US gov't to young Kenyans: 'Yes Youth Can!'

US gov't to young Kenyans: 'Yes Youth Can!'

By TOM ODULA, Associated Press – 1 hour ago  

NAIROBI, Kenya (AP) — A U.S. government-backed program is telling young Kenyans that "Yes Youth Can!" in a political program designed to improve leadership skills that carries overtones of President Barack Obama's election message.

Hundreds of young Kenyans gathered Tuesday for the program's first county-level meeting. The initiative, though, has caused anxiety among Kenyan politicians who fear the $45 million project is a way to oust them from power, prompting the U.S. Embassy to issue several clarifications

U.S. Ambassador Scott Gration said in an email on Tuesday that the U.S. is not empowering young Kenyans to overthrow the government.

"We are working with young people in both urban and rural areas to help them know what empowerment means. There is a leadership vacuum that the youth should be prepared to fill," Gration said. "We want the youth to be for something useful — to be able to contribute positively to Kenyan society, politics, and its economy."

Kenyan President Mwai Kibaki and Prime Minister Raila Odinga last year raised concern about the project and its motives, but their sentiments did not seem to deter Kenyan youth from joining the initiative.

More than 500,000 youth from thousands of villages are involved in the initiative, according to the U.S. Agency for International Development, the U.S. government aid arm known as USAID.

On Tuesday, 400 delegates representing 200 village parliaments formed by the U.S. initiative in Taita Taveta County gathered to elect county representatives. They also passed a constitution governing the group's activities.

The meeting was the first of its kind and other counties will soon hold similar meetings, said Katya Thomas, a U.S. Embassy spokeswoman.

Elizabeth Awuor, a 25-year-old from Taita Taveta County, said by telephone from Tuesday's meeting that politicians' opposition to the initiative comes from the fear they will no longer be able to manipulate young people.

"Leaders are panicking because we are being empowered and they will not be able to misuse us the way they did in the 2007 elections," Awuor said.

A government report found that social inequality caused by corruption helped fuel Kenya's 2007-08 postelection violence, attacks in which more than 1,000 people died. Frustrated, unemployed youth were behind most of the violence, joining tribal militias and gangs at the behest of politicians fighting for power, the October 2008 report said.

Violence erupted in late 2007 after Kibaki was declared the winner of an election international observers and Odinga — Kibaki's main challenger — said was flawed. More than 600,000 Kenyans were evicted from their homes during tribe-on-tribe violence. A peace agreement formed a coalition government in which Odinga became prime minister.

Following the violence USAID commissioned a survey on why youth in the country are vulnerable.

The 2009 research found that almost 2 million youth — Kenyans aged 15 to 30 — were out of school, and a majority had no regular work or income. That made them vulnerable to recruitment for pay into political campaigns and criminal gangs, the research found.

Kenya's youth also expressed a desire to have their own voice in affairs that affect them through youth-run organizations, the report said.

The report's findings led to the formation of the "Yes Youth Can!" initiative.

The former U.S. ambassador to Kenya, Michael Ranneberger, who launched the project, said in an interview in April, just before he left his post, that youth empowerment will help avoid a repeat of postelection violence during Kenya's next presidential election in 2012.

"If you have poverty the way it is, of course it is always going to be possible to manipulate people, but if enough attitudes change and youth start networking with each other and talking that could be a huge dynamic," Ranneberger said in April.

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 A very humble question; do we need America to know that we can? Food for thought........

