such as pulses, nuts and seeds, and dairy products. Socioeconomic factors, particularly education and household wealth, were positively associated with both DDS and MDD. In contrast, cooking fuel use showed a limited association with dietary outcomes. After adjustment, primary cooks using liquefied petroleum gas (LPG) as their cooking fuel had slightly lower dietary diversity compared to primary cooks relying on biomass fuels, while no significant differences were observed among primary cooks using a combination of fuels.

Conclusion: Dietary diversity in our setting appears to be driven more strongly by socioeconomic conditions than by cooking fuel use alone. Improving nutrition in Cambodia will likely require addressing structural barriers, including education and economic access to diverse foods, alongside ongoing efforts to expand clean cooking technologies.

Key words: Dietary diversity; Cooking fuel use; Fuel stacking; Socioeconomic status; Cambodia; Primary cook energy; Nutrition; Public health

Table of Contents

I. INTRODUCTION…………………………………..….…………………………………..........…….1

II. METHODS…………………………………………..….…………………………...................……3

 2.1. Study Design………………………………………………………………...………....................3

 2.2. Study Setting…………………………………………………………………...……....................3

2.3. Study Population and Eligibility Criteria…….……………………………………..…............4

2.4. Data Collection Procedures ……………………..…...………………………………................5

2.5. Study Variables……………………...………….……………………………..................….....…5

2.5.1. Study Outcome…………………………………….....………...………..……........................5

2.5.2. Exposure Variable…………….……………………….....…...………..................…........….6

2.6. Statistical Analysis………………………………………...……………….…….....................…6

2.7. Ethical Considerations……………………….…………...………….…………..…................…8

III. RESULTS……...…………………………………….…………....……………….......…....…....…..8

3.1. Aim 1: Characterization of dietary diversity and food consumption patterns…...…......8

3.2. Aim 2: Socioeconomic and demographic determinants of dietary diversity……..........11

3.3. Aim 3: Association between cooking practices and dietary diversity……………........…13

IV. DISCUSSION………...…………………………………………………………….……........ .....…13

V. CONCLUSION…………………………………………..…………..…………………..…..............17

VI. APPENDIX…………………………………………………………………...………........……......18

VII. REFERENCES………………………………………….......……………………………..............18

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health
Keyword	Cooking fuel use Public health Dietary diversity
Committee Chair / Thesis Advisor	Matthew Freeman, Emory University
Committee Members	Jedidiah S. Snyder, Emory University Ajay Pillarisetti, University of California, Berkeley

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