By Gitonga Njeru

Philemon is just nine years old but she has been constantly sick for the last few years. She has been in and out of hospital with breathing-related complications.

“I often have headaches, feel tired, and cough a lot almost every day. I sometimes even faint when doing extra activities in school. I also feel nausea and headaches. I am taking prescribed medicine regularly,” Philemon notes.

“But after taking a short nap, I get temporary relief. I regularly get bullied in school and teased by other children because of my short height. I feel like changing to a new school but my parents are short of cash.”

Philemon has medical conditions that are related to exposure to unclean air. Some of the symptoms and conditions she experiences often vary. They are associated with the lungs, kidneys, and the liver. These symptoms include high toxicity levels and inflammation of the organs.

According to her mother, Frieda Nyarangi, Philemon has also developed stunted growth as her health continues to worsen.

The average height for a nine-year-old girl is 48 inches or 122 centimeters. However, she has not shown signs of physical growth since the age of six. She is currently only 43 inches and only 18 kilograms. Her weight is way below what is recommended by the World Health Organization(WHO) of 28.12 kilograms.

Nyarangi has for a long time been unaware of the health problems of her children. She has been using firewood and charcoal to cook her food, mostly on a cooking stove that causes a lot of smoke.

Although she has recently switched to cooking using gas which is far less harmful, it has not undone the effect of the former cooking stove on her children.

While there are smokeless and clean cookstoves available, the most commonly used cookstoves in Nairobi produce plumes of smoke that contain carbon monoxide formaldehyde which is toxic to humans.

Immediate fatalities have been known to occur when doors and windows are closed with little or no ventilation.

As a parent, Nyarangi has done her best to raise her children in a happy and safe environment. However, the effects of indoor air pollution on her children have taken a huge burden on her, both psychologically and financially.

Most of her income now goes to purchasing drugs and other medical-related expenses.

Freida is only 29 years old and her children are three and nine years respectively. She sells part of the food she cooks to add to the family income and uses the leftovers to feed her family.

She lives in an area called Baba Ndogo, a poor neighborhood on the outskirts of the Kenyan capital of Nairobi.

The area has poor infrastructure that also includes little or no clean piped water, poor roads, and unsanitary conditions such as unsecured garbage dumpsites.

Her fellow residents burn the uncollected garbage, increasing public health risks associated with air pollution caused by greenhouse gases and the substances they burn.

Nyarangi says that both her children are often in and out of hospital.

“My husband is a casual worker and only survives on short contractual jobs. Every time we visit a doctor, he tells us that my children have developed stunted growth and their nervous system has been affected,” Nyarangi says, adding that doctors confirmed to her that chemicals such as carbon monoxide formaldehyde and other indoor pollutants have contributed negatively to the problem.

Apart from physical development challenges, her children have also been diagnosed with slow cognitive development over the years.

She notes that she has taken them to see different specialized doctors but some advanced diagnostic kits and equipment can only be found in India.

“I plan to do some fundraising as hospital costs are estimated to be expensive abroad. I have incurred about 1.4 million so far in four years and I am in need of more money for more medical needs for my children. You have to budget for further diagnosis and specialized treatment. But you also have to include the costs of living while in India”, says Nyarangi.

She confirms that her children often experience flu-like symptoms such as coughing, wheezing, sneezing, and sometimes difficulty breathing. The symptoms are seasonal but they last longer than the average cold. They often last six weeks. She has reduced the use of firewood for cooking. A lot of her expenses have been paid for by well-wishers and a few relatives.

Dr. Gacheri Nyamu, a pediatrician working in Nairobi, says that air pollution affects children more than adults.  “Their immunity is not as strong as that of adults,” Dr. Nyamu notes.

She says that the data kept in her facility has left strong evidence between air pollution and stunted growth in children.

“Some of the physical and cognitive challenges start during pregnancy and are evident during the perinatal and neonatal stages of life. But they begin to reflect clearly during the later stages of childhood between the ages of two years to an average of eleven years old. Air pollution is real and we have to put preventive other than curative measures”, says Dr. Nyamu.

A week hardly passes by without having at least five cases of children who have health complications associated with air pollution.

She says that more research needs to be done on air pollution and the pituitary gland hormone which is responsible for the physical height increase in children.

“The pituitary is a great source of plasma but the effects on the brain are not known much. Pollutants affect physical growth and sleep is interrupted, obviously affecting the brain. More research needs to be done. There is, however, very strong evidence that air pollutants affect physical growth”, says Dr. Nyamu.

Some of the chemicals found in the bloodstream and other internal organs include carbon monoxide formaldehyde. These chemicals were found in different blood tests conducted including a liver function test.

“This is the most common chemical found in the bloodstream of children. Most households in Nairobi cannot afford safe cooking gas as they are expensive.

“Carbon monoxide poisoning is fatal. Very fatal within a very short time in some incidences if ignored. When it builds up in the blood, the body replaces the oxygen available in the red blood cells. It often leads to damage to the internal organs including the kidneys and lungs”, says Dr. Nyamu, adding that carbon monoxide formaldehyde has no smell.

She continues: “Also using charcoal stoves indoors behind closed doors and windows is dangerous. Some households keep themselves warm overnight under burning charcoal stoves. That is dangerous and should be prohibited.”