 CHAPTER FOUR: SELF-REPORTED ALCOHOL USE
4.1. LIFETIME PREVALENCE
Of the community members surveyed, 29.6% had used alcohol on at least one occasion in their lifetimes (Figure 8)7. The lifetime prevalence rate was 52.7% among males and 8.4% among females. Compared to the 2007 national alcohol use survey (NACADAA 2007), the above Central Province overall lifetime prevalence rate is lower than the national rate of 39% (i.e., among 15 – 65 year olds). In addition, while the Central Province lifetime prevalence rate among males is comparable to the national rate of 53.2%, the rate among females was considerably lower than the national rate of 25.8%.
Figure 8: Lifetime alcohol prevalence rate (%) by district and gender
Disaggregating for districts lifetime prevalence ranged from a low of 18.0% for Maragua to a high of 37.0% for Nyandarua and 38.8% for Nyeri. Among males the prevalence rate ranged from a low of 31.4% for Maragua and a high of 60.8% for Nyeri and 61.7% for Nyandarua. Among women it ranged from a low of 4.3% for each of Maragua and Muranga and a high of 11.5% for Nyandarua and 15.8% for Kirinyaga. This data corresponds partially to the community perceptions on alcohol usage in this survey which indicated high usage of alcohol in
7 The lifetime prevalence rate is based on responses from 2,781 respondents out of the total sample size of 3,237 – a response rate of 85.9% to the particular question.
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Nyeri for males and Kirinyaga for females. However, the self-reported lifetime prevalence for Nyandarua was far much higher for both males and females than the community perceptions which actually indicated that Nyandarua had the lowest usage. Furthermore, as it is shown in the next section, Nyandarua had high current prevalence of alcohol usage especially among females which indicate that the community perceptions about low usage in this district to some extent reflect a collective denial.
4.2. CURRENT USAGE
4.2.1. The Prevalence Rate (Past-30- Days)
The survey revealed that the current prevalence rate of alcohol use – measured by use in the past 30 days – was 18.1%, with male rate of 34.4% and female rate of 3.2% (Figure 9).8 The overall rate is comparable with the 2007 Central Province rate of 17.7% but higher than the national average rate of 14.2% (among ages 15-65 years) (NACADDA, 2007). It is noteworthy that the Central Province rate for males is much higher than the 2007 national male rate of 22.9% while the female rate is lower than the national average rate of 5.9%. This goes on to say that the Central Province’s alcohol problem is primarily a problem among males.
Figure 9: Current alcohol prevalence rate (%) by district and gender
8 These rates are based on the number of respondents who responded to the question of lifetime use – 2,781 (1,330 male and 1,451).
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Across the districts the prevalence ranged from a low of 7.4% for Maragua and a high of 25.3% for Nyeri and 25.5% for Muranga. Among males, the prevalence rate ranged from a low of 14.3% for Maragua and a high of 49.4% for Muranga. Among women the prevalence rate ranged from a low of 0.5% for each of Maragua and Thika and a high of 3.7% for Nyandarua and 8.1% for Kirinyaga. Of significant emphasis is the higher rate for males in Muranga and for females in Nyandarua and Kirinyaga.
4.2.2. Types of Alcohol Used
The type of alcohol used is significant in understanding alcohol problem since there are different implications for lethality or negative effects depending on the type of alcohol consumed. In Kenya today, the second generation alcohol and chang’aa are the most lethal because of high potency and adulteration with dangerous and unhygienic substances. The high potency and adulteration of these two types is motivated by their commercialization (unlike traditional liquor that is often consumed in social functions like weddings) and little or no government regulation or self-regulation on the part of the marketers (as opposed to the first generation alcohol).
Given that only the first generation alcohol can be assumed to be of hygienic standard and moderate potency, it is a significant finding that out of the total current alcohol users (within the past 30 days) less than half (exact, 48.4%) were using the first generation alcohol as their regular drink. In contrast, a large number of the respondents were regularly consuming the second generation (40.3%) and a few others the traditional liquor (9.9%) and chang’aa (1.4%) (Figure 10).
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Figure 10: Prevalence rate (%) of different types of alcohol by district
Across the districts, the usage of the first generation alcohol ranged from a low of 34.8% for Kirinyaga to a high of 60.6% for Maragua. The use of second generation alcohol ranged from a low of 19.7% for Maragua to a high of 51.3% for Kirinyaga and 52.8% for Muranga. These data indicate that areas with low prevalence of first generation will have high prevalence of the other types of alcohol.
Disaggregating for gender, the survey revealed that among men the prevalence of the first and second generations of alcohol was comparable at 45% and 43% respectively (Figure 11). Among women, majority of them (67%) consume the first generation but a significant number (25%, n = 17) also consume the second generation (Figure 12).
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Figure 11: Male alcohol Prevalence by type
Figure 12: Female alcohol prevalence by type
30
Disaggregating by gender and districts, the survey revealed that men from Muranga and Kirinyaga had the highest usage of second generation alcohol (22.4% and 20.4% respectively) with those in Kirinyaga having the highest usage of chang’aa (50%) (Figure 13). Women from Kirinyaga had the highest usage of any type of alcohol including all the users of chang’aa, two-thirds of second generation users and nearly 60% of the traditional liquor users (Figure 14). An important emphasis is the Nyandarua women’s usage of the second generation alcohol which was relatively higher than in the other districts except Kirinyaga.
Figure 13: Male usage of different types of alcohol
Figure 14: Female usage of different types of alcohol
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4.2.3. The Prevalence Rate (Past 14 and 7 Days)
The survey also investigated the current usage in the past 14 and 7 days. This more recent timeframe, compared to past 30 days, is in this report not intended to show the prevalence rate but more so to show an element of abuse. The assumption is that the use of alcohol in the very recent times is partly an indicator of a habitual use and therefore an element of abuse. The results showed that of the people who had used alcohol in the last 14 and 7 days, about half of them had consumed the second generation alcohol (Figures 15 and 16).
Figure 15: Last 14 days prevalence rate (%) of alcohol by type
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Figure 16: Last 7 days prevalence rate (%) of alcohol by type
4.2.4. Frequency of Alcohol Use
The survey revealed that out of the total of those who consume the second generation alcohol, more than half (55.6%) use it daily or up to four times a week while the remainder (44.4%) uses it between once and four times a month. Equally abused was traditional liquor with 43.2% using it daily or four times a week and chang’aa (with 6 out of 8 users consuming it daily or four times a week) (Figure 17).
Figure 17: Alcohol usage at different time periods by type
Disaggregating by districts, the rate of abuse – measured daily use or four times in a week – for the second generation alcohol ranged from a low of 31.0% for Nyandarua and a high of 75.7%
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for Kiambu (Figure 18).
Figure 18: Usage of second generation alcohol daily or four (4) times in a week
Frequency of use was also investigated by looking at the time periods of the day when alcohol was consumed. The survey revealed that a significant number of people were using alcohol before 12 noon (14.9%) and between 12 noon – 6 pm, which shows the extent of alcohol use in the Province (Figure 19). Disaggregating for type of alcohol, the usage before noon and between 12 noon – 6 pm was highest for chang’aa and second generation compared with first generation and traditional liquor (Figures 20 and 21).
