OPINION: How long can our biggest killer be denied as a health issue?

Preventing the loss of lives to respiratory diseases is a goal within Kenya’s grasp. Yet it will require a shift in attention that is currently eluding us – at a huge cost in unnecessary deaths.

The biggest killer of our babies and young children, today, is the smoke caused by cooking with firewood and charcoal inside the home.

However, we are currently chasing goals to reduce childhood morbidity and mortality as if we genuinely did not have access to data showing what is killing our under-fives. The result is a woeful lag in our ability to keep our newborns and young children alive.

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As it is, the current goals for reducing the under-five child mortality rate were set in 2015 as part of the Millennial Development Goals (MDGs).

By then, Rwanda had achieved the continent’s highest annual reductions in under-five mortality rate, saving the lives of more than 590,000 children.

Kenya had also made progress, according to its Millennial Goal Status report, reducing infant mortality rates from 77 to 52 per 1,000 lives by 2009, and under-five mortality from 115 to 74 per 1,000 lives.

This represented considerable progress, but remained far below the 2015 MDGs targets of 26/1,000 for infant mortality rate and 33/1,000 for under-five mortality. However, the aim of the new targets was to end preventable child deaths from pneumonia and diarrhea by 2025, in line with the integrated Global Action Plan for pneumonia and diarrhea.

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Instead, pneumonia remains Kenya’s largest killer of infants, ahead of malaria, diarrhea, poor nutrition, and lack of vaccinations, with one in three childhood deaths caused by pneumonia, followed by malaria.

In fact, if Kenya is to achieve any serious progress in reducing pneumonia deaths in its under-fives – to a targeted 3 per 1000 lives – it needs to start addressing the cause of so many deaths.

The new government report, the Kenya Household Cooking Sector Study, which was launched at the Clean Cooking Forum this November, indicates that more than 50 Kenyans die every day from cooking with traditional fuels.

The study was jointly commissioned by the Clean Cooking Association of Kenya and the Kenya Ministry of Energy and supported by the Netherlands Development Organization and the Netherlands Enterprise Agency.

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It adds to a growing body of research showing that indoor air pollution caused by traditional cooking fuels is driving the respiratory morbidity and mortality of an estimated 21,600 Kenyans a year, with 40 per cent being young children and infants.

Continuous exposure to the pollutants released by these fuels is equivalent to smoking 400 cigarettes an hour, with young children particularly susceptible to the consequent lung damage.

Yet, the government of Kenya spends millions each year tackling preventable diseases while doing literally nothing to address the killing going on in Kenyan kitchens – with around 90 per cent of rural households still relying on firewood for cooking and heating, while more than 80 per cent of urban households continue to use charcoal.

To whit, of the Sh18.3bn allocated to the Ministry of Health towards the Big Four Agenda of Universal Healthcare Coverage, Sh2.17bn was for the preventive Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) programme to reduce morbidity and mortality due to preventable causes.

Such preventable, non-communicable diseases account for 50 per cent of hospital admissions and 55 per cent of hospital deaths. Yet not one shilling was spent in stopping home cooking with smoking fuels, despite it being the single biggest cause of the death pile-up.

Indeed, the Health Ministry was notably absent from the Clean Cooking Forum 2019 itself, which brought together over 550 people from 50 countries. Yet, according to the Global Burden of Disease 2010 report, four million people die prematurely each year in Sub-Saharan Africa from illness attributable directly and indirectly to indoor air pollution due to solid fuel.

Of these deaths, 500,000 are caused by the effects of secondhand cooking smoke that wafts up the chimney and out the doors, and another 500,000 is attributed to child pneumonia.

Indoor air pollution has also been associated with chronic bronchitis, chronic obstructive pulmonary disease, lung cancer, acute lower respiratory infections, and low birth weights.

A 2014 study in Ghana on pregnant women even found that the use of clean fuel before the third trimester of pregnancy led to a significant increase in average birth weight, and a reduction in severe pneumonia in children within the first year of life.

As it is, the government is trying in other arms of executive management to move the nation to clean fuels, and notably to LPG for these reasons. But Kenya’s LPG consumption still stands at just two kilos per capita, where consumption in Ghana, South Africa, and Senegal is running at five, six and 10 kilos per person. And the country’s health system is nowhere in addressing the cooking fuel scourge.

A key factor in this remains the lack of understanding by many mothers that indoor cooking with solid fuels is a killer, putting their families and children at the highest possible risk. Many literally have no idea of the danger.

Thus, while primary healthcare budgets can be spent on health appointments and tests, simply informing the public at every clinic and in every contact that indoor fires kill could go a long way to saving our newborns and young children from respiratory destruction.

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