REPORT ON HEALTH AT SHALOM CITY VILLAGE

A STUDY INTO NUTRITION, FOOD SECURITY AND

CARDIOVASCULAR DISEASE RISK FACTORS

Professor Robyn Richmond, Professor Heather Worth,

Dr Holly Seale, Mr Kamal Singh, Mr Varun Bhoopathy

Representatives from UNSW Kenya Research Team with residents of Shalom and Public Health Officers

2

Acknowledgements

We would like to sincerely thank the following people for their generous contributions to this study:

Simon Kahoro, Kenyan High Commission in Canberra – for his endearing support for the

project from the beginning and for aiding in establishing communication with local contacts

Edward Gita Kamau, elected member of County Assembly of Nakuru – for his support and

encouragement for the project

Chief Peter Kimani, Office of the President, Nakuru – for his instrumental role in enabling

us to conduct research at Shalom, and for meeting with the research team during our visit

Peter Kariuki, IDP Chairman Kenya – for his interesting presentation to the UNSW Kenya

Research Team on the history of IDPs in Kenya

Chief John Njagi and Assistant Chief Augustine Too, Provincial Administration, Rongai

Location – for facilitating the study in the village and liaising with the residents to organise

the initial seeds

Julian Torotich, Susan Muhia, Rose Moses, Ezekiel Terer and associated Public Health

Officials – for ongoing interest with the project and providing a helping hand with data

collection

Professor Elizabeth Ngugi, University of Nairobi – for her inspirational and informative

talks given to the residents, and as well as her ongoing support with this project

Duncan Mwangi, Springs High School Principal, Shalom City Village – for generously

allowing the research team the use of classrooms for the study, and for showcasing the

academic and sporting talents present in the community

Cheryle Robinson and Ritu Bahal, Rongai Transport – for accommodating flexible

transport options for the research team, and for constant support throughout the development

phase

Interpreters, Shalom City Village – for their kind assistance with the study, particularly

Ayoub, Ann, Salome, Paul, and others.

Finally without the interest and support of Residents of Shalom City Village, the UNSW

Kenya Research Team would not have been able to carry out this study. We thank them for

this, and for their hospitality and willingness to participate, and for openly sharing their

stories and experiences.

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Contents Acknowledgements .............................................................................................................................. 2

Summary .............................................................................................................................................. 4

Short Report on Nutrition, Food Security, and CVD Risk Factors...................................................... 5

Introduction ...................................................................................................................................... 5

Background on Nutrition and Food Security ................................................................................... 5

Background on Cardiovascular Disease and associated Risk Factors ............................................. 6

Data Collection ................................................................................................................................ 7

Results .............................................................................................................................................. 8

Demographics .............................................................................................................................. 8

Nutritional Status ......................................................................................................................... 9

Food Security ............................................................................................................................... 9

Dietary Diversity ........................................................................................................................ 10

Cardiovascular Risk Factors ...................................................................................................... 10

Tobacco Smoking ...................................................................................................................... 10

Alcohol Consumption ................................................................................................................ 12

Hypertension .............................................................................................................................. 12

Diabetes ...................................................................................................................................... 12

Recommendations .......................................................................................................................... 13

Short report on the value of Solar Lighting ....................................................................................... 15

Distribution of Solar Lights ........................................................................................................... 15

Data Collection .............................................................................................................................. 15

Current use of lighting ................................................................................................................... 15

Injuries, harm and damage due to current lighting ........................................................................ 18

Opportunity Cost of Poor Lighting ................................................................................................ 19

The Value of Flexiway Solar Lights .............................................................................................. 19

References .......................................................................................................................................... 20

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Summary

This study outlines several health care challenges relating to nutrition, food security, and

cardiovascular risk factors, confronted by Internally Displaced Persons residing in the Shalom City

IDP village. Data from other parts of the world suggests undernutrition and food insecurity tends to

be widespread among IDPs, little is known about those in Kenya. Burden of cardiovascular disease

(CVD) is projected to increase particularly in sub-Saharan Africa over the next 20 years. Similar to

undernutrition, little is known about the CVD risk factor status of IDPs in Kenya.

Undernutrition, food security, and CVD risk factor status were analysed for 267 men residing in the

Shalom City IDP Village using a survey and biometrical measurements. Following are a summary

of the results from the study:

The mean age of participants was 37 years, 84.5% were of Kikuyu ethnicity and 82.1% had

resided in the former Rift Valley province prior to displacement.