Figure 19: Alcohol usage rate (%) at different periods of the day
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Figure 20: Alcohol usage rate (%) of 1st Generation and 2nd Generation alcohol at different periods of the day
Figure 21: Alcohol usage rate (%) of Chang’aa and traditional liquor at different periods of the day
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4.2.5. Alcohol Dependency Rates
Alcohol dependency was investigated using a set of questions from validated tools (i.e., CAGE and AUDIT) divided into three sets. The first set of questions looked into alcohol associated problems felt/experienced “daily or almost daily”, “weekly”, “monthly”, “less than monthly (i.e., felt beyond one month)” or “never”. Based on the results of the combined response categories of “daily or almost daily” and “weekly” the results showed that, for any type of alcohol, expressions of alcohol dependency ranged from a low of 10.4% for “failing to do what was expected due to drinking” to a high of 16.4% for “needing a drink in the morning to get started” (Table 10). Disaggregating for types of alcohol, dependency was much more reported for chang’aa, traditional liquor and second generation alcohol compared with the first generation alcohol. For example, 6 out of 8 (75%) of chang’aa users regularly felt that they needed it to remove hangover. Comparing across gender, alcohol dependency was reported more for male users expect for failing to do what one was expected to do due to drinking which was reported more for female users (Table 11).
Table 10: Expressions of Drinking Problem felt Daily or at Least Once a Week
Table 11: Expressions of Drinking Problem felt Daily or at least once a week by Gender Measurement Item Male Female
Have been unable to stop drinking once they had started
12.3%
9.6%
Failed to do what was expected because of drinking
10.6%
11.5%
Have needed a drink in the morning to get going after a heavy drinking session (“Removing hangover”)
16.8%
14.5%
Have felt remorseful or guilty after drinking
14.4%
4.9%
Had been unable to remember what happened the night before because they had been drinking
16.4%
8.0%
The second set of questions looked into alcohol associated problems felt/experienced “during the last one year”, “over the last one year”, or “never”. For those who reported alcohol associated problems felt/experienced in the last one year the results showed that, for any type of alcohol, one-third of the current users have had someone significant complaint about their Measurement Item Total (i.e., for any type of alcohol) 1st generation 2nd generation Traditional liquor Chang’aa
Have needed a drink in the morning to get going after a heavy drinking session (“Removing hangover”)
16.4%
9.5% (27)
21.2% (55)
23.7% (9)
75.0% (6)
Had been unable to remember what happened the night before because they had been drinking
15.2%
9.5% (27)
19.7% (51)
18.5% (7)
50% (4)
Have felt remorseful or guilty after drinking
13.9%
8.1% (23)
20.1% (52)
15.8% (6)
12.5% (1)
Have been unable to stop drinking once they had started
12.4%
7.4% (21)
16.4% (42)
13.5% (5)
57.2% (4)
Failed to do what was expected because of drinking
10.4%
5.6% (16)
14.3% (37)
10.5% (4)
50.0% (4)
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drinking and suggested they should cut down or stop while nearly one-quarter had either been injured or injured someone else because of drinking (Table 12). These problems were reported more often for chang’aa and second generation alcohol compared to the first generation and traditional liquor. Disaggregating by gender the problems were much more among men although a significant proportion of women also reported the same problems (Table 13).
Table 12: Expressions of Drinking Problem felt during the last one year Measurement Item Total (for any type of alcohol) 1st generation 2nd generation Traditional liquor Chang’aa
Have had a relative, friend, doctor or health worker complained about their drinking and suggested they should stop or cut down
33.3% (197)
25.6% (73)
41.5% (108)
31.6% (12)
50.0% (4)
Have been injured or injured someone else because of drinking
23.8% (139)
18.3% (51)
30.9% (80)
7.9% (3)
62.5% (5)
Table 13: Expressions of Drinking Problem felt during the last one year by gender Measurement Item Male Female
Have had a relative, friend, doctor or health worker complained about their drinking and suggested they should stop or cut down
36.2%
16.4%
Have been injured or injured someone else because of drinking
24.9%
18.0%
The third set of questions examined alcohol associated problems felt/experienced in the lifetime with a “yes” or “no” response. For those who reported having ever felt/experienced alcohol associated problems the results showed that, for any type of alcohol, over half (56.4%) of the current users have ever felt the need to stop or cut down on their drinking while 45.7% had been annoyed by people complaining about their drinking habit (Table 14). Disaggregating for gender, more males reported the above feelings than females but the proportions of the females were also considerably high (Table 15).
Table 14: Expressions of Drinking Problem Measurement Item Total 1st generation 2nd generation Traditional liquor Chang’aa
Ever felt need to cut down on drinking
56.4%
54.4% (153)
60.1% (155)
52.6% (20)
25.0% (2)
Have been annoyed by people who complain about their drinking
45.7%
39.9% (112)
51.9% (135)
45.9% (17)
50.0% (4)
Table 15: Expressions of Drinking Problem by gender Measurement Item Male Female
Ever felt need to cut down on drinking
56.8%
50.0%
Have been annoyed by people who complain about their (users) drinking
45.6%
41.9%
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4.3. EXPLANATIONS FOR INDIVIDUAL ALCOHOL USE
4.3.1. Risk Factors for Alcohol Use
The risk factors for alcohol use were investigated by asking respondents to state what factors were leading to their current use. The question read: Thinking about your life today what makes you use alcohol? For each suggested factor the fixed responses were “yes” “no” “don’t know”. For those who responded affirmatively, the results showed that, for any type of alcohol, the affirmation of risk factors ranged from a low 5.7% for media influence to a high of work related stress (39.5%) and peer pressure (35.3%) (Table 16). An important emphasis is the significant number who cited idleness (28.4%) and the relatively fewer number (19.6%) who cited poverty, despite the popular association between poverty and social problems in the Province. Disaggregating for types of alcohol, the results showed that the risk factors were associated more with the use of second generation alcohol and chang’aa compared with first generation alcohol and traditional liquor. The risk factors also varied by gender, a significant finding being that while more of the males used alcohol due to occupational factors (i.e., 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 (Table 17).
Table 16: Risk factors for alcohol use by type of alcohol Measurement Item Total 1st generation 2nd generation Traditional liquor Chang’aa
Work related stress
39.5%
31.9%
50.6%
21.4%
50.0%
Peer pressure
35.3%
31.4%
41.5%
28.6%
12.5%
Idleness
28.4%
18.3%
39.9%
23.8%
50.0%
Unemployment
23.3%
14.1%
31.9%
28.6%
50.0%
Poverty
19.6%
10.1%
29.0%
16.7%
75.0%
Marital problems
14.6%
11.1%
19.5%
9.5%
12.5%
Problems with parents
6.7%
3.5%
10.1%
7.1%
12.5%
Media influence
5.7%
3.1%
7.8%
9.5%
12.5%
Table 17: Risk factors for alcohol use by gender Measurement Item Male Female
Work related stress
41.2%
29.7%
Peer pressure
34.4%
39.1%
Idleness
30.0%
20.3%
Unemployment
24.3%
18.8%
Poverty
19.5%
25.0%
Marital problems
14.5%
15.6%
Problems with parents
6.0%
7.8%
Media influence
6.0%
4.7%
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4.3.2. Reasons for Alcohol Use
