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ITDG smoke and health project, Kenya
[top] [end]1.0 project description[top] [end]1.1 locationThe project was located in Kenya among communities with whom ITDG had been working for several years. These are the Maasai community in the Kajiado region, located 80km south of Nairobi and the Kisii and Luhya communities in West Kenya, located in Nyamira district (60 km SSE of Kisumu) and Mumias-Butere, 40km west of Kakamega respectively. The Kajiado region covers an area of 21,105 Km2 and had a population of approximately 406,054 in 1999, based on the 1989 census results. It has a population density of about 19 people per Km2 (IEA, 2002). In Western Kenya, the Smoke project was implemented in Nyamira and Mumias-Butere districts with the Kisii and Luhya communities respectively. The two areas are different topographically since Kisii is a highland zone while Mumias is situated at a lower altitude. Nyamira had a population of approximately 498,102 people and a population density of 556 people per Km2 while Butere had a population of approximately 476,928 people and a population density of 508 people/Km2 (IEA, 2002).[top] [end]1.2 Key statisticsLocation Kajiado District, Nyamira District and Mum ias-Butere District Scale Small Budget: GBP 57,587 No. Households - current 50 (25 Kajiado 25 Nyamira) - Projected 50[top] [end]1.3 Contact detailsIntermediate Technology Development Group Eastern Africa (ITDG-EA)P.O. Box 39493 - 00623, Nairobi, Kenya AAYMCA Building, Along State House Crescent, Off State House Avenue Tel: +254 2 2713540 / 2719313 / 2719413 Fax: +254 2 2710083 E-mail: itdgEA@... Web site: www.itdg.org [top] [end]1.4 Replication potentialThe project has a high replication potential. Currently, more work is being done in Western Kenya, targeting households in a peri-urban area. A market study is also under way to establish potential for commercialisation of the smoke reducing interventions. Scaling up has also started in the East African region focusing mainly on development of appropriate interventions, based on the results of the studies done in Kenya.[top] [end]2.0 fundingThe following organisations funded the project:
The balance of 12987 pounds was funded by Emerging Markets Charity and Veta Bailey Charitable Trust [top] [end]3.0 backgroundAround 80% of people in rural sub-Saharan Africa depend on traditional biomass (wood, dung, crop residues) for domestic energy. There is mounting evidence that the resulting indoor air pollution (IAP) increases common but serious health problems, including childhood pneumonia and chronic lung disease. Previous attempts to reduce this have often failed due to lack of community involvement in developing appropriate, sustainable solutions.The ITDG Smoke Project was launched on May 6,1998. The aim of the project was to contribute to the reduction of exposure to indoor air pollution in the light of the negative health effects it produces. Working with 50 households in rural Kenyan communities, participatory technology development through participatory research methodologies enabled the project to reduce this pollution in people's kitchens. Evaluation of changes in pollution levels and community views about the process and interventions was carried out. Two study areas were chosen; Kajiado, where ITDG was involved in the Maasai Housing Project and two communities in West Kenya, where ITDG is engaged in the Stoves and Household Energy project. These two areas are different climatically and geographically as well as culturally (lifestyles, cooking habits and house types). Baseline monitoring in the kitchens in these areas showed that smoke levels were unacceptably high: in Kajiado, the 24-hour average of respirable particulates was 5526µg/m3 and in West Kenya, the levels were 1713µg/m3. If one compares these values to the EPA standards for acceptable annual levels of respirable particulates of 50µg/m3, it can be seen that the daily rates (which are comparable, in these societies to the annual rates) are over one hundred times greater in Kajiado and twenty times greater in West Kenya than the accepted values. By involving communities in areas where ITDG is well known and respected, participation and co-operation from people in monitoring the smoke levels of their houses was assured. Main objectives The main objectives of the project were twofold: to improve the quality of life, through reduction in indoor air pollution, for households in these study areas; and to develop a participatory methodology for further research into appropriate ways to alleviate indoor air pollution. [top] [end]4.0 project descriptionThe objectives of the project were to be achieved through the following activities:
These activities were carried out as follows: [top] [end]1. Household selectionThere was no shortage of people wanting to take part in the project. Using the women's groups as the basis for identifying houses proved very satisfactory. A participatory approach, which gave the responsibility of selecting households to the communities involved, meant that the majority were satisfied that the correct houses were being monitoredFor quantitative measurements of IAP in households, the levels of smoke must be measured both within the kitchen itself, and also the smoke inhaled by the person most affected - the woman of the house who does the cooking - described as 'the cook'. Since in Kajiado women moved house within the area, and cared for different numbers of children, and houses did not have any kind of recognised 'address', it was important to determine and record the name of the cook. This was done to ensure that the cook was still living in the same house for each round of the study. [top] [end]2. Carrying out the baseline assessment of pollution and exposure, fuel use and house structureThe surveys set out to collect data and information on pollution and exposure, fuel use and house structure. Pollution and exposure measurement Two key components of smoke were measured; respirable particulates (PMresp ) - less than 10microns diameter, and carbon monoxide (CO). Respirable particulates were measured using an air sampler, while carbon monoxide was measured using stain tubes. These were measured for each household for a period of 24hours. However, since the monitoring was being conducted through the night as well as by day, it was important that the equipment used to measure the dose inhaled by the cook was as non-intrusive as possible. For this reason, the measured level of carbon monoxide she inhaled served as a proxy to assess the amount of particulates to which she had been exposed over this time. It was felt appropriate to adopt this method for 24hour monitoring as the CO/ PMresp relationship has been shown in earlier studies to be approximately a direct ratio (Naeher LP, Smith KR, Leaderer BP, Neufeld L, Mage D, 2001) for given physical conditions. The monitoring methodology was a compromise between obtaining sufficiently accurate results and not intruding too much on the lives of the women involved in the study. The latter aspect was vital, or the results would not reflect the usual day-to-day activities of the woman herself. For each household, two rounds of monitoring were done before, and two rounds after, interventions had been installed in the houses. The two rounds were to reflect the wet and dry seasons and their effect on the levels of indoor air pollution in the kitchen. Since many of the women sleep in the same room as the fire, this was essential to capture her full exposure to indoor air pollution during the two seasons. A specific height and distance from the fire was selected, as the spatial distribution of concentrations would otherwise affect the 'before and after' nature of the study. Readings from the CO stain tubes were recorded by the field staff directly into the questionnaires. The particulates were collected on a filter paper, which was dried and weighed using a six-point balance before and after monitoring to give the weight difference caused by the particulates. This procedure was organised by the project's scientific adviser at the University of Nairobi. By comparing the levels of particulate matter respirable (PMresp) and CO before and after particular interventions had been installed in a range of houses, it was possible to identify which interventions reduced indoor air pollution levels appreciably. A further step was to see the effect of the interventions on the indoor air pollution inhaled by the cook. The method used proved adequately sensitive to change, since the project was looking for substantial reductions in indoor air pollution, in order to impact on the quality of life of the cooks and their families. The methodology provided a reasonable balance between accuracy and the low levels of disruption to household routine needed to make the results meaningful. Equipment The equipment used in the study was chosen to measure the dose of CO and PMresp inhaled by the cook while being as non-intrusive as possible. A Buck I.H. pump sampling at 2.2 litres/minute, a Higgins-Dewell type cyclone and 35 mm glass fibre filters (Whatmann) - which conforms to BSEN-481 for inhalable thoracic response was used to measure 24 hour respirable particulates (approximate aerodynamic diameter 5 microns or less). The pumps were calibrated using a Munro RM1069 rotometer prior to each sampling period. The cyclone was placed at 4 feet above the floor of the kitchen, and 4 feet horizontally from the hearth (in Maasai kitchens it is typically difficult to exceed this distance due to the small size of the room). Due to the very high levels of pollution, filter cassettes were changed after 12 hours to avoid clogging. The equipment was designed such that, if the sampling flow rate dropped by 5% or more, the Buck pump sampler suspended air sampling, and recorded the elapsed time and volume sampled before shutting down. Carbon monoxide Carbon monoxide (CO) was measured in the kitchens using Gastec 1D (1000 ppm/hr) diffusion tubes co-located with the cyclone. In Kajiado, the high levels of indoor air pollution meant that some of the first round of monitoring was inconclusive. The solution was to change the filters and CO monitors after six hours during the day, and over twelve hours through the night. Nevertheless, the equipment became very dirty and contaminated very quickly, therefore required regular servicing. Initial charging of the monitors in Kenya proved unsatisfactory due to climatic conditions. The pumps erroneously recorded that the built-in batteries were fully charged, with consequent failure in the field. This problem is now resolved by using the car battery. Monitor height The first round of sampling was conducted with the PMresp and CO monitors set at 4ft height and 4ft distance from the fire. Following