Most households (95.2%) did not have ready access to cooking fuel

Nutritional status of men residing at the village is very similar to those men in rest of Kenya,

however the food security is very low in the village. The majority, 180 (71.7%) participants,

reported severe food insecurity within their household.

Low monthly household income (<2000 Kenyan Shillings) was associated with a higher

food insecurity, greater likelihood of residing in a severely food insecure household, low

dietary diversity score and being underweight.

Tobacco and alcohol use were reported in 36% and 31% of the population, respectively.

Current tobacco smokers were also likely to be current alcohol consumers.

CVD risk factors are present within this population, with 36% of the participants having a

single risk factor profile and 30% having two or more risk factors.

Hypertension was reported in 9.6% of the population.

We found a mean BMI of 20.3 (SD ± 2.5), with 23.9% of participants in the underweight

category (BMI<18.5). Central obesity was only found in 4 participants.

The UNSW Research Team recommends the establishment and implementation of a mobile

preventive health service. It is envisaged that the mobile service would operate from a large vehicle

(van or bus) and travel to different IDP settlement sites in the Rift Valley, including Shalom, where

preventive information would be provided on a range of health care issues (e.g. CVD Health Issues)

by the Public Health Officers from Nakuru.

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Short Report on Nutrition, Food Security, and CVD Risk Factors

Introduction

This report outlines several health care challenges, relating to nutrition, food security, and

cardiovascular risk factors, confronted by Internally Displaced Persons residing in the Shalom City

IDP village, near Rongai in Kenya’s Great Rift Valley. The information presented is based on a

descriptive, cross sectional study involving a questionnaire and biometric measurements conducted

by the UNSW research team at Shalom in late June 2013. The aims of the study were to explore the

nutritional status, determine dietary diversity and food security, and determine the cardiovascular

disease risk factor status of men residing in an Internally Displaced Persons (IDP) village in Kenya.

Background on Nutrition and Food Security

Malnutrition is the term used to describe all deviations from an adequate diet and optimal

nutritional status. It can arise due to an inadequate (undernutrition) or excess (overnutrition) diet (2)

.

IDPs worldwide experience undernutrition with insufficient macronutrient and micronutrient intake

(3). Nutritional status, as shown in Figure 1, is a result of the interaction between numerous basic,

underlying and immediate causes (1, 4)

. Studies among IDPs in other regions suggest they continue

to experience undernutrition with insufficient macronutrient and micronutrient intake.

Food security is an evolving, composite concept which is said to exist ‘when all people, at all times,

have physical and economic access to sufficient safe and nutritious food to meet their dietary needs

nd food preferences for a healthy and active life’ (5)

. Three distinct variables are critical to the

attainment of food security (Figure 2); availability, access and utilisation of food (4)

.

Figure 1: Undernutrition is an outcome indicator with numerous determinants (1)

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Food Security

Food Availability

Sufficent quantities of

appropriate food from domestic production and

imports

Food Access

Sufficent resources to obtain

appropriate foods for a nutritious diet

Food Utilisation

Proper use, processing and storage of food with adequate

care, health and sanitation

Figure 2: The three key facets of food security; food availability at national and subnational levels, access

to food at the household level and proper utilisation of food at the individual level.

Food insecurity not only contributes to undernutrition across all ages, but is also a determinant of

morbidity among IDPs (6)

. IDPs with insufficient food security are more likely to report symptoms

of posttraumatic stress disorder (PTSD), depression and anxiety (7, 8)

.

Background on Cardiovascular Disease and associated Risk Factors

The burden of cardiovascular disease (CVD) is projected to increase in resource poor countries,

particularly in sub-Saharan Africa over the next 20 years (Figure 3) (9)

.

Figure 3: Estimated proportions of age-standardised mortality rates by cause in sub-Saharan Africa (9).

7

Currently in Kenya, infectious diseases and neonatal disorders remain the largest cause of excess

mortality (10)

. However, similar to global trends, CVDs are becoming increasingly prominent (10)

.

Accurate data does not exist regarding CVDs amongst Kenyan IDPs, evidence from conflicts and

natural disasters from other regions shows that rapidly increasing magnitude of these diseases

disproportionately affects these populations, in turn contributing to widening health disparities (11)

.