The survey also examined reasons that people give for their alcohol use. In this case reasons are meanings – or ideas or goals – that underlie human behavior. The reasons behind alcohol use were examined by asking respondents to state what reasons were leading to their current use. The question read: There are various reasons that people give to explain why they use alcohol. Does this – a suggested reason – apply to you? For each suggested reason the fixed responses were “yes” and “no”. For those who responded affirmatively, the results showed that, for any type of alcohol, the affirmation of reasons ranged from a low of 9.6% for “health benefits” to a high of 89.1% for “fun” and 85.0% for “relaxation” (Table 18). With regard to gender, the reasons for alcohol use were more common among males with the surprising exception “feeling important” which was more common among females than among males (males, 31.5%; females 35.9%) (Table 19). Some significant differences were reported for “killing time”, “business deals” and “working and thinking smart” which were more common among males than among females.
Table 18: Reasons for alcohol use by type of alcohol Measurement Item Total 1st generation 2nd generation Traditional liquor Chang’aa
Makes me have fun
89.1%
86.8%
93.8%
74.4%
100%
Makes me relax
85.0%
80.0%
92.2%
72.1%
100%
Makes me interact/associate with others
77.6%
73.2%
84.9%
58.1%
100%
Helps kill time
66.7%
60.4%
76.4%
51.2%
62.5%
Helps me cope with stress
63.2%
51.9%
76.4%
51.2%
100%
Makes me feel important
31.2%
21.0%
43.1%
16.3%
87.5%
Helps me relate with opposite sex more
Freely
28.7%
20.8%
35.7%
32.6%
62.5%
Enables me get business deals
20.1%
17.6%
23.3%
16.3%
25.0%
Makes me work and think smart
18.8%
14.0%
23.5%
20.9%
25.0%
Has health benefits like helping stomach problems
9.6%
5.3%
13.5%
14.0%
12.5%
Table 19: Reasons for alcohol use by gender Measurement Item Male Female
Makes me have fun
89.4%
85.9%
Makes me relax
85.5%
82.3%
Makes me interact/associate with others
79.0%
73.4%
Helps me “kill” time
70.5%
40.6%
Helps me cope with stress
64.3%
62.5%
Makes me feel important
31.5%
35.9%
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Measurement Item Male Female
Helps me relate with opposite sex more Freely
28.7%
28.1%
Enables me get business deals
22.2%
7.8%
Makes me work and think smart
20.5%
10.9%
Has health benefits like helping me with stomach problems
9.9%
4.8%
4.4. EFFECTS OF INDIVIDUAL ALCOHOL USE
The effects of alcohol use were examined by a question that read: Does alcohol affects you in the following way – a suggested effect –? For each suggested effect the fixed responses were “yes”, “no” and “don’t know”. For those who responded affirmatively, the results showed that, for any type of alcohol, the affirmation of effects that some of the commonest effects were episodes of loss of consciousness and inability to meet financial obligations (Table 20). Extreme effects such as having multiple sex partners, raping and being raped, threatened and attempted suicides were also reported. Disaggregating for gender, most of the effects were more amongst males than amongst females (Table 21). An important emphasis is that higher risk for males to be victims of criminal assault, illegal selling of household property and surprisingly being raped. On the other hand it is significant that females reported more of divorce and separation and battering their children.
Table 20: Effects of alcohol use by type of alcohol Measurement Item Total 1st Generation 2nd Generation Traditional liquor Chang’aa
Lost consciences or victim of blackout
37.4%
27.6%
48.2%
34.1%
62.5%
Makes you unable to meet your financial obligations
36.1%
27.7%
46.9%
25.6%
50.0%
Quarreled with parents
28.0%
21.9%
34.2%
27.9%
50.0%
Makes you unable to work effectively
27.3%
20.5%
36.3%
14.0%
62.5%
Contributes to problems with spouse
27.3%
22.9%
32.4%
23.3%
50.0%
Victim of criminal assautlt
23.0%
18.3%
27.0%
26.2%
50.0%
Fought with other family members e.g. brothers, sisters, uncles
19.8%
11.8%
27.2%
23.3%
50.0%
Has/had multiple partners
19.2%
11.8%
25.5%
23.3%
62.5%
Reduced interest in sexual activity
18.3%
11.2%
25.0%
18.6%
62.5%
sold/sells family property without due consultation with family members
16.2%
9.7%
22.4%
18.6%
37.5%
made you lose your job
15.3%
8.5%
23.0%
9.3%
50.0%
gambling
14.5%
12.1%
17.2%
14.3%
12.5%
batter spouse
13.0%
7.8%
17.9%
16.3%
25.0%
separated or divorced
11.4%
7.5%
14.5%
16.3%
25.0%
victim of drink spiking / kamucere
10.9%
12.5%
9.7%
7.1%
12.5%
drunk driving
9.3%
11.5%
7.5%
7.1%
.0%
battered own children
5.3%
2.7%
8.2%
2.3%
25.0%
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Measurement Item Total 1st Generation 2nd Generation Traditional liquor Chang’aa
threatened to commit suicide
4.8%
3.4%
6.6%
4.7%
.0%
attempted suicide
4.0%
2.4%
6.2%
2.3%
.0%
fought with parents
3.5%
3.1%
3.5%
4.7%
12.5%
Lead to impotence
2.5%
1.4%
3.1%
4.7%
12.5%
was raped
.7%
1.0%
.0%
2.3%
.0%
raped someone
.3%
.3%
.4%
.0%
.0%
Table 21: Effects of alcohol use by gender Measurement Item Male Female
Lost consciousness/victim of blackout
30.4%
27.0%
Makes you unable to meet financial obligations
37.4%
30.8%
Quarreled with parents
28.3%
27.7%
Makes you unable to work effectively
27.7%
27.7%
Contributes to problems with spouse
28.1%
21.5%
Victim of criminal assault
24.6%
10.8%
Fought with other family members
20.7%
16.9%
Has/had multiple partners
20.2%
13.8%
Reduced interest in sexual activity
18.8%
16.9%
Sold/sells family property without due consultation with family members
17.9%
6.2%
Lost employment
15.2%
15.6%
Gambling
16.3%
1.5%
Battered spouse
13.1%
6.2%
Separated or divorced
11.4%
14.1%
Victim of spiking/kamucere
11.0%
7.7%
Drunk driving
10.2%
3.1%
Battered own children
4.6%
6.2%
Threatened to commit suicide
4.8%
3.1%
Attempted suicide
4.0%
3.1%
Fought with parents
3.7%
3.1%
Led to impotence
2.5%
1.5%
Was raped
.8%
.0%
Raped someone
.4%
.0%
The survey further looked into alcohol effects in terms of their own alcohol expenditure compared with other money uses. The results showed that alcohol expenditure averaged (by median) one thousand shillings per month which was only half of their expenditure on food (median, 2000Ksh) and comparable to expenditure on savings and school fees but higher than expenditure on clothing or health (Table 22). This clearly shows that alcohol – which was being used mainly for fun and relaxation – was taking a significant portion of an individual’s resources from basic necessities such as food, savings, health and children’s education.
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Table 22: Individual Monthly Expenditure on Selected Items
Items
Median
Mode
Mean Food 2000.00 1000a 2427.91
Savings
1000.00
0
3745.63 Alcohol 1000.00 1000 2251.72
School fees
1000.00
0
3444.92 Clothing 500.00 500 1083.71
Transport
500.00
0
1536.98 Health 100.00 0 641.28
house rent
0.00
0
1003.42
a. Multiple modes exist. The smallest value is shown
4.5. ALCOHOL USE INTERVENTIONS
The survey also examined a range of interventions that current alcohol users had utilized, either through their own or others initiative. The results showed that the most overwhelmingly utilized intervention (i.e., by 62.2%) was informal counseling by a family member, friend or religious leader (Table 23). Others significant interventions included police arrests initiated by family (13.9%) and church prayers (13.6%). Only few had utilized professional counseling or rehabilitation services. With respect to gender, males were more of the users of the interventions except for “taken to hospital” and “professional counseling” which were more common amongst women (Table 24). An important emphasis is the 13.6% of the women who were put under police custody as an intervention against alcohol use.
Table 23: Alcohol Use Interventions by types of Alcohol
Intervention
Total
1st Generation
2nd Generation
Traditional liquor
Chang’aa Informal counseling e.g., from pastor, family, friend 62.2% (199) 51.1% (70) 69.7% (108) 77.3% (17) 66.7% (4)
Taken to police through family intervention
13.9% (30)
11.8% (11)
14.9% (15)
23.5% (4)
.0% (0) Prayed for in church 13.6% (29) 13.8% (13) 14.0% (14) 13.3% (2) .0% (0)
Chased away from home
11.4% (24)
14.6% (14)
9.4% (9)
7.1% (1)
.0% (0) Taken to hospital 7.9% (16) 5.6% (5) 8.5% (8) 7.7% (1) 40.0% (2)
Professional counseling
5.4% (11)
6.5% (6)
4.3% (4)
.0% (0)
20.0% (1) Rehabilitation centre 4.5% (9) 4.5% (4) 4.3% (4) 6.7% (1) .0% (0)
Taken to a witch doctor
0.5% (1)
1.1% (1)
.0% (0)
.0% (0)
.0% (0)
42
Table 24: Alcohol Use Interventions by Gender
Intervention
Male
Female Informal counseling e.g., from pastor, family, friend 64.0% 41.9%
Taken to police through family intervention
14.1%
13.6% Prayed for in church 14.1% 10.0%
Chased away from home
11.3%
9.1% Taken to hospital 7.3% 9.5%
Professional counseling
4.9%
5.0% Rehabilitation centre 5.0% 0.0%
Taken to a witch doctor
0.6%
0.0%

