Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Other studies support that transitioning to solar lighting can bring benefits beyond pollution exposure reduction, including household savings, more income-generating activity, gender empowerment, social inclusion, and improved education from more homework time.
“Other studies have corroborated that the potential benefits of a transition to solar lighting extend well beyond reductions in pollution exposure to include savings on household expenditures, increase in income generating activities, gender empowerment, social inclusion, and improved education due to more time spent on homework12,13.”
From Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial (2022) · cites this paper as [13]
The Results (Qualitative interviews; page not provided) report lower household lighting expenditures, more time for income-generating activities, improved community relationships, and educational gains linked to children being able to do homework after sunset. The study enrolled women, but the passages do not report gender empowerment as an outcome; that part of the claim is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA separate publication from this trial estimated that, based on self-reported household lighting costs and assuming up-front payment, households switching from kerosene to solar lighting would recover their investment after 2.76 years.
“In a separate publication from this trial, we have estimated that based on participant self-reported household lighting costs, assuming participants paid the up-front costs of the solar system used in this study, households converting from kerosene to solar lighting would recoup their investment after 2.76 years13.”
From Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial (2022) · cites this paper as [13]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30752-2 · Cited by 9,854 · see citing works
Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., Bonsel, G., & Badia, X. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9903-x · Cited by 9,795 · see citing works
A Conceptual Framework for Action on the Social Determinants of Health
UNSPECIFIED (2010) · University Libraries (University of Maryland) · doi:10.13016/17cr-aqb9 · Cited by 2,362 · see citing works
Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities
Miguel, E., & Kremer, M. (2004) · Econometrica · doi:10.1111/j.1468-0262.2004.00481.x · Cited by 2,268 · see citing works
Janssen, M. F., Pickard, A. S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., Swinburn, P., & Busschbach, J. (2013) · Quality of Life Research · doi:10.1007/s11136-012-0322-4 · Cited by 1,582 · cited 1× · see citing works
“The EQ5D5L, as a generic health-related quality of life survey, suffers from a well-known ‘ceiling effect’ where many health conditions do not actually register as a decreased quality of life [45].”
Background[The national population and housing census, 2000].
Kuciarska-ciesielska, M., & Nowak, L. (1997) · PubMed · Cited by 1,410 · see citing works
Qualitative thematic analysis based on descriptive phenomenology
Sundler, A. J., Lindberg, E., Nilsson, C., & Palmér, L. (2019) · Nursing Open · doi:10.1002/nop2.275 · Cited by 1,085 · see citing works
Smith, K. R., McCracken, J. P., Weber, M. W., Hubbard, A., Jenny, A., Thompson, L. M., Balmes, J., Diaz, A., Arana, B., & Bruce, N. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60921-5 · Cited by 560 · see citing works
Kerosene: A Review of Household Uses and their Hazards in Low- and Middle-Income Countries
Lam, N. L., Smith, K. R., Gauthier, A., & Bates, M. N. (2012) · Journal of Toxicology and Environmental Health, Part B · doi:10.1080/10937404.2012.710134 · Cited by 443 · see citing works
Self-citationDecentralized energy systems for clean electricity access
Alstone, P., Gershenson, D., & Kammen, D. M. (2015) · Nature Climate Change · doi:10.1038/nclimate2512 · Cited by 434 · see citing works
Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries
Thomson, H., Snell, C., & Bouzarovski, S. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14060584 · Cited by 412 · see citing works
Mouelhi, Y., Jouve, E., Castelli, C., & Gentile, S. (2020) · Health and Quality of Life Outcomes · doi:10.1186/s12955-020-01344-w · Cited by 397 · see citing works
Energy poverty, health and education outcomes: Evidence from the developing world
Banerjee, R., Mishra, V., & Maruta, A. A. (2021) · Energy Economics · doi:10.1016/j.eneco.2021.105447 · Cited by 365 · see citing works
Instrument-Defined Estimates of the Minimally Important Difference for EQ-5D-5L Index Scores
McClure, N. S., Sayah, F. A., Xie, F., Luo, N., & Johnson, J. A. (2017) · Value in Health · doi:10.1016/j.jval.2016.11.015 · Cited by 336 · see citing works
Mortimer, K., Ndamala, C. B., Naunje, A. W., Malava, J., Katundu, C., Weston, W., Havens, D., Pope, D., Bruce, N. G., Nyirenda, M., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(16)32507-7 · Cited by 323 · see citing works
Up in Smoke: The Influence of Household Behavior on the Long-Run Impact of Improved Cooking Stoves
Hanna, R., Duflo, E., & Greenstone, M. (2016) · American Economic Journal: Economic Policy · doi:10.1257/pol.20140008 · Cited by 323 · see citing works
The energy requirements of a developed world
Arto, I., Capellán‐Pérez, I., Lago, R., Bueno, G., & Bermejo, R. (2016) · Energy Sustainable Development/Energy for sustainable development · doi:10.1016/j.esd.2016.04.001 · Cited by 299 · see citing works
Quansah, R., Semple, S. E., Ochieng, C., Juvekar, S. K., Armah, F. A., Luginaah, I., & Emina, J. B. O. (2017) · Environment International · doi:10.1016/j.envint.2017.03.010 · Cited by 203 · see citing works
Household electrification and indoor air pollution
Barron, M., & Torero, M. (2017) · Journal of Environmental Economics and Management · doi:10.1016/j.jeem.2017.07.007 · Cited by 180 · see citing works
Household Light Makes Global Heat: High Black Carbon Emissions From Kerosene Wick Lamps
Lam, N. L., Chen, Y., Weyant, C., Venkataraman, C., Sadavarte, P., Johnson, M. A., Smith, K. R., Brem, B. T., Arineitwe, J., Ellis, J. E., et al. (2012) · Environmental Science & Technology · doi:10.1021/es302697h · Cited by 152 · see citing works
Self-citationHollada, J., Williams, K. N., Miele, C. H., Danz, D., Harvey, S. A., & Checkley, W. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14020182 · Cited by 129 · see citing works
Clasen, T., Checkley, W., Peel, J. L., Balakrishnan, K., McCracken, J. P., Rosa, G., Thompson, L. M., Barr, D. B., Clark, M. L., Johnson, M. A., et al. (2020) · Environmental Health Perspectives · doi:10.1289/ehp6407 · Cited by 122 · see citing works
Valuing Health State: An EQ-5D-5L Value Set for Ethiopians
Welie, A. G., Gebretekle, G. B., Stolk, E. A., Mukuria, C., Krahn, M. D., Enquoselassie, F., & Fenta, T. G. (2019) · Value in Health Regional Issues · doi:10.1016/j.vhri.2019.08.475 · Cited by 96 · see citing works
Thakur, M., Nuyts, P. A. W., Boudewijns, E. A., Kim, J. F., Faber, T., Babu, G. R., van Schayck, O. C. P., & Been, J. V. (2018) · Thorax · doi:10.1136/thoraxjnl-2017-210952 · Cited by 90 · see citing works
Fuel poverty and Well-Being:A consumer theory and stochastic frontier approach
Rodrı́guez-Álvarez, A., Orea, L., & Jamasb, T. (2019) · Energy Policy · doi:10.1016/j.enpol.2019.04.031 · Cited by 87 · see citing works
Household electricity access, availability and human well-being: Evidence from India
Ahmad, S., Mathai, M. V., & Parayil, G. (2014) · Energy Policy · doi:10.1016/j.enpol.2014.02.004 · Cited by 73 · see citing works
Apple, J., Vicente, R., Yarberry, A., Lohse, N., Mills, E., Jacobson, A., & Poppendieck, D. (2010) · Indoor Air · doi:10.1111/j.1600-0668.2010.00664.x · Cited by 72 · see citing works
Solar home systems and solar lanterns in rural areas of the Global South: What impact?