‘Risk factor’ is defined as a measurable characteristic that is an independent predictor of an

increased risk of presenting with a particular disease (12)

. Over the last half century, various risk

factors have been identified for CVD. Figure 4 shows these risk factors subdivided into several

categories.

Figure 4: Natural history of CVD and associated risk factors (12).

Having population based estimates of the CVD risk factors listed above and understanding its

distribution, is crucial in helping tailor policies and interventions to address the burden of CVD.

Population data on CVD risk factors are lacking on IDPs in Kenya. For the planning and execution

of an effective CVD prevention program for IDPs, it is essential to establish a baseline data of

prevalence of CVD risk factors through a comprehensive study within this population group.

Data Collection

Participants recruited into the study proceeded through a number of ‘stations’ where they completed

a questionnaire and had various biometrical measurements performed.

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Results

Demographics

Two hundred and fifty one men participated in the study. Their demographic characteristics are

highlighted in the table below (Table 1).

Table 1: Demographic characteristics of men at Shalom City IDP village included in the study.

Characteristic Participants n=251 (%)

Mean age (overall) ± SD 37 ± 16.0

Ethnicity

Kikuyu 212 (84.5)

Other 39 (15.5)

Education

No schooling/primary school incomplete 90 (35.9)

Primary School 101 (40.2)

Secondary School 55 (21.9)

College/University 3 (1.2)

Not Specified 2 (0.8)

Province of Origin

Rift Valley 206 (82.1)

Central 25 (10.0)

Other 20 (7.9)

Relationship Status

Currently Married/living together 143 (57)

Never Married 79 (31.5)

Other 41 (16.3)

Employment over preceding 12 months

Employed 124 (49.4)

Agriculture 94 (37.5)

Sales/Services 11 (4.4)

Other 19 (7.5)

Unemployed (able to work) 121 (48.2)

Unemployed (unable to work) 5 (2)

Other 1 (0.6)

Monthly household income over preceding 12 months (KES)a

0 – 2000 ($AUD 0 – 25) 120 (47.8)

2001 – 4000 ($AUD 25 – 60.00) 59 (23.5)

> 4000 ($AUD > 60.00) 64 (25.5)

Don’t Know 5 (2.0)

Refuse to Answer 3 (1.2)

Mean number of people at home (overall) ± SD 7 ± 4.7

Mean number of children at home (overall) ± SD 3.5 ± 3

a KES = Kenyan Shillings

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Nutritional Status

Our study found that men at the Shalom City IDP village had a mean BMI of 20.3 (SD ± 2.5) with

23.9% of participants underweight (BMI <18.5). The nutritional status of men in our study is

similar to the nutritional status examined by studies looking into non-displaced men living in rural

Kenya. This is in contrast with literature in other regions which has suggested that IDPs generally

have poorer nutritional status than surrounding, comparable non-displaced populations. As

undernutrition is an outcome indicator with numerous determinants (Figure 1), we hypothesise there

may be many reasons for this difference. Notably, previous studies have been completed earlier

following displacement when instability, disease and food shortages may be more widespread. This

study was completed five years following displacement in a relatively stable and well developed

village. Perhaps more importantly, households at Shalom City IDP village have been allocated two

acres of agricultural land each reducing reliance on food aid, which has been unreliable and

insufficient in other regions (13, 14)

.

We also found that men aged over 40 were more likely to record an underweight BMI. As the

median maternal age at birth of first child in the Rift Valley is approximately 20, this age group

represents grandparents within Shalom households (15)

. This association corresponds with the

findings of limited research into the nutritional vulnerability of similarly aged displaced persons in

Sub-Saharan Africa and elsewhere. Discussions and observation at the Shalom City IDP village

have also suggested that grandparents may be forgoing meals to allow children to eat, however

further research is necessary to validate such findings.

Food Security

In our study, 180 (71.7%) participants reported severe food insecurity within their household.

Comparison of our data with literature suggests that food insecurity among Shalom households is

more similar to vulnerable populations affected by HIV and AIDS than average rural settings in the

region. We hypothesise this may be, to some extent due to the lack of household capital to support

agriculture. Though households at Shalom have been provided two acre plots of land, discussions

with community members suggest that lack of income means that fertiliser, agricultural implements

and seeds are still difficult to access. This limits cultivation to maize and beans, which are used to

prepare the staple foods ugali (thick maize porridge) and githeri (maize and kidney beans).

