Nairobi, Kenya: Families residing in the informal settlements of Kibera and Mathare face a multitude of health challenges. Living in cramped, poorly ventilated single-room houses where cooking takes place poses significant risks. Due to economic constraints, most households rely on stoves, charcoal, and firewood as their primary sources of cooking fuel, despite the associated dangers.
Household air pollution is a grave global concern, causing an estimated 2.6 million premature deaths annually (GBD 2016 Mortality Collaborators, 2017). One of the leading contributors to this staggering figure is the burning of biomass for cooking and heating, a practice embraced by nearly half of the world’s population.
Inadequate housing, poor ventilation, and overcrowding exacerbate the situation, resulting in men, women, and children being exposed to alarmingly high levels of pollution.
Derrick Amwai, a single father in Kibera, steps outside his cramped dwelling after finishing his cooking. With his front door wide open, he waits for the smoke emitted by the stove to dissipate into the air.
The 28-year-old man reveals that he himself battles asthma, a chronic illness diagnosed eight years ago. “My four-year-old son also suffers from asthma, and I’ve come to accept it as a part of our lives,” Derrick shares.
His decision to seek medical attention stemmed from experiencing severe headaches, as well as irritations of the nose and eyes, all of which prompted concern. The diagnosis confirmed asthma, and he soon realized his son was going through a similar ordeal. “My son had persistent coughs and headaches, all caused by the smoke emitted by the stove we used for cooking,” Derrick adds.
Determined to alleviate his symptoms, Derrick often wakes up in the middle of the night, stepping outside his house to inhale fresh air. This practice has proven beneficial, and his understanding neighbors have grown accustomed to his nocturnal routine. Living with asthma has taught him to remain vigilant about his condition and take necessary precautions.
According to data from the World Health Organization (WHO), approximately 2.4 billion people worldwide, roughly one-third of the global population, rely on open fires or inefficient stoves fueled by kerosene, biomass (wood, animal dung, and crop waste), and coal, thereby generating harmful household air pollution.
The WHO further reports that household air pollution was responsible for an estimated 3.2 million deaths in 2020 alone, with over 237,000 of those deaths being children under the age of 5. Exposure to household air pollution contributes to non-communicable diseases such as stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer.
Women and children, who are primarily responsible for household chores like cooking and collecting firewood, bear the brunt of the health burden associated with using polluting fuels and technologies within their homes.
Just 200 meters from Derrick’s residence in Kibera, we meet Evans Oloo, a 40-year-old man who moved to the settlement after finding city life unaffordable. He now earns a living as a charcoal seller.
Having been introduced to smoking by his teenage friends two decades ago, Evans has since become a heavy smoker. “I smoke close to a pack of cigarettes every day,” he admits.
During the night, Evans indulges in his habit inside his cramped dwelling, evident from the pervasive smell of tobacco. He recounts the detrimental effects of his prolonged smoking, including heart-related conditions.
“I wake up at night to smoke because I am addicted. Sometimes, I even forgo eating to satisfy my craving,” Evans confesses.
He suffers from severe coughing fits and frequent headaches. Unable to afford expensive medical treatments, Evans relies on over-the-counter drugs purchased from a local pharmacy to alleviate his symptoms.
Despite existing laws in Kenya, tobacco-related deaths continue to mount. The STEPwise Survey for Non-communicable Diseases (NCDs) risk factors in Kenya, conducted by the Ministry of Health in collaboration with the Kenya National Bureau of Statistics and supported by the WHO, reveals that tobacco use is the leading preventable cause of death in the country.
Annually, 9,000 deaths in Kenya can be attributed to tobacco-related causes, leaving thousands more severely ill and on the brink of extinction. Shockingly, tobacco use is one of four risk factors contributing to an increasing burden of NCDs in the country.
Preliminary findings of a study being conducted by the Kenya Tobacco Board, on the use of tobacco and its products in four counties, have shown that tobacco use among the youth in higher learning institutions is higher than in any age group. This threatens to claw back on the achievements made so far to protect Kenyans from the harmful effects of tobacco.
Data from the World Health Organisation, states that tobacco kills up to half of its users who don’t quit. More than 8 million people each year, including an estimated 1.3 million nonsmokers, are exposed to second-hand smoke, while around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. In 2020, 22.3% of the world’s population used tobacco: 36.7% of men and 7.8% of women.
Approximately 15 kilometers from Kibera, we are in Mathare, located in the Eastlands of Nairobi, Kenya. It’s the oldest and second-largest urban slum in Kenya after Kibera. Mathare is overpopulated. It covers 157 hectares, starting from Pangani down to Gitathuru river.
Pangani borders the west side of Mathare, and a police station sits at its northernmost point. Juja Road, a significant road in Nairobi’s Eastlands, separates Mathare from Eastleigh, another informal settlement south of Mathare. On the east side, Mathare borders Huruma. Mathare has a total of 13 slum villages.
We meet Wycliffe, a family man ready to give us his story about his asthmatic condition. The 55-year-old man, says he was born in the Western part of Kenya, where firewood and charcoal have been their source of cooking energy.
“Due to the smoke from the sources, I have a running nose almost daily, which occurs early in the morning and late evening. I suffer a lot during the cold season, as smoke has affected me completely.I also suffer from breathing problems, and I have been using inhalers for quite a long period,’’ says Wycliffe.
Wafula Moses, a health practitioner at Rosade Medical Centre in Kibera, states that inhalers are the primary delivery method for medications, used to treat asthma and chronic obstructive pulmonary disease (COPD). However, they can only be effective if they are correctly used.
He further says that many cases are reported of people suffering from asthma and coughs, which is a result of the poor sources of energy used in their houses.
The 55-year-old Wycliffe, says that during the nights, when the environment is calm, he experiences breathing problems, and at times, he is always rushed to health facilities for some injections. Even though he struggles for his life, he is happy that his family has not been affected by the condition.
Wycliffe and his family use charcoal as their energy source in their single room. Charcoal is among the sources of energy that emits a dangerous and toxic gas known as carbon monoxide. Long-term use of this energy source may lead his family members to suffer from diseases related to indoor air pollution.
“I dislike smells from various sources including paints, onions, cement, perfumes, and insecticides. When I enter a room full of smell, I sneeze a lot. It forces me to use masks whenever I attend public meetings, including church services,” adds Wycliffe.
“You must exercise self-control by avoiding anything that may trigger the condition. Recently, when the rains were back, our rooftops were dusty. The smell that hits from the iron sheets led me to be sickly for a few days,” says Wycliffe.
He further says that when one understands their condition, it is part of the healing process. Wycliffe uses warm water at all times, as cold water has been a trigger of his condition for a long time.
“I have used various drugs, including ventolin, which my body seems not to react to. I have also been convinced to use traditional methods, which have never worked. At the moment, inhalers and injections have helped me a lot, and by also understanding my condition, I am at peace with it,” adds Wycliffe.
Purity Munyambu, a gender specialist from the World Research Institute Africa (WRI), says that women are most affected by indoor air pollution as they are always in direct contact with energy sources compared to men.
She further states that men are not left out as they are dwellers in the informal settlements. Children, on the other hand, suffer from consequences met in the informal settlements.
“There is a rise in respiratory diseases brought about by indoor air pollution, especially in informal settlements and the rural areas, which should be addressed,” adds Purity.
Dr. George Mwaniki is the Head of Air Quality at the World Resources Institute (WRI) Africa. He says both men and women are affected by indoor air pollution.
“ Tied to culture, most men are not always in the house when cooking takes place, but at the time they show up, the emissions are still active, affecting them,” adds Dr Mwaniki.
“ Men who are not exposed directly to indoor air pollution are affected from outside on their hustle duties as the pollution inside the house escapes into the atmosphere and impacts them.”
He says that stoves and charcoal, when used as sources of energy, emit substantial black carbon and particulate matter (PM 2.5) that, when breathed, have health effects that weaken various systems in the human body, leading to severe ailments.
He further states that the body’s immunity in children is weak. Thus, they are prone to diseases related to indoor air pollution. “Children are not young adults; their systems are weak, and when they breathe in the air pollutants, it has serious detrimental impacts on their health.”
“Cement is very detrimental when being mixed. Some particles are breathable and may go to the lungs, which is dangerous to human health. This particle is at the range of pm 1O,” says Dr. Mwaniki.
“Historically, paint has been having volatile organic carbons that, when exposed to room or high temperature, evaporate. This may impact health when stored in rooms or houses occupied by families,” adds Dr Mwaniki.
Dr Mwaniki says that cigarette smoking in poorly ventilated houses leads to the lounging of particles in the lungs, even to the nonsmokers, as they breathe the dirty air. This reduces the efficiency of the lungs, which affects the normal functioning of the body systems.
“As WRI, we are implementing an air quality project in Kenya known as The Clean Air Catalyst funded by USAID, focusing on three major objectives, namely source awareness, potential solutions that can be used to address air pollution in the city, and production of tools to support air quality management,” adds Dr. Mwaniki.
“In close partnership with the Nairobi county, the national government, and other stakeholders, we are working together to ensure air quality management,” says Dr Mwaniki.
He advises households, using stoves and charcoal as sources of energy, to consider minimizing exposure to the particulate, by ensuring enough ventilation in their houses and also cooking from outside where emissions are blown away.
Sammy Simiyu is a co-chair of the health committee in Nairobi County. He admits that there is a gap that should be addressed.
“This gap should be addressed by each entity involved by creating awareness to the community for them to take responsibility,” he says.
Simiyu adds that recording various illnesses, caused by indoor air pollution in health facilities is a problem. A victim goes back to the same environment and same exposure until they come back again to the hospital, not knowing the cause of the condition they are suffering from.
“Stakeholders should come together and advocate more on indoor air pollution to enlighten the communities on what they should do,” says Simiyu.
This story was made possible with a grant from The Earth Journalism Network (EJN).