an external review which advised that monitoring at 2.5 feet would aid comparative studies with other indoor air pollution projects (4ft and 2.5ft are currently used by other practitioners), the suggestion to use 2.5ft was adopted for the second round of monitoring in West Kenya. The change only became evident to the rest of the team once the results from the monitoring came from the field. As it was not feasible to monitor every house again, a sample of kitchens was monitored at both 4ft and 2.5ft, and two-height monitoring was used in the post-intervention rounds. Fuel use and house structure Information on the quantity and type of fuel used most often by the study household was collected. With regard to household structures, excellent sketches, showing the positions of key components, such as doors, windows, stoves, both before and after the interventions were installed were provided. Key questions reflected the number of windows, eaves spaces, roofing etc. that could possibly affect the smoke levels in each house. Recording data The following tools were used to record and collect the information above:
The enumerators also recorded the number of hours spent, and the number of times that people collected fuel. This was found to be a rather broad classification, and future studies would try to calculate the total fuel used more accurately. Prior to fieldwork, the team was given training in monitoring and field techniques. The importance of the team understanding why they were making specific measurements or asking particular questions could not be overstated. The questionnaires used to collect the above information were developed in consultation with staff in the regions. The questionnaires had two roles: to provide an overview of the lifestyles of the people involved and to identify any changes that have taken place during the project. [top] [end]3. Identifying participatory ways of alleviating indoor air pollutionWomen's group discussions allowed the field team to identify possible acceptable and appropriate ways to alleviate smoke. The project team gave lead to some possible interventions that could be installed. The community were empowered to find their own solutions to their problems, which were realised through manufacture of the interventions in collaboration with the local technical college in Kajiado, and with local artisans in West Kenya- thus providing sustainable skills in the region. The commitment and enthusiasm of local field teams, working with communities who were keen to be involved throughout the process was of great value to the project.More information on the development of interventions is presented in section 4.3 on Delivery Structure [top] [end]4. Installation of InterventionsThe field teams formed the link between the communities and the whole of the project team. Belonging to, or having worked with the communities in the area meant that the team themselves had ideas which could catalyse the initial discussions on what would be appropriate. These ideas were distilled into three key interventions: ventilation by enlarging the size of windows or opening eaves spaces; adding smoke hoods over the cooking area; and thirdly the option of installing improved cook stoves.The selection and installation of interventions was vital, as a random collection of interventions, all being installed, would have prevented any kind of analysis on the impact of the interventions. This approach enabled both the communities themselves, and the wider development community, to benefit from the research. In some instances extra 'interventions' were made during the study. One or two of the households, were found to have a wood-rack Irongo blocking the smoke from leaving through the eaves spaces. In these cases, the rack was repositioned. These extra interventions were documented systematically. Installation of hood in Kajiado proved to be difficult due to their size and the geometry of the houses. Despite the hoods being in 2 parts, they still required 2 people to transport and install. Other observations made during installation included the length of time taken to install the hood and the dust and soot disturbed necessitating the use of protective clothing during installation. Installing the interventions into new buildings would be considerably easier. Post-intervention focus group meetings were used to understand the changes, which had occurred in the communities over the duration of the project in West Kenya. The post-intervention discussions included training on how to use and maintain the interventions, such as the need to open windows for them to be effective. The focus groups involved the stakeholder communities, mostly the participating women, and sometimes their husbands. These provided a forum for highlighting the effects and benefits of these activities. [top] [end]5. Training and maintenanceTraining and maintenance was mainly conducted through women's groups, and often involved other organisations, such as the representative from the Ministry of Health. Aspects of smoke alleviation were incorporated into other health messages. By using group discussion, everyone involved was able to share advice based on their own experience, thus increasing the knowledge base of the whole community.Linkages with other organisations were important as they raised the level of awareness among far wider groups than would otherwise have been the