Furthermore those with lower monthly income, as expected, reported higher food insecurity and

were more likely to reside in a household categorised as severely food insecure. In contrast, those

with higher monthly income may be able to invest in the cultivation of more land, grow a greater

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diversity of crops and utilise other sources of food including the market and livestock leading to

improved food security.

Dietary Diversity

Starchy staples (e.g. thick maize porridge ugali, and thin maize porridge uji) were the most

commonly consumed food group in the preceding 24 hours, eaten by 92% of participants. Organ

meat (e.g. liver, heart and kidney) was the least common, consumed by only 21.9%. We also found

that those with low dietary diversity reported a monthly income below 2000 Kenyan Shillings,

greater food insecurity and were more likely to report severe household hunger. This is similar to

findings in another study in South Africa where an inverse relationship between food insecurity and

dietary diversity was documented (16)

. It has already been established in other settings that dietary

diversity scores are positively correlated with adequate macronutrient and micronutrient intake

across all ages, including adults (17-19)

. It is therefore likely that residents in food insecure

households may be eating a diet of less nutritional adequacy compared to food secure households

which may have implications for future health and wellbeing.

Cardiovascular Risk Factors

Table 2 highlights the status of various CVD risk factors. We found that 36% of the participants

have at least a single risk factor profile and 30% having multiple risk factors.

Tobacco Smoking

Just over half the participants (52%) reported smoking tobacco in their lifetime, with 36% of the

participants’ currently smoking tobacco on a daily basis. The smoking prevalence in men living at

the Shalom IDP Village is considerably higher than the national prevalence found by the Kenyan

demographic health survey of 2003 and 2009. Our study’s finding is also higher than most of the

reported rates of current tobacco use from other studies throughout sub-Saharan Africa, which

ranges from 11% in Ethiopia to 33% in Madagascar (20)

. We suggest that factors contributing to

these differences include health education, social and religious norms, and communal smoking

patterns. It should also be noted that a small percentage of the participants reported tobacco being

grown within this village, although this was not observed by the research team. However, such an

ease of access may be a contributing factor to the high prevalence of smoking.

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Table 2: CVD Risk Factors amongst the men residing in the Shalom City IDP Village

Age 18 - 34y Age 35 - 54y Age ≥ 55y All Ages

n = 131 (%) n = 83 (%) n = 36 (%)

n = 251

(%)

Tobacco Smoking

Ever smoked 52 (39.7) 54 (65.1) 24 (66.7) 130 (51.8)

Current Daily 35 (26.7) 40 (48.2) 16 (44.4) 91 (36.3)

Mean age when started smoking 18.12 n/a 20.24 n/a 25.67 n/a 20.41 n/a

Mean number of cigarettes smoked per day 11.14 n/a 8.75 n/a 6.19 n/a 9.3 n/a

Mean age of smoking cessation 24 n/a 29.73 n/a 43.75 n/a 30.42 n/a

Alcohol Consumption

Abstainer 72 (55) 25 (30.1) 15 (41.7) 112 (44.6)

Last 12 months 46 (35.1) 40 (48.2) 12 (33.3) 98 (39)

Current (w/in 30 days) 36 (27.5) 32 (38.6) 10 (27.8) 78 (31.1)

Mean number of occasions in past 30days 5.65 n/a 6 n/a 4.5 n/a 5.64 n/a

Blood Pressure

Self-reported raised blood pressure 3 (2.3) 6 (7.2) 3 (8.3) 12 (4.8)

Desired (90-119/60-79 mmHg) 36 (27.5) 26 (31.3) 11 (30.6) 73 (29.1)

Prehypertension (120-139/80-89 mmHg) 85 (64.9) 49 (59) 17 (47.2) 151 (60.2)

Hypertension (≥140/90 mmHg) 12 (9.2) 5 (6) 7 (19.4) 24 (9.6)

Body Mass Index

Underweight (<18.5) 26 (19.8) 23 (27.7) 11 (30.6) 60 (23.9)

Grade I (mild) thinness 25 (30.1) 19 (22.9) 7 (19.4) 51 (20.4)

Grade II (moderate) thinness 1 (12) 3 (3.6) 4 (1.1) 8 (3.1) Grade III (severe) thinness 0 (0) 1 (1.2) 0 (0) 1 (0.4)