Lemaire, X. (2018) · WIREs Energy and Environment · doi:10.1002/wene.301 · Cited by 59 · see citing works
The impact of off-grid solar home systems in Kenya on energy consumption and expenditures
Wagner, N., Rieger, M., Bedi, A. S., Vermeulen, J., & Demena, B. A. (2021) · Energy Economics · doi:10.1016/j.eneco.2021.105314 · Cited by 57 · see citing works
Kerosene lighting contributes to household air pollution in rural Uganda
Muyanja, D., Allen, J. G., Vallarino, J., Valeri, L., Kakuhikire, B., Bangsberg, D. R., Christiani, D. C., Tsai, A. C., & Lai, P. S. (2017) · Indoor Air · doi:10.1111/ina.12377 · Cited by 49 · see citing works
Self-citationSéguin, R., Flax, V. L., & Jagger, P. (2018) · PLoS ONE · doi:10.1371/journal.pone.0203775 · Cited by 42 · see citing works
Rosenthal, J. P., Arku, R. E., Baumgartner, J., Brown, J. M., Clasen, T., Eisenberg, J. N. S., Hovmand, P. S., Jagger, P., Luke, D. A., Quinn, A., et al. (2020) · Environmental Health Perspectives · doi:10.1289/ehp7010 · Cited by 42 · see citing works
Simkovich, S. M., Williams, K. N., Pollard, S. L., Dowdy, D. W., Sinharoy, S. S., Clasen, T., Puzzolo, E., & Checkley, W. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16132277 · Cited by 38 · see citing works
Household Air Pollution and Acute Lower Respiratory Infections in Adults: A Systematic Review
Jary, H. R., Simpson, H., Havens, D., Manda, G. E., Pope, D. P., Bruce, N., & Mortimer, K. J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0167656 · Cited by 37 · see citing works
Mahajan, A., Harish, S. P., & Urpelainen, J. (2020) · Energy Sustainable Development/Energy for sustainable development · doi:10.1016/j.esd.2020.04.005 · Cited by 33 · see citing works
Lam, N. L., Muhwezi, G., Isabirye, F., Harrison, K., Ruiz-Mercado, I., Amukoye, E., Mokaya, T., Wambua, M., & Bates, M. N. (2018) · Indoor Air · doi:10.1111/ina.12433 · Cited by 30 · see citing works
Self-citationToilet training: what can the cookstove sector learn from improved sanitation promotion?
Sesan, T., Jewitt, S., Clifford, M., & Ray, C. (2018) · International Journal of Environmental Health Research · doi:10.1080/09603123.2018.1503235 · Cited by 21 · see citing works
Kelly, C. A., Crampin, A. C., Mortimer, K. J., Dube, A. L. N., Malava, J., Johnston, D., Unterhalter, E., & Glynn, J. R. (2018) · PLoS ONE · doi:10.1371/journal.pone.0193376 · Cited by 20 · see citing works
Welfare impacts of an entry-level solar home system in Uganda
Chen, A. Z., Fischer, J., Fraker, A., Shah, N. B., Shirrell, S., & Stein, D. (2017) · Journal of Development Effectiveness · doi:10.1080/19439342.2017.1307248 · Cited by 18 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [27]Devlin N,, Methods for Analysing and Reporting EQ-5D Data [Internet]. 2020: Springer. 33347096
- [31]Braun V,, Thematic Analysis, in Handbook of research methods in health social sciences, LP, Editor. 2019, Springer Nature: Singapore. p. 844– 58.
Cited by
Sorted by citations
Nassikas, N. J., McCormack, M. C., Ewart, G. W., Balmes, J. R., Bond, T. C., Brigham, E. P., Cromar, K. R., Goldstein, A. H., Hicks, A., Hopke, P. K., et al. (2024) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202312-1067st · Cited by 57 · see citing works
Attributing observed increase in extreme precipitation in China to human influence
Dong, S., Sun, Y., & Zhang, X. (2022) · Environmental Research Letters · doi:10.1088/1748-9326/ac888e · Cited by 42 · see citing works
Wallach, E. S., Lam, N. L., Nuwagira, E., Muyanja, D., Tayebwa, M., Valeri, L., Tsai, A. C., Vallarino, J., Allen, J. G., & Lai, P. S. (2022) · Indoor Air · doi:10.1111/ina.12986 · Cited by 13 · see citing works
Self-citationElom, C. O., Onyeneke, R. U., Ayerakwa, H. M., Atta‐Ankomah, R., Deffor, E. W., & Uwaleke, C. C. (2024) · Education and Information Technologies · doi:10.1007/s10639-024-12504-6 · Cited by 11 · see citing works
Environmentally sustainable surgical systems