case. They also pave the way for future work in-country and in other areas within that country. A further aspect is that the project brings together practitioners from several disciplines, health, finance, energy, technology, business, and their skills can provide a holistic solution in the longer term. [top] [end]4.2 Cost of serviceDue to the economic differences in the two areas (Kajiado and West Kenya) and the level of poverty among the communities involved in the project, the financial arrangements for securing the interventions differed in each area. Kajiado suffers from severe poverty, which was exacerbated, during the project period, by a drought, which caused loss of livestock. Food aid was being sent by the government to the project families, and under these circumstances, it was agreed that there would be no costs incurred by the project families. Nevertheless, some provided assistance in installation of interventions, and some of the materials for building the interventions were purchased by the men in the community.In West Kenya, there was a cost-sharing agreement from the start. An agreement was reached with the household owners of what each would contribute towards the cost of interventions. [top] [end]4.3 Delivery structureSelection of interventions A participatory approach was adopted right from the start, using individual and group discussions with the project families, especially the women. The discussions were used to identify possible smoke-alleviation methods, which beneficiaries would find acceptable, affordable and which were felt, could be effective. This approach involved:
The role of ITDG staff was to highlight the need for smoke interventions and to provide ideas and stimulate discussion on what might be done. The community members, in their turn, generated ideas based on their knowledge of the reality of their lives, identified constraints and ensured that the final decisions were realistic and in accordance with their wishes. The information from these meetings was shared with the whole ITDG smoke team resulting in three possible types of intervention being identified: ventilation by enlarging the size of windows or opening eaves spaces; adding smoke hoods over the cooking area; and thirdly the option of installing improved cook stoves. Although women in Kajiado believed (probably correctly) that those who had raised their roof height felt that indoor air pollution had been alleviated, the project team felt that this intervention was too costly to be reproduced by large numbers of people, so it was not adopted by the project. The women themselves identified the final design and materials used for the interventions and depended on availability of materials. In this way, local skills were used and the interventions were well accepted. This should promote higher potential for future replication of the interventions in the area. [top] [end]4.4 Implementation progressThe project was successfully implemented and is now complete. Follow up projects are currently underway in Kisumu. The key impacts of the project are highlighted below.Reducing smoke The primary concern of the project was to reduce indoor air pollution. There were substantial reductions in the carbon monoxide and particulate matter levels in the sample households after the interventions were installed. The table below gives an overview of the results of the interventions on IAP reduction. Table 1: Overview of reductions in particulates and carbon monoxide resulting from implementation of interventions
Poverty impacts The project has seen the households accrue socio-economic, health, and cost benefits as a result of project activities and interventions. Whilst maintaining cultural requirements of housing design, the project has made improvements in ventilation, natural lighting, maintenance, and general comfort compared with traditional structures without interventions.
Negative Impacts
[top] [end]5.0 project management[top] [end]Kenya staffStephen Gitonga; Justin Nyaga; Hellen Owalla; Martha Mathenge; Milka Lang'at, Edward Marona, Peres Olumbo (deceased); Rose Okodo; Sharon Looremeta; Simon Ireri; Tony Katampoi Lemayian; Moses Mosiany; Vincent Okello; Amina Mateu; James Letiah; Michael Kathuri ; Joseph Gitahi, Charles Ganda and John Koite[top] [end]UK staffAlison Doig, Liz Bates[top] [end]Project advisersDr Nigel Bruce; Dr. Jacob Kithinji[top] [end]Project statisticiansRosemary Nguti, Henry Mwambi[top] [end]6.0 lessons learnt[top] [end]SocialEnd-user acceptability of project process The feedback from the community members is that the alleviation of indoor air pollution has far exceeded their expectations and a major reason for this is the participatory nature of the project. The marked decrease in smoke and increased well-being associated with this reduction were reflected in many of the formal and informal comments made to the project teams. Nevertheless, there are outstanding concerns, which need to be addressed. These include, improving privacy, which can be dealt with by ensuring that eaves spaces can be closed in inclement weather. The observations made by the community, both structured and unsolicited, were recorded by the staff in field notes from focus group discussions and individual interviews. Empowerment
Gender impact The project targets women and children but the whole family benefits. Both men and women were involved in the project at all levels.
