A BASELINE SURVEY ON MAGNITUDE, CAUSES AND EFFECTS FROM THE PERSPECTIVE OF COMMUNITY MEMBERS AND INDIVIDUAL USERS
Carried out by NACADA and released in December 2010.
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EXECUTIVE SUMMARY
This baseline survey on alcohol use in Central Province came in the background of public and Government concern over increasing alcohol use in the province. It also came in the background of a previous fact finding mission (NACADA, 2009) that confirmed the existence of an acute alcohol problem. The purpose of this study was to investigate principally through quantitative means the magnitude of alcohol use and the underlying causative factors and effects. The ultimate goal was to gather data and information that would assist in formulation and implementation of effective prevention and control policies and other interventions. The specific objectives were to:
1. Ascertain the magnitude of alcohol abuse with respect to types of alcohol, age, gender, and other social, economic and demographic factors;
2. Identify social environmental risk and protective factors to alcohol abuse;
3. Establish the impact of alcohol abuse on health, security and socioeconomic indicators in the community;
4. Assess the influence of existing alcohol regulations, related policies and other interventions;
5. Make recommendations with regard to appropriate policies and interventions.
The overall design of the study was a cross-sectional survey which gathered views of community members and of individual alcohol users from seven Central Province districts (as at 1999 Census) namely Kiambu, Kirinyaga, Muranga, Nyandarua, Nyeri, Thika and Maragua. The survey also disaggregated for rural and urban areas of the province. The sampling procedure involved selection of Enumeration Areas (EAs) using Probability Proportional to Size (PPS) and random selection of households. In computation of the sample size, it was estimated that 30 % of adults in Central province consume alcohol, a coefficient of variation (CV) of 10% is targeted, design effect of 2 and a non-response adjustment of 5%. Based on above assumptions a uniform sample of 500 households per district was expected resulting into an overall sample of 3,500, which as adjusted to 3,495. The survey managed to capture 3,259 or 93.2%.
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From the community views on alcohol use, the findings point at the following key findings:
Magnitude: There is a very strong consensus in the community that alcohol use is a major problem in the province owing to the high level of usage, increasing trend and ease of availability, affordability and accessibility.
Level of alcohol consumption: About two thirds of community members reported that alcohol consumption in their areas is high or very high. Across the districts, the level of usage ranged from a low of 51.5 per cent in Nyandarua to a high of 75.4 per cent in Kirinyaga.
Trends: More than 80 per cent of the respondents felt that the second generation alcohol was increasing, while 58 per cent expressed the view that the first generation alcohol was decreasing. However, a significant proportion of the respondents held the view that traditional liquor and chang’aa usage was more of constant than increasing or decreasing.
Availability, affordability and accessibility: The findings reveal that the second generation alcohol as the most available, affordable and accessible type of alcohol in the province. Chang’aa and traditional liquor were reported to be the least available and accessible types of alcohol.
Drinking time: A significant proportion of the respondents (nearly 60%) reported that in their areas there is alcohol consumption before noon, apparently the most productive hours of the day. There was also a clustering of drinking activities between noon and 6 pm.
Alcohol usage by age and gender: A significant proportion of the respondents rated the consumption of alcohol among people aged less than 18 years as “high”. Further, results point at the concentration of the drinking among the youth, gender notwithstanding. “Very high” usage was reported for ages 25 – 34 years (males, 79%; and females, 15%); and 19 – 24 years (males, 77%; and females, 14%). Alcohol consumption among males aged 35 – 54 years was rated as “very high”. However, alcohol usage declined with reference to ages 55 years or above.
Besides the community perspective on alcohol use, this survey made an inquiry on individual experiences with alcohol. Some of the key highlights include:
Life time prevalence: The findings show that 29.6 per cent of the community members surveyed had used alcohol on at least one occasion in their lifetimes. However, the lifetime prevalence rate was higher among males than for females with 53 per cent and 8 per cent respectively.
Current usage (last 30 days): As measured by use in the past 30 days, current usage was estimated at 18 per cent with a male rate of 34 per cent while the female rate stood at 3 per cent.
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Type of alcohol: Less than 50 per cent of the respondents were using first generation alcohol, while consumption of the second generation alcohol stood at 40 per cent. The others accounted for 10 per cent.
Frequency of use: As was the case with the community perception, a significant number of people reported using alcohol before noon. Further scrutiny reveals that most of those taking alcohol before noon were clustered around chang’aa and the second generation alcohol
Alcohol dependency rates: The findings show that dependency was higher for chang’aa, traditional liquor and second generation alcohol compared with the first generation brands. For instance, 75 per cent of chang’aa users regularly felt that they needed it to remove hangover. In addition, alcohol dependency was reported more for male users.
The findings reveal that some of the risk factors include: idleness; peer pressure; unemployment; work related stress. The risk factors also varied by gender. For instance, while more males used alcohol due to occupational factors (e.g. work related stress, idleness, and unemployment) more of the females used it due to relational issues notably marital problems, problems with parents and peer pressure. Some of the reasons pointed out for taking alcohol include: to feel good or have fun; relaxation; cope with stress; interact with others; and ‘kill time’. These factors also vary with district. Religious values; parental restrictions; positive peer pressure; work and school commitment; fear of stigmatization and peoples bad experience with alcohol were found to be important protective factors.
The study further found out that alcohol abuse has several adverse effects to the individual, the household and the community. Such effects included: episodes of loss of consciousness; inability to meet financial obligations; having multiple sex partners; threatened and attempted suicides; motor vehicle accidents and domestic violence. Others include community level effects such as: low school enrollment; high school drop-out rates; poor results in national examinations; decreased employability; marital breakdown; and infertility.
In conclusion, the findings point to a relatively high level of usage of alcohol in Central Province of Kenya. This vindicates the current public and policy makers concern of high alcohol use in the province. However, a more worrying question is the increasing penetration of the second generation brands that are eating into the market of the first generation alcohol. Nevertheless, the fact that many people do not know about the trend of traditional liquor and chang’aa may partly be linked to their illegality. This is because, unlike the first and second generation brands, chang’aa and traditional liquor are processed, marketed and consumed with some secrecy.
From the community and individual perspective there is strong consensus on the adverse implications of alcohol use in the province in general. In fact the
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findings show an overwhelming disapproval of alcohol use in the community implying that those who abuse alcohol do so against the expectations of the community. Across the seven districts, hard work and education as still highly treasured values. Such solid community disapproval of alcohol use augurs very well for any interventions meant to address the challenge posed by the problem of alcohol abuse in the province.
In view of the study findings, the following recommendations are made:
Increased community education on the adverse effects of alcohol at the individual, household and community level. This may include the provision of IEC materials, use of theater, mass media and especially the local FM radio stations; games and sports and increased targeting of the youth.
Enhanced enforcement of the new legal provision on alcohol since it became evident that there was laxity in the enforcement of the old legal regime that governed the production and sale of alcohol in the country.
Pro-actively engage the community leaders in leading the campaigns against alcohol abuse in Central Kenya.
Working with relevant government departments to ensure that the youth are positively engaged into productive activities e.g. increased uptake of the devolved funds in a way that is beneficial to the youth.