CHAPTER THREE: COMMUNITY VIEWS ON ALCOHOL USE

3.1. MAGNITUDE OF ALCOHOL USAGE


The magnitude of alcohol use was examined using four items – level of use, trend availability, affordability and accessibility. The results of the survey indicated a very strong consensus in the community that alcohol use is a major problem in the Province owing to its high level of usage, increasing trend and ease of availability, affordability and accessibility.

3.1.1. Level of Alcohol Usage
The level of usage was examined with the question: How would you describe alcohol consumption in this area? The suggested responses were “very high”, “high”, “moderate”, “low”, “very low” and “don’t know”. About two-thirds (exact, 65.4%) of community members reported that alcohol consumption in their areas was high or very high (Table 3). Across the districts the level of usage, based on the response “high” and “very high”, ranged from a low of 51.5% for Nyandarua to a high of 75.4% for Kirinyaga. The perceived high level of usage vindicates the current public and policy makers’ concern of high alcohol use in the province. Only a paltry 0.3% of the population did not know the level of alcohol use in their areas reflecting both awareness of, and exposure to, the behavior. This implies that some people will be attracted to alcohol through the need for experimentation or peer pressure while others will be dissuaded from it by observing the harmful effects it may have on some people. This presents an opportunity for agencies interested in prevention of alcohol abuse as there are enough cases to learn from.

