Drug Abuse in the Global Village
Drug Abuse in Africa
Kenya

                                    EXTENT, PATTERNS AND TRENDS IN DRUG ABUSE

Extent of Drug Abuse

According to a 1994 rapid assessment, alcohol, tobacco, cannabis, khat, amphetamines and other prescription drugs as the main drugs of abuse in Kenya. Abuse of heroin, cocaine, methaqualone and solvents is also reported, but to a lesser extent. In general, drug abuse is not considered a major problem (Mwenesi Abdullah Halima 1995).

            During the 1994 rapid assessment, 383 drug abusers were interviewed, using a non-random snowball sample. The incidence of drug abuse reported, by type, is as follows:
cannabis (420) (the number exceeds 383 due to aggregation of different types of cannabis abused), tobacco (300), alcohol (200), solvents (100), khat (24), heroin (19), cocaine (19, methaqualone (7). Abusers report that they use drugs to cope with problems (350), to feel good (300), to overcome boredom (200), to gain courage (200) and to "belong" (152). (Mwenesi Abdullah Halima 1995).

            In a 1990 study conducted among 306 drug abusers in treatment in psychiatric treatment, 46.7 per cent reported that the primary substance of abuse is alcohol, followed by tobacco (35.3 per cent), "local herbs" 17.3 per cent and heroin 0.7 per cent. Most of the drug abusers in the study reported abusing more than one drug. Further, about 4 per cent reported using drugs only once in their lifetime, 44.7 per cent use drugs from time to time, 17.3 per cent abuse drugs daily and 34 per cent several times a day. It was also reported that about 50 per cent of the drug abusers in treatment considered themselves drug dependent, while another 34.8 per cent considered their drug consumption abusive (Facy F. and Delile J.M. 1990).

            According to a 1982 study among 249 high school students and 138 parents and teachers, in the districts of Kajiado, Kiambu, Kisumu, Kakamega and Kericho, students consumed alcohol at least three time per week (32,4%), smoked cigarettes (20.6%) occasionally chewed khat (1.9%) and 2 per cent tried cannabis. The pattern of drug consumption by parents and teachers is identical to that of the students  (Wasunna and Wasunna 1973 in Acuda, S.W. and Yambo, M. 1983).

            Findings from a 1990 survey among 4200 students in Western Kenya suggest that use of drugs "ever in one's lifetime" is low (table 1).
                                                                               Table 1
"Ever use" of drugs among students in Western Kenya, age 14-26, in 1990

* Without Medical Advice
Sample:            4200 in 19 schools, of which 5 were females schools.
Source: Survey report, drug use in secondary schools in Western Kenya, 1990.

            However, other sources of information have indicated that drug abuse may be more prevalent in some part of Kenya. Data in table 2 suggest much higher drug abuse in the Coastal rural and urban area, Kimusy, Busia, as well as in Nairobi and other areas. However, the reliability of the information could not be assessed.

                                                                               Table 2
Drug abuse among youth in Kenya in 1989 by type and region in percentages.
----------------------------------------------------------------------------------------------------------------------------------------------------------
                                                Coast                                                                          Other including
                                                                                                                                    Nairobi
                                    ---------------------------------------------------------------------------------------------------------------------------
                                    Urban       Rural                 Kisumu       Busia                        Urban              Urban  Rural
                                                                                                                                                perip-
                                                                                                                                                hery
----------------------------------------------------------------------------------------------------------------------------------------------------------
Cannabis
More than once
 a week                             28.9            6.7                   59.4        19.1                      13.0          23.3     4.1

Khat
More than three
 times per week                 23.7            7.6                   20.8        48.2                      -               -                       -

Cocaine
Ever use                            11.1            8.2                   9.4          8.8                        -               -                       -

Amphetamines
Use without
 prescription                      2.6              -                       -             -                           -               -                       -

Tranquilizers
Use without
 prescription                      7.1              0.3                   -             -                           -               -                       -

Any drug to
 get high                            1.7              3                      11.0        11.8                      13.5          26.0     11.0
----------------------------------------------------------------------------------------------------------------------------------------------------------
Source: Dr. Baya Kijana, "Drug Abuse - A Challenge" in Preventive Education against Drug Abuse, Ministry of Health, 1991.