Normal (18.5 – 24.9) 100 (76.3) 49 (59) 23 (63.9) 172 (68.5)

Overweight (25 – 29.9) 4 (3.1) 9 (10.8) 2 (5.6) 15 (6)

Obese (≥ 30.0) 0 (0) 1 (1.2) 0 (0) 1 (0.4)

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Alcohol Consumption

Lifetime abstinence from alcohol was reported by 45% of the participants. Approximately 30% of

the participants reported current (within the last 30 days) alcohol use, and drink on an average of 6

occasions per month. Men who are currently drinking are likely to be current smokers as well (OR

2.80, 95%CI 1.04 – 7.52, p<0.05). Our findings suggest that the prevalence of alcohol use within

our study population is similar to not only that of non-displaced persons in Kenya, but also to

another similar IDP population in Uganda (21).

Hypertension

Twenty four participants were found to have hypertension, out of which 18 were classified as Stage

1 Hypertensive, five participants were Stage 2 Hypertensive, and one participant was classified as

Hypertensive Emergency. One participant was measured to be hypotensive. Participants who were

classified with Stage 2 Hypertension were more likely to have a body mass index greater than 24.9

(OR 2.49 95%CI 1.06 – 5.83, p<0.05).

In our study, only two out of the 24 participants who were hypertensive were previously aware of

their condition. In neighbouring countries, Tanzania and Ethiopia, 50% and 65%, respectively, of

those found to be hypertensive were unaware of their condition (20, 22)

. The rate of awareness in our

study was comparatively low, but this is unsurprising considering only 16% of the participants had

previously had their blood pressure measured.

Diabetes

Rates of diagnosed diabetes have been reported at 4.2% in Kenya (23)

. Surrounding countries range

from 2.4% in Zimbabwe to 10% in Seychelles (20)

. Our rates of self-reported history of raised blood

sugar were very low at 1%. None of the participants had been receiving any treatment or were told

in the preceding 12 months of the study that they had raised blood sugar. This low rate could be

attributed to low awareness and lack of testing. Low awareness of diabetes has been reported

throughout sub-Saharan Africa, even amongst those previously diagnosed with the condition (24)

. As

this study only used a self-reporting methodology, which is often associated with underestimating

prevalence, a confirmatory blood sampling and testing is needed to put our findings in context (25)

.

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Recommendations

Kenya, as a signatory to numerous regional IDP protection agreements, is bound to safeguard the

economic, cultural, social and civil rights of Internally Displaced Persons (26)

. The government of

Kenya has taken numerous notable steps to ensure that the wave of displacement witnessed in

2007/08 is not repeated. The continuing implementation of the National Accord and Reconciliation

Act (2008) has been a positive step to reconcile communities and mitigate against future conflicts.

Enshrined within this act are key agenda items including putting an end to violence based on

political differences (item 1), addressing the humanitarian crisis of displaced persons from 2007/08

(item 2), and examining the underlying causes of the violence to enact constitutional, legal and land

reforms (item 4) (27)

. In 2012 the Kenyan parliament tabled a National IDP Policy and Bill. Once

implemented, it will become one of only 22 other nations (including 6 in Africa) to have legislation

for IDP protection (28)

.

Addressing the needs of those displaced in 2007/08 will also assist with ethnic reconciliation. As a

matter of urgency, the government needs to ensure all IDPs residing in deplorable makeshift

villages throughout Kenya are provided resettlement sites with land allocation similar to Shalom

City IDP village. However, as our research shows, the establishment of a resettlement site does not

mark the end of challenges faced, rather it signifies a shift in needs. The productivity of the land

allocated to households at Shalom is reliant on many complementary investments in the form of

seeds, fertiliser and farming equipment, all of which yield benefits over time. Allocated land could

be registered and title deeds provided to households to allow them to access credit and encourage a

sense of security and ownership which is associated with improved yield and productivity (29)

.

Furthermore, access to cooking fuel was also alarmingly low. As it is illegal to trim trees in the area

for firewood, village residents often resort to illegally collected firewood from neighbouring farms.

While we did observe a tree planting and sapling distribution project underway at the village,

solutions to the short term demand need to be a priority for village leadership. However, this was a

study of one of the many villages in Kenya and similar needs assessment research should be carried

out among other villages to guide interventions for the future.