Table 3: Community Perception of level of Alcohol usage by Districts

3.1.2. Trend of Alcohol Usage
The trend of alcohol usage was examined by asking respondents their views on whether the alcohol usage, disaggregating for the first generation, second generation, traditional liquor and chang’aa, was increasing, decreasing or constant in their own areas. A significant majority of 81.4% felt that the second generation was increasing compared to 11.4% and 5.3% who felt it was decreasing or constant (Figure 1). Over half (58.6%) of the respondents felt that the first generation alcohol was decreasing. More people felt that traditional liquor and chang’aa usage was more of constant than increasing or decreasing. This indicates that the main competition is between the first and second generation types of alcohol, with the newly introduced second generation eating into the market of the traditional first generation alcohol.
The results also showed that more people did not know about the trend of traditional liquor and chang’aa compared to the first and second generation types reflecting, partly, their actual infrequency or lack of knowledge which is possible because their illegality means they are processed, marketed and consumed with some secrecy.
Thika had the highest proportion of people (33.9%) who felt that the use chang’aa was increasing, which seem to imply that where the second generation alcohol has not taken stronghold then the equally potent chang’aa will take its place. Across the districts, another important finding is the large number of people in Nyandarua who didn’t know the trend in the usage of traditional liquor (73.7%) and chang’aa (70.6%). Nyandarua also had the highest of those who didn’t know the trend of first generation alcohol use. This raises the question whether the lack of knowledge is true – meaning that, for instance chang’aa and traditional liquor are infrequent, or whether it is fear of law.

3.1.3. Availability, Affordability and Accessibility of Alcohol
The survey showed that the second generation alcohol was the most available, affordable and accessible type of alcohol in the province (Figures 2, 3 and 4). Nearly 90% of the respondents reported that this type of alcohol was available (both easily available and moderately available), 91.2% felt it was affordable (both very affordable and affordable) and two-thirds felt that it was accessible (both very many and many selling places). Only a paltry 2.8% reported lack of knowledge of its availability. On the other hand, chang’aa and traditional liquor were reported to be the least available and accessible types of alcohol. Nonetheless, it is an important note that one-quarter of the respondents reported knowledge of chang’aa selling places, despite its illegal status at the time of the survey. This in part reflects ineffective legal enforcement against the brew.

3.1.4. Alcohol Drinking Times
The survey also examined community views on alcohol drinking periods of the day in their own areas using the question: Are you like to see people drinking in this area in the following hours: “before noon”, “12.00 noon to 12.00 pm”, “12.00 pm – 11.00 pm” and “Past 11.00 pm”. The expected responses were “yes”, “no” and “don’t know”. Alcohol drinking times is an important indicator of the alcohol problem since usage during day time/working hours would generally occur at the expense of engaging in social and/or economic productive activity. Likewise, late night drinking compromises sleep or rest time meaning that the individual may not be very productive in the following day.
It is therefore a serious indictment of the Province that nearly 60% of the respondents reported that in their areas there is alcohol consumption before noon, apparently the most productive hours of the day (Figure 5). A significant majority also reported occurrence of alcohol consumption between 12.00 noon and 6.00 pm (80.6%) and past 11 pm (55.9%). These results while showing the magnitude of the problem are also an indictment of law enforcement since bars – where most of the drinking occurs – are generally and especially in rural areas prohibited from operating before noon, 2.00 pm to 5.00 pm and past 11.00 pm.
6 Although the two slum areas were selected as part of the Enumeration Areas for the survey, the data collectors were unable to access them for security reasons. Certainly an investigation touching on the illicit chang’aa would not go well with its marketers and consumers.

3.1.5. Alcohol Consumption by Age and Gender Groups
The community view of the prevalence of alcohol consumption among age and gender groups was measured using the question, “how would you describe alcohol consumption among… (Males/females of various age groups) The expected responses were “very high”, “high”, “low”, and “very low”. Alcohol problem among any age and gender group would be of great concern but it is the consumption among children and the youth – the group with the greatest potential from socioeconomic productivity – that raises the most concern. The survey revealed that while there is variability in which age and gender group is affected by alcohol, each group has an issue which ultimately needs to be addressed. To begin with, a number of respondents reported “high” (combining very high and high) existence of alcohol consumption among under age – those aged under 18 years which is the minimum legal age for alcohol consumption – males (25.6%) and females (5.8%)

TO BE CONTINUED.....

CHAPTER TWO: METHODOLOGY

The overall design of the study was a cross-sectional survey of patterns of alcohol abuse in terms of frequency, risk and protective factors and impacts. This necessitates examination of self-reported use and abuse in the general population and among users, as well as examination of their views and those of key stakeholders including users significant others, government officials, civil society, faith based organization, business community among others. The study was conducted through the following methods and tools:

2.1. HOUSEHOLD SURVEY

2.1.1. Survey coverage
The target population for the study was all adults aged 15 – 64 years. The survey covered all the 7 districts (as of 1999 Census) in Central province ; Kiambu, Kirinyaga, Muranga, Nyandarua, Nyeri, Thika and Maragua (as at now Central province is divided into several other districts but there is no complete information, since 2009 census results have not been released)3. The survey disaggregated for rural and urban areas of the province.
2.1.2. Sampling methodology
A two stage cluster sample design was adopted. The first stage involved selection of EAs using Probability Proportional to Size (PPS) and the second was random selection of households.
2.1.3. Sampling Frame
The sampling frame for the study was the EAs from 1999 census and stratified according to district and urban/rural classification.
3 In addition, the new constitution of 2010 has abolished and replaced the districts with counties. The province has now five counties namely Kiambu, Muranga, Nyeri, Kirinyaga, and Nyandarua. However, the specific boundaries have not yet been specified. This implies that although the counties would be suitable context for presentation of the current survey, it is not possible to do so given that the survey was designed in the context of the seven districts existing as of 1999.