            According to a study on khat, conducted in Garissa, in the North Eastern Province in 1983, among key informants (20), Households (150) and retailers (30), earnings from khat has been on steady increase and were close to overtaking livestock earnings.  Khat sales and chewing were a very widespread activity and in evidence all around town. Among khat chewers in Garissa, 45 per cent were daily chewers and 32% chewed two to four a week. Most chewers chew four or more hours per day. Chewing Khat was associated with pass time rather than productive activities (Haji A.R.J.1983).
 
            Selected diverted prescription drugs are sold without prescription in bus stations and open air markets, among other crowded public areas. The drugs are used for self medication, which is considered a cheaper alternative to costly and overcrowded medical services (Wasunna and Wasunna 1973 in Acuda, S.W. and Yambo, M. 1983).

Abuser Characteristics

According to the 1994 rapid assessment, most abusers are males, aged from 6 to 90 years old, with the majority between 11 and 39 years. About 123 were unemployed and 100 homeless. Another 58 were serving a prison term when interviewed (Mwenesi Abdullah Halima 1995).

            According to a 1990 study conducted among 306 drug abusers in treatment in psychiatric treatment, 60 per cent were 19 years old or younger, 33.1 per cent between 20 and 24 years of age, 4.8 per cent between 25 and 30 years old and 2.1 per cent over 30 years old (Facy F. and Delile J.M. 1990).

            Male students tend to use non medical drugs while female students use prescription and over the counter drugs (Wasunna and Wassuna 1973 in Acuda, S.W. and Yambo, M. 1983).

            The expansion of drug abuse is attributed to the transformation of the Kenyan society due to the impact of colonial rule, i.e., urbanization, weakening of traditional family ties and increasing individualism (Mwenesi Abdullah Halima 1995).

            In Western Kenya, a 1990 study among students aged 10 through 24, suggest that drug abuse is low, even among high risk groups aged 15 to 24 (table 3).
 
                                                                               Table 3
"Ever Use" of drugs among students in Western Kenya, by age and type of drug, in 1990.

Source: Survey report, drug use in secondary schools in Western Kenya, 1990.

            Khat abuse is common among all groups but more pronounced among males (89.4%) compared to 10.6 percent among females, those aged 21 to 30 years (56.9%) and 31 to 40 years old (23.6%). The majority (70%) of khat chewers had secondary education and held medium level jobs (48.8%). The lower level of khat chewing among women is attributed to strong norms against women who chew the drug (Haji A.R.J.1983).

                                                                     Regional Variations

Heroin and cocaine are abused mainly in urban centres. Cannabis is abused in the coastal region. Hallucinogen abuse is reported in the main cities. Methaqualone and tranquilizers are abused in most regions (Mwenesi Abdullah Halima 1995).

            Khat is used to varying degrees in Kenya, but its abuse is concentrated in the North Eastern and Coast provinces, especially among the Muslim population (Haji A.R.J.1983).
Trends

Community concern is increasing in relation to the abuse of heroin, cocaine, methaqualone and solvents. However, drug abuse is not considered a major problem (Mwenesi Abdullah Halima 1995).

Mode of Intake

According to a 1994 rapid assessment, health workers reported that injecting drugs is not popular among drug abusers, although it was observed among heroin abusers. Some of the injecting abusers are hospital workers who abuse morphine and other prescription drugs. Injecting in the tongue and legs is reported. Needles and syringes are readily available from pharmacies but shared use is reported among one third of those who inject. Health worker also report that they could not attribute detected HIV cases to drug injecting (Mwenesi Abdullah Halima 1995).

            Khat appears to be a gateway drug to tranquilizers, which are used to