Ledda, V., Adisa, A., Agyei, F., Caton, L., George, C., Ghaffar, A., Ghosh, D., Hachach‐Haram, N., Haque, P. D., Ingabire, J. A., et al. (2024) · BMJ Global Health · doi:10.1136/bmjgh-2024-015066 · Cited by 7 · see citing works
Self-citationYavuz, C., Ravat, Z., León, M. D. A., Lee, S., Fernandes, P., Reifmesser, Q., Gaved, F. E., Pilato, S., Parrao, C. G., & Snilstveit, B. (2025) · Campbell Systematic Reviews · doi:10.1002/cl2.70060 · Cited by 7 · see citing works
Wright, C. Y., Benyon, M., Diab, R. D., Naidoo, N., Kwatala, N., Kunene, S., Batini, C., Micklesfield, L. K., Cai, S., Panchal, R., et al. (2024) · Atmospheric Environment · doi:10.1016/j.atmosenv.2024.120996 · Cited by 5 · see citing works
Behavioral savings sessions increase the pursuit of solar products among refugees in Uganda
Elven, S., Núñez, J. L. C., Martino, S. D., DUGAS, M. A., & Kundu, S. (2025) · npj Climate Action · doi:10.1038/s44168-025-00212-x · Cited by 4 · see citing works
Ponticiello, M. N., Nuwagira, E., Tayebwa, M., Mugerwa, J., Nahabwe, H., Nakasita, C., Tumuhimbise, J. B., Lam, N. L., Wiens, M. O., Vallarino, J., et al. (2023) · Journal of Global Health · doi:10.7189/jogh.13.04026 · Cited by 4 · see citing works
Self-citationEffect of Household Air Pollution on the Gut Microbiome and Virome of Adult Women Living in Uganda
Huang, C.-Y., Nuwagira, E., Tisza, M., Kim, M., Tayebwa, M., Vieira, J., Lam, N., Wallach, E., Wiens, M., Tsai, A. C., et al. (2026) · Environmental Health Perspectives · doi:10.1021/ehp.6c00064 · Cited by 1 · see citing works
Self-citationGendered extractivism in Uganda: implications for Just Transitions
Müller, T. (2025) · Environmental Research Letters · doi:10.1088/1748-9326/ade26a · Cited by 3 · see citing works
Solar Energy and Environmental Application
Majumder, S., Thakur, P., & Thakur, A. (2025) · Clean Energy Production Technologies · doi:10.1007/978-981-97-9626-7_3 · Cited by 1 · see citing works
The Effect of Light on Wellbeing: A Systematic Review and Meta-analysisPreprint
Landvreugd, A., Nivard, M. G., & Bartels, M. (2023) · doi:10.31234/osf.io/69m72
A system dynamics approach to energy, green spaces, and sustainability in cities
Khaksar, R. Y., Farmani, H., Mahmood, A., Dhoska, K., Gheibi, M., & Moezzi, R. (2026) · Proceedings of the Institution of Civil Engineers - Engineering Sustainability · doi:10.1680/jensu.25.00076
- Authors
- Sundararajan, R., D’Couto, H., Mugerwa, J., Tayebwa, M., Lam, N. L., Wallach, E. S., Wiens, M. O., Ponticiello, M., Stanistreet, D., Tsai, A. C., Vallarino, J., Allen, J. G., Muyanja, D., Shrime, M. G., Nuwagira, E., & Lai, P. S.
- Affiliations
- Cornell University (US)
- Massachusetts General Hospital (US)
- Mbarara University of Science and Technology (UG)
- Cal Poly Humboldt (US)
- Royal College of Surgeons in Ireland (IE)
- Harvard University (US)
- Corresponding author
- Lai, Peggy S
- ORCID
- Venue
- Environmental Research Letters
- Publisher
- IOP Publishing
- Published
- 2021-12-22
- Volume
- 17
- Issue
- 1
- Pages
- 015002
- ISSN
- 1748-9326 (ISSN-L)
- PMC
- PMC8923618
- OpenAlex
- W3216666073
- Cited by
- 14
- References
- 40
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 2 · 2022: 2
- FWCI
- 0.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Environmental Research Letters (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Harvard School of Public Health National Institute of Environmental Health Sciences and Center for Environmental Health (P30ES000002)
- Massachusetts General Hospital Department of Medicine Transformative Scholars Award
- National Institutes of Health (K23 ES023700)
- Friends of a Healthy Uganda
- American Thoracic Society Unrestricted Grant
- Topics
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Physical Sciences › Environmental Science › Global and Planetary Change › Impact of Light on Environment and Health
- Keywords
- energy poverty, household lighting, clean energy adoption, cost-effectiveness, health-related quality of life, social determinants of health, household air pollution, rural households, Uganda, home safety
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