2.1.4. Sample Size and Allocation
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. Given that the Kenyan population distribution is 80% rural and 20% urban, the number of households to be selected from the various districts as in Table 2.
Table 1: Sample Allocation Dist Code District 1999 Census HH Estimated Sample (HH) Estimated EAs Rural EAs Urban EAs Total EAs Final Adjusted Sample (HH)

Table 2: Selection of Households Dist Code District Rural Number of households Urban number of households Total

2.1.5. Sampling of Eligible Respondents
Upon entry into a household the head of that household or in event of his/her absence any responsible member of that household (i.e., aged between 18 – 64 years and mentally aware) was selected to provide general household information. Such information included the identity of household members in terms of age, gender, occupation etc. and the general socioeconomic indicators such as property/assets owned, types of income generating activities, expenditure etc.
Out of all the members of the household, one of them aged 15 - 64 years was selected randomly to provide information on their own alcohol use or abstinence and related risk and/or preventive and impacts. The only exclusion criteria were mental or physical illness that would render such respondent unreliable or distressed from the interview.

2.1.6. Data Collection Methods
Face to face interviews with the aid of questionnaires was conducted among the household level respondents to identify the prevalence of alcohol use and abuse and quantifiable impacts (e.g., deaths) and identify perceptions on risk and protective factors.

2.1.7. Methods of Data Analysis
Quantitative data were summarized, organized and presented through graphics including pie-charts, histograms and frequency tables through SPSS.

2.1.8. Expected Outputs, Outcomes and Impact
The major output of the study is a report detailing:
1. Key evidence in terms of findings, conclusions, recommendations and other relevant information emerging,
2. A review on how alcohol abuse has been mainstreamed in the public policy and make proposals for further mainstreaming,
3. Specific recommendations feasible interventions relevant for internal and external mainstreaming of alcohol abuse which may be translated into programmes.

The major expected outcome is improved policy formulation, planning and programming towards evidence-based alcohol abuse interventions in Central Province and in Kenya. A related outcome is improved networking among various actors involved.
The major expected impact is ensuring that alcohol abuse does not compromise developmental objectives. This will be achieved by ensuring that abuse is mitigated among all but particularly among the youth.

CHAPTER ONE: INTRODUCTION

1.1. Background

The World Health Organization (WHO) estimates that there are about 2 billion (33%) people worldwide who consume alcoholic beverages and 76.3 million with diagnosable alcohol use disorders (WHO, 2004) making alcohol the most widely used and abused substance world over (Basangwa et al., 2006). The widespread use of alcohol is fuelled by ease of its production process (i.e., a plain process of fermentation achieved by yeast acting on sugar) and multiple daily usage for recreation, curative and religious purposes (Basangwa et al., 2006). Alcohol use, however, has serious health and social effects making its prevention and control a public health priority. According to WHO (2002, 2004), alcohol causes 1.8 million deaths (3.2% of total) one third (600,000) of which result from unintentional injuries. It also causes a loss of 58.3 million (4% of total) of Disability-Adjusted Life Years (DALY) of which 40% are due to neuro-psychiatric conditions.
Alcohol consumption and abuse is influenced by multiple factors including gender, family history and parental influence. Men are more likely to use alcohol with some estimates indicating a ratio of 5:1 (Emmite and Swierzewski, 2008). Men are also at higher risk of heavy drinking and intoxication (Gmel, Rehm, & Kuntsche, 2003) and developing alcohol use disorders (Jhingan et al., 2003). However, the number of women who drink, abuse, and become dependent on alcohol is rising.
Studies indicate that up to 25% of children with an alcoholic parent will develop alcohol abuse or dependence (Basangwa et al., 2006). The prevalence of alcoholism among individuals with alcoholic parents or siblings is two and half times that of the general population. The major familial risk factors for alcoholism include growing up with parents who are dependent on alcohol, use alcohol to cope with stress, and have coexisting psychological disorder(s). Others are family violence and having several close blood relatives who are alcohol dependent.

Some studies show that regardless of a family history of alcoholism, a lack of parental monitoring, severe and recurrent family conflict, and poor parent-child relationships can contribute to alcohol abuse in adolescents. Children with conduct disorders, poor socialization, and ineffective coping skills as well as those with little connection to parents, other family members, or school may be at an increased risk for alcohol abuse and/or dependence. Peers also influence drinking behavior. Recent studies in the USA reported that lower educational levels and unemployment do not cause higher rates of alcoholism (Emmite and Swierzewski, 2008).
Studies indicate that intoxication is the most common cause of alcohol-related problems, leading to injuries and premature deaths (Basangwa et al., 2006). In Australia alcohol intoxication is responsible for 30% of road accidents, 44% of fire injuries, 34% of falls and drowning, 16% of child abuse cases, 12% of suicides, 10% of industrial accidents and 67% of the years of life lost from drinking (Government of South Australia, 2010) over a 25% of all drug-caused deaths and five (5) per cent of deaths from all causes (Health Department of Western Australia, 1998). Alcohol also leads to criminal behaviour – in Australia over 70% of prisoners convicted of violent assaults have drunk alcohol before committing the offence and more than 40% of domestic violence incidents involve alcohol.
Alcohol contributes to short-term effects including loss of work productivity through absenteeism, lateness or leaving early, feeling sick at work, having problems with job tasks, accidents, and damage to co-worker and customer relations (Blum, Roman and Martin, 1993; Gordis, 1999; Randerson, 2007)1. This further leads to organizational constraints in form of high turn-over and subsequent recruitment, consumption of health benefits, for example, in case of illness or accidents that would result to compensation (Randerson, 2007). In the United States, alcohol and drug abuse by employees is estimated to contribute to company loss of $100 billion a year (Buddy, 2003). Furthermore, alcohol abuse among employees can threaten public safety, for instance, in the case of neglect of essential duty as health/medical care, security or

1 Employee relationships are hampered because colleagues may resent or feel they must ‘cover up’ for someone with a problem.
3 aggression among workers or with clients. Besides alcohol causes enormous psycho-social losses in terms of pain and suffering experienced by the users and their significant others as well as by the employer.