To address the needs of the residents of Shalom City IDP village, the UNSW Kenya IDP research

team propose the implementation of a mobile preventive health service. The service would be

operated out of a large vehicle (such as a van or bus) and travel to different IDP village sites,

including Shalom where information would be provided by the Public Health Officers about a range

of healthcare issues outlined in Table 3.

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Table 3: Prevention topics to be covered by proposed mobile health prevention service

Prevention Topic Rationale for Topic

Screening and education on

cardiovascular risk factors –

focusing on reducing alcohol

consumption and tobacco use

Our study showed that very few participants were aware of

their cardiovascular risk factor status, and one in three

participants were either smoke or consume alcohol.

Improving nutrition by

growing better crops

Though land allocation has occurred, extensive food insecurity

still exists in Shalom households. Providing education and

training about agricultural practises to improve crop yields and

allow greater diversity of crops.

Family planning and use of

condoms

Information provided to improve the low rates of family

planning and condom usage by all ages in Kenya (30)

.

Educational information about

certain diseases – HIV,

diabetes, cardiovascular

disease

Information about prevention and management of chronic

diseases provided to rectify low awareness rates found in our

study and noted by other surveys (30)

.

In addition to this, a health promotion idea suggested by the Principal of Rongai High School has

already been put in place. Information about the harms associated with poor health choices

including smoking, excess alcohol consumption and poor lifestyle is provided by members of the

UNSW research team to teachers at Rongai High School. Educators can then use culturally

appropriate and innovative means to relay the message to the children. With continued co-operation

we hope to see both the health promotion program in schools and the mobile health prevention

service increase in size.

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Short report on the value of Solar Lighting

The UNSW Research team consulted with several key stakeholders on the issue of lightings and the

potential value of Solar lighting within Shalom. Following is a short report on the findings from the

consultations.

Distribution of Solar Lights

The Flexiway Solar Lights (Figure 5) were distributed to the residents of Shalom City Village

through various avenues. These included through the Camp Chief, High School Principal, Senior

Public Health Officials and local Member of Legislative Assembly.

Data Collection

The data presented in this report was collected through

consultations with a number of key stakeholders at

Shalom City Village, including:

- Two regional chiefs in charge of administration of

Shalom City Village

- Springs High School Principal

- Two officers from the Public Health Unit, Rongai

- Numerous Community Leaders

Current use of lighting

The majority of households do use some form of lighting for activities, eating and schoolwork

between sundown (6:30 pm) and around 10:30 pm when they go to sleep. Lighting is also used to

aid walking to outdoor toilets, cooking and for security purposes.

The main sources of lighting used in this region include:

- Kerosene lamps, both home-made and purchased lamps (see photos below)

- Electricity

- Solar power

- Wood

Kerosene lamps are the most widely used source of lighting. The majority of households use cheap

homemade lamps which consist of a sawn-off tin can. Kerosene is poured into the tin can and then

lit using a cloth wick. Local names for this lamp include ‘karabusg’ and ‘tandika nilale’ (figure 6:

Figure 5 – Flexiway Solar Light

16

left). These homemade lamps cost approximately 40 Kenyan Shillings1 each to buy pre-made. A

small percentage of households have access to commercially manufactured kerosene lamps at a cost

of approximately 500 Kenyan Shillings each (figure 6: right).

Figure 6: Traditional homemade kerosene lamp (left) and commercially purchased kerosene lamp (right).

Purchasing fuel for these lamps is difficult as kerosene is an expensive commodity in rural Kenya.

The current price is approximately 100 Kenyan Shillings for 1 litre of kerosene which will last the

typical family 3-4 days. Hence the weekly cost of kerosene is 200-250 shillings, and any excess fuel

is used to ignite firewood for cooking. This value represents 10-30% of monthly family income. On

top of the fuel, households also purchase matchboxes for 3 Kenyan Shillings each. A major

drawback of both kerosene lamps is that they do not work when it rains.

A very small proportion of households (reportedly as low as 3 out of 444 households) have an

electricity connection to their home which they make use of for lighting. However, significant

increases in the cost of electricity in the past year and intermittent power outages mean that many of

these households rely on kerosene as well.

Solar panels have been donated to a small number of households and were seen secured to their

roofs (figure 7). They provide a viable alternative to kerosene as the region receives a good year-

round supply of sunlight, they have low running cost and provide more light than kerosene lamps.