The cases are rising in Kenya and can be attributed to rapid urbanization.

“There is very strong evidence that air pollution is killing children. There is also strong evidence that mostly, indoor air pollution is stunting the growth of children, both physically and cognitively”, she says.

According to Dr. Nyamu, other household pollutants that are found in the bloodstream of Kenyan children include asbestos, carpet cleaning items, cockroaches, and building and plant products.

“These pollutants are a public health hazard. They have stunted the growth of many children. But the worst part is that many children have lost their lives”, she says.

But typical pollutants such as combustion byproducts including carbon monoxide and tobacco smoke should be a cause of concern for policy makers.

“Nitrogen dioxide and cookstoves should be avoided and especially in the case of pregnant and lactating women. The stunted growth cases I receive are from these pollutants. Lead is probably the worst health threat to children”, says Dr. Nyamu.

She says that carbon monoxide traps haemoglobin in the blood. This reduces the ability of blood to carry oxygen to major organs of the body. This results in many health conditions including stunted physical growth.

Though there are no exact figures, Kenya has at least 207 registered pediatricians as per WHO data. Most go to foreign countries to seek bigger opportunities as they are poorly renumerated locally.

The United Nations (UN) health watchdog notes that the ratio is one pediatrician to 84,000 children. But, the WHO recommends a ratio of one for every 15,000 children.

“Many opt to go abroad for advanced treatment. Some cases are extremely expensive and the diagnosis stage is very costly. Also, there is not enough equipment to test for pollutants in the blood.

“For example, a lead test costs anywhere between Kshs.115,000 ($800) to about Kshs.173,000 ($1,200) depending on the toxicity levels and medical facility,” says Dr. Phillip Onyango, a pediatrician working in Nairobi.

These tests are cheaper for children but the costs are much higher for adults. The treatment costs are even more expensive as it involves removing the pollutants from the blood and internal organs.

He says that lead can be transmitted through the air in small particles but also from the soil and combustion fuels such as fossil diesel.

If lead levels in the blood are high, doctors recommend retesting in one month.

“Children develop Chronic Kidney Disease (CKD) and different forms of oxygen therapy are administered to them in cases of carbon monoxide poisoning. Doctors do this to try and avoid permanent organ damage that can result in eventual transplant or dialysis”, adds Dr. Onyango.

A number of complicated cases are referred to Kenyatta National Hospital for advanced treatment. However, due to large volumes of children with air pollution health cases, they are referred abroad to specialized physicians. Most cases are sent to India and the University of California Medical Center (UCLA) in Los Angeles, USA.

Kenyatta National Hospital deals with these cases countrywide. It has a special unit called the Department of Occupational Health. All referrals are sent to this facility which is Eastern Africa’s largest referral Hospital.

All of the country’s health data on pediatric health is kept in this facility, in addition to those from other countries within the region.

It is also one of the very few facilities that also performs repeat lead tests on children.

In children between one to three years, testing is recommended twice a year. Regular tests become more relevant and common as they get older.

“Health challenges associated with air pollution is a serious concern in children. In the Department of Occupational Health, we deal with all kinds of cases. All the way from pregnancy to later stages of childhood after birth,” says Professor Machoki M”Munya from the University of Nairobi, Faculty of Health Sciences.

“In carbon monoxide poisoning, most children test for chronic exposure. Usually over seven cubic milligrams is dangerous and eventually fatal. The interesting part is that most children do not experience any symptoms. The health implications just set in such as stunted growth.”

He confirmed that the hospital department which he is a board member will soon publish findings in the British Medical Journal.

“About 3,5 milligrams (g/dL) of lead in the blood can cause renal failure in adolescents and slow physical growth or even no growth at all. This is what is referred to as the chronic stage. Even in the early stages, there is stunted growth. Lead poisoning has no symptoms and so it is difficult to detect. Children are more vulnerable than adults.

“Air pollution is killing Kenyan children, about 4,124 as of 2022. This year, the numbers continue to rise. We are also dealing with referrals from as far as D.R Congo”, says Professor M’Munya.

He says that 22 percent of the cases they receive at Kenyatta National Hospital on children, is stunted growth related to air pollution substances. Sixty percent of the total cases are from Nairobi.

Sammy Simiyu sits on the Health Committee of Nairobi County. He says that air pollution is a serious issue in Nairobi especially as the city continues to urbanize.

“About 5,000 Kenyan children died from air pollution in 2019 according to Global Health. This is close to 25 percent of the 22,000 total deaths,” Simiyu says.

Professor Paul Njogu teaches analytical Chemistry at the Jomo Kenyatta University of Agriculture and Technology.

He predicts based on studies that air pollution is set to get worse in the coming years. This is partly due to poor policy in the country to control and regulate air pollution.

“Black carbon is a greenhouse substance and it should be a major concern for the country. It is produced when fossil fuels are burned. It contributes greatly to indoor air pollution from cooking stoves and burning wood. It has health implications”, says Professor Njogu.

The County government of Nairobi is planning to introduce clean cooking stoves at designated public cooking places such as kiosks. According to Simiyu, this will help curb the problem.

“We plan to introduce affordable clean cooking stoves to different eating outlets in the coming months. We have set about $5 million for the initiative”, he says.

This story was made possible with a grant from The Earth Journalism Network (EJN).