1.2. The Context


WHO normally estimates the scale of alcohol consumption on the basis of recorded alcohol data, which refers to licensed liquor and unrecorded alcohol data that refers to unlicensed liquor. The unrecorded alcohol in Kenya constitutes traditional and illegal beverages (e.g., chang’aa) that are poorly monitored for quality and strength and often contain impurities and adulterants. For instance kumi kumi is illicit liquor made from sorghum, maize or millet but contains methanol and is adulterated with car battery acid and formalin.
In Kenya only 15% of alcohol consumption is recorded and based on this measure Kenyans aged 15 years and above on average consume 1.74 liters of pure alcohol annually (WHO, 2004). This is a moderate level compared to some other African countries like Zimbabwe (5.08 litres) Tanzania (5.29 litres) and Botswana (5.38 litres). On the other hand, based on unrecorded alcohol the per capita consumption (15+) from 1995 was 5.0 litres, which compares with levels found in the high range African countries such as Swaziland (4.1 litres), Rwanda (4.3 litres), Burundi (4.7 litres), Seychelles (5.2 litres), Zimbabwe (9.0 litres) and Uganda (10.7 litres) (WHO, 2004).
Recent community studies (NACADAA, 2007, 2009a, b) indicate significant alcohol consumption in Kenya. The NACADAA (2007) countrywide survey indicated a current usage of alcohol (i.e., consumption in the last 30 days) among persons aged 15-65 years (n = 3,356) to be 14.2% with male consumption being 22.9% and female consumption being 5.9%. Other rates of consumption were: rural - 13.0%, urban - 17.7%; legal/packaged alcohol – 9.1%, traditional liquor – 5.5% and chang’aa2 – 3.8%. Disaggregating by province, the lowest use was found in North Eastern (0 %) and Western provinces (6.8%) while the other six provinces were comparable with a range of 13% - 19% (i.e., Rift Valley - 12.5%, Eastern – 14.8%, Nyanza – 17.0%, Central – 17.7%, Coast – 18.6%, Nairobi – 18.6%).

The survey also looked at lifetime usage (i.e., ever used alcohol) with the results showing 39% usage among 15 – 65 year olds (53.2% male and 25.8% female; 38.8% rural and 40.2% urban) and 8% among children aged 10 – 14 years (8.6% males, 7.1% females; 8.6% rural and 5.6% urban). The study further revealed that 2.4% of the children (10- 14 years old) had ever consumed chang’aa while 15% of 15-65 year olds had ever consumed the same highly potent illicit spirit. In terms of impact, the survey showed that 5% of alcohol users had ever sought medical treatment for alcohol related ailments.
Alcohol use has also led to so many deaths in Kenya. In this year (2010) alone, the cases of large number of people dying out of a single episode of drinking poisonous illicit liquor have occurred in Shauri Moyo and Laikipia. Other most conspicuous cases include the use of kumi kimi in November 2000 which resulted in 140 deaths and lose of sight among some users in poor Nairobi neighborhoods (Mukuru kwa Njenga and Mukuru Kaiyaba) (Mureithi, 2002; WHO, 2004). Similar incidents have also been in Muranga (Muthithi and Kabati areas), Naivasha and Machakos. This shows an urgent need to prevent and control alcohol abuse in Kenya, which however, would only be possible if such efforts were backed by scientific evidence.

1.3. Study Rationale and Objectives

The purpose of this study was to conduct a baseline survey on alcohol use in Central Province with a view to influencing prevention and control policies and other interventions. The
2 Chang’aa is an illegal alcoholic drink which is distilled from grains like maize and sorghum and sometimes adulterated with jet fuel battery acid to accelerate fermentation and make it more potent.

proposed study comes in the back of a recent fact finding study (NACADA, 2009) which explored through public forums and secondary data various manifestations of alcohol abuse in the province. The study found out that alcohol use begins early as 10 years of age with the highest use being among those aged between 15-35 years. It also established the key predisposing and protective factors as well as impacts.
The broad objective of the present study is to examine quantitatively the nature, patterns and scale of alcohol abuse in Central Province and identify appropriate prevention and control policies and interventions. The specific objectives were:

1. To ascertain the magnitude of alcohol abuse with respect to types of alcohol, and to age, gender, and other social, economic and demographic factors;
2. To identify social environmental risk and protective factors to alcohol abuse;
3. To establish the impact of alcohol abuse on health, security and socioeconomic indicators in the community;
4. To assess the influence of existing alcohol regulations, related policies and other interventions;
5. To make recommendations with regard to appropriate policies and interventions.

1.4. Scope of the study

The magnitude of alcohol abuse was established through lifetime and current amount used and frequency of abuse disaggregating for age, gender, situational factors like marital status and religion, socioeconomic status and dwelling (rural-urban; slum). Other factors were availability and accessibility of various types of alcohol, consumption hours and frequency of selling points relative to other amenities like schools, hospitals, churches, groceries, money transaction outlets etc.
The risk factors were established through examination of situational factors like unemployment, poverty, family history of alcohol use, beliefs and values, legal and regulatory provisions and enforcement among others. The protective factors were established through examination of individual, family and community resources available including resilience and coping skills, family responsibility and values, religion, legal/regulatory provisions and Enforcement among others.
The impact of alcohol abuse were established through analysis of alcohol related mortality (death by alcohol; by alcohol related suicide, murder and accidents; related morbidity (e.g., sexual disorder, infertility, liver cirrhosis, suicide ideation, attempts and completion; disability adjusted years of life lost (e.g., contrast risk of death among alcohol users and non-using populations), reckless behavior (e.g. drunk driving, fighting, unprotected sex, prostitution). Others were economic consequences including household expenditure (compare alcohol and others including food, clothing, school fees etc), financial management (e.g., improper selling/disposing of property such as land and livestock, betting/gambling), exposure to criminal victimization (e.g., drinking in dark alleys, late at night), family stability, participation in community projects and activities (baraza, kazi kwa vijana), employability, cultural identity etc. The study also reviewed provisions and enforcement of laws and regulations with reference to liquor licensing, control of illegal alcohol etc.

Tomorrow we continue with the third edition - METHODOLOGY