In Kajiado, women provided labour on voluntary basis; participated in project meetings/discussions; determined the position/location of the windows and chimneys/hoods and assisted in hood design. Culturally, among the Maasai community members, it is the women who are involved in house construction. However, when the men saw the improvements and the benefits derived by their families they started helping out in the construction of interventions e.g. buying water, windows, cutting trees/twigs, mixing mud, paid for cutting of poles for repairs during window installations. They can now stay in the kitchen, a place they previously used to avoid because of indoor air pollution, and entertain their friends and take beer in the greatly improved environment. In Western Kenya, men paid for window construction and installation while others offered artisan skills. Generally, the men in this region are involved in house construction while the women are involved in house maintenance (smearing, installation of improved stoves, positioning and size of windows, eaves spaces). Spouses now spend more time in the kitchen in West Kenya, sitting by the fireplace while women work, and eating food there, provided the children are not there. Occasionally men will assist in the kitchen, which was not a characteristic phenomenon before the interventions were installed [top] [end]6.2 economicAffordability.Affordability remains a major constraint to indoor air pollution alleviation. There are positive signs that, in the case of some of those living in the nearby communities, the realisation of the benefits has made them re-evaluate the cost of the interventions. Of particular note is the interest taken by the men in the communities. They are the ones who, on the whole, are in control of household finances. On a positive note, having been involved in installing the interventions, community members are discussing interventions in terms of the comfort value of a less smoky environment. Reports from the field suggest that people are now asking how and from where they can obtain hoods and windows. Entrepreneurs to promote, manufacture and supply these interventions will form part of future work within the project areas. Funding is actively being sought to provide this next phase in scaling up. In Kajiado, the project families were not asked to contribute to the cost of the interventions. Smoke hoods, which cost the equivalent of the cost of two goats, are deemed expensive, especially if it is only the women who benefit from them. However, the men in the Maasai community are expressing interest in the increased comfort levels in the homes with smoke hoods, and if they decide that the hoods should be installed, it is likely that this intervention will be widely adopted, since they are the ones who control most of the family income. Reducing the cost of hoods by using cheaper, but effective, materials, or seeking a subsidy, comparable to that provided for vaccination on the grounds of health, could further increase the prospects for smoke hoods. In West Kenya, households participating in the project invested in the in the interventions through paying part of the cost, reflecting their level of commitment to remove smoke from their kitchens. However, some households chose the less-costly option of eaves spaces, which though still effective, is not as effective as the smoke [top] [end]6.3 technicalTechnical problems
[top] [end]Ecological / environmentalImproved living environment and comfort
[top] [end]6.5 Implementation lessonsAs a pilot project, this work enabled the team to test the methodology and protocols and identify shortcomings and improve future studies. Implementation lessons learnt included:
[top] [end]7.0 references and documentationITDG, 2001, "Reducing indoor air pollution in rural households in Kenya: working with communities to find solutions." The ITDG Smoke and Health project: 1998-2001. Intermediate Technology Development Group.IEA, 2002, "The Little Fact Book: The Socio-Economic and Political Profiles of Kenya's Districts." Institute of Economic Affairs, Nairobi, Kenya The ITDG Smoke and Health project | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 Page created:
05 May 2005; Last edited:
05 May 2005; Version: 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pagename: ITDGSmokeAndHealthProjectKenya @HEDON: XECA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
