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.
26
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).
29
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)
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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%