However, their current price puts them beyond the reach of most households.

1 At the time of publication the exchange rate was approximately 1 AUS dollar for 74 Kenyan Shillings. To give an

indication of income, one full day of manual labour on a farm is worth approximately 250 Kenyan Shillings.

17

Figure 7: House with solar panel attached to roof (inset)

Firewood is also commonly used for lighting. However, this tends to be limited by poor access to

firewood due to strict regulations set by the government on cutting down trees. Many residents of

the Shalom City Village illegally collect firewood from a neighbouring farm (figure 8). Households

often resort to purchasing firewood at a cost of 20 shillings per bundle. The average household can

use up to 10 bundles per week, spending approximately 10-30% of monthly family income.

Figure 8: Firewood collected by the Shalom City Village locals from the neighbouring farm.

The majority of households in Shalom City Village cannot afford any form of lighting. Most of

these households have supper and go to sleep at sundown.

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Injuries, harm and damage due to current lighting

Injuries due to kerosene or wood fuelled lighting are common. They tend to occur among those who

are intoxicated or among children who are playing near open flames. Homemade kerosene lamps

when prepared incorrectly can explode causing extensive burns to the members of a household.

People have accidentally dropped kerosene lamps while using outdoor toilets. This presents a

significant fire risk as the construction of the toilets often incorporates wood and hay (figure 9).

Figure 9: Outdoor toilets are constructed using wood, mud and hay. Often people can accidentally

drop kerosene lamps while using the toilet presenting a significant fire risk.

The key stakeholders were aware of the harms of breathing in kerosene fumes and smoke. One

stakeholder reported attending a seminar on the dangers of carbon monoxide conducted by a local

doctor. Being exposed to and breathing in the fumes and smoke has been linked with respiratory

irritation, eye irritation, aggravation of asthma, chronic coughing and headaches. Lung disorders

occur commonly among children, a trend reflected in other parts of the world. The elderly, who

may already have underlying lung disorders are also significantly affected. A talk with a local

public health worker revealed that breathing in the fumes and smoke predisposes residents to

tuberculosis. The dim flickering light produced by kerosene lamps has the often unnoticed effect of

placing strain upon the eyes of schoolchildren as they complete homework.

Possessions have been lost and houses have burnt down when kerosene lamps have been placed

close to flammable items or the lamps not been switched off before sleep. The housing in Shalom

City Village is mainly composed of mud-brick exteriors with tin roofs. The most flammable

components are the wooden support structures for the tin roof. In the past these have ignited when

flames have spread through clothing, hay or other flammable materials reaching up from the floor.

19

Opportunity Cost of Poor Lighting Apart from the real cost and physical harm/damage caused by traditional lighting, other costs

including though not limited to lost income, learning and family time are also incurred.

All stakeholders were particularly concerned about the impact on schooling, as education represents

a real means of escaping the poverty cycle for families. Current kerosene lamps do not enable

school children to satisfactorily complete homework. Many students resort to rushing through their

work while they can during the daylight hours. Unfortunately responsibilities around the home

mean that it is often left incomplete resulting in reprimand from the teacher the following day.

The lack of affordable lighting also prevents any income generating activity (e.g. small commercial

ventures) occurring after sunset. This limits the economic potential of the household.

Thus improving household lighting provides a low cost opportunity to promote development,

improve health and ensure safety for families.

Addressing the multiple challenges of development, energy security, energy access, fossil fuel

subsidies and climate change is often fraught with conflicting interests and disagreements about

priority and pacing. The case of kerosene lighting is an unusual opportunity in which priorities are

aligned. Improved access to clean and reliable lighting benefits health, children’s education and

well-being…

- Jacobson, Bond, Lam and Hultman (2013)

The Value of Flexiway Solar Lights The stakeholders consulted by the research team were unanimous in their view that the use of solar

lights in households would significantly improve health and safety. A single solar light is enough to

illuminate an entire house, including the bedrooms. The lights would be used for a wide range of

purposes:

- Allow activities at home after sunset, particularly small business ventures with economic

potential.

- Permit schoolchildren to complete their school work. The solar lights will benefit the

performance of schoolchildren, especially those who are approaching their final exams.

- Enable cooking of meals

- Ensure security around the house

- Assist in walking outside, particularly when going to outdoor toilets

20

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