By Lillian Aluanga-Delvaux
Dusk is fast approaching in Kibera’s Laini Saba area and ‘WaKaranja’, as she prefers to be called, is mulling over whether to close her stall early.
The stream of customers combing through the assortment of koroboi, kerosene lamps, pocket radios and cutlery has been thinning steadily. Before it is dark enough to require a light, WaKaranja gathers her wares and hurries off to her nearby home.
Like on many other evenings, she lights her kerosene stove inside the small family room. Although it is poorly ventilated, she shuts the door and windows to prepare a meal.
“We always cook inside the house,” she says. On closer scrutiny one cannot fail to notice why. The alternatives are few. Houses stand shoulder to shoulder in this vast slum, where living room is at a premium.
There are an estimated 2,000 to 3,000 people per hectare, a level of overcrowding considered dangerous. Rivulets of sewage, mixed with water from rains that have pounded the city in recent days, flow outside the home. A heavy smell of rotting garbage hangs in the air, while swarms of flies perch on almost every surface. Given the precarious position the stove would have to occupy outside the house, a gust of wind could tip it and its contents into the murk.
When asked if she is aware of the health risks from using a kerosene stove or charcoal jiko in a poorly ventilated room, WaKaranja shrugs and says she has never thought of it.
“I only know they (stove, jiko) can sometimes cause fire but I don’t know of other dangers,” she says.
Continual exposure
And she is not alone. Hundreds of people are continually exposing themselves to indoor air pollution that could result in disease and even death years later. Besides the more common tobacco smoke and carbon monoxide, asbestos, lead, aerosol sprays, faulty gas appliances, formaldehyde, which is contained in plywood, paints, air fresheners and dust, are other silent killers that could be making the air inside homes more polluted than the outdoors.
According to the 2010 Global Burden of Disease (GBD) study, indoor air pollution is currently the fourth leading global risk factor for death. This puts it at about the same level with tobacco smoke as a preventable risk for early death and a major health concern given that people spend a lot of time in their homes. Studies have also shown that continuous exposure to these kinds of pollutants can lead to respiratory illnesses, lung cancer and chronic obstructive pulmonary disease (COPD).
The GBD study is “the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries and health risk factors”. It was conducted in more than 180 countries over two decades as part of a global collaboration, coordinated by the Institute for Health Metrics and Evaluation at the University of Washington, as well as a steering committee of several organisations like the World Health Organisation (WHO). Findings of the study were first published in December last year.
In South Asia, for instance, indoor air pollution topped the list among risk factors for burden of disease in 2010. It ranked second in Eastern, Central and Western Sub Saharan Africa. Findings of the study show that indoor and outdoor air pollution account for more than 6 million deaths annually worldwide, including 3.5 million from household air pollution from solid fuels.
Florence Mutindi, 19, who also lives in Kibera, admits to using kerosene stove inside her single roomed house for the past couple of years. She, too, is unaware of the dangers of using the stove in a poorly ventilated room and chuckles when she recounts the hassle involved in using such means to cook.
“I sometimes tear up and cough so much when cooking because of the smoke,” she says. “When it becomes too much to bear I leave the room and stay outside for about 10 minutes then resume cooking.”
Mutindi is one of the three billion people who WHO estimates still cook and heat their homes using solid fuels in open fires and leaky stoves. Of this number, at least 2.7 billion burn biomass (wood, animal, dung, crop waste), while another 400 million uses coal. Majority are poor and live in developing countries, with Africa and Asia having more than 70 per cent of the population using these kinds of fuels. Earlier studies (2004) showed that nearly two million people were dying each year, prematurely, from illnesses attributed to indoor air pollution due to solid fuels use. Of these, 44 per cent were from cases of pneumonia, four per cent from COPD, and two per cent from lung cancer. A 2009 study by WHO also found that almost half the deaths among children under five years were caused by acute lower respiratory infections linked to matter inhaled through indoor air pollution.
Respiratory infections
A health officer at the Saola medical centre, located within Kibera, says the clinic often receives cases of respiratory infections that can be linked to the use of kerosene stoves and charcoal jikos commonly used in poorly ventilated rooms that dot the area. These can prove fatal in children weakened by other illnesses common in the area. As she speaks, a woman cradling her two-year-old child rushes into the cramped medical centre. The child has a severe case of diarrhoea.
The mother admits that the child has suffered similar symptoms before but is now also wheezing. The clinical officer, who identifies herself as Anastacia, then prepares an oral solution for the baby and urges the mother to ensure she gives the child plenty of water to drink. While cases of diarrhoea are not uncommon here, Anastacia acknowledges that others like coughing, sneezing, sinusitis, bronchitis, tonsillitis, and tuberculosis are rising. Although fewer in number instances of asthma have also been reported at the clinic.
“The most affected are children and the elderly and when you interrogate the patients, there is often a link to the fuels used in the homes,” she says.
University of Nairobi’s John Ng’ang’a says indoor air pollution is not only a trigger for diseases likes asthma and bronchitis, but worsens pre existing conditions. Prof Ng’ang’a, a lecturer in the Department of Meteorology and an environmental management consultant, says solid fuels used in homes with poor ventilation are the main cause of indoor air pollution locally. He says that smoke particles are small enough to be inhaled and when deposited in the lungs could increase chances of disease.
“Some of these particles are left within the respiratory tract when inhaled through the nose and mouth, and find their way to the lungs,” he says. “Bigger particles, however, are trapped within the walls of the upper respiratory tract and may be expelled as coughs or sneezes.
Air pollution indoors has been estimated to be two or three times worse than it is outdoors.
Rural areas
“Our indoor environments, particularly in the lower income and rural areas are poorly ventilated. Many people may not even know that when charcoal burns under inadequate levels of oxygen it produces carbon monoxide instead of carbon dioxide,” he says. Carbon monoxide, a colourless and odourless gas, is toxic to both humans and animals when inhaled in high quantities and can cause sudden death. Ng’ang’a proposes that as a start towards minimising risks of indoor air pollution, homes begin to pay greater attention to the importance of ventilation.
“It is not enough to just open the door in rooms where we are using these fuels. The windows should be opened as well to increase air flow,” he says. Keeping houseplants – though not desirable in all situations – and using alternative energy sources like solar for cooking, are also recommended.
Use of products, building materials and furniture that contain Volatile Organic Compounds (VOCs) should also be monitored, experts say. VOCs are harmful chemicals that commonly exist in high concentrations indoors. They are often released from products like aerosol sprays, glues, pesticides, cleaning products, paints, air fresheners, office equipment like copiers and printers, furnishings, carpets and dry cleaning chemicals and may have short or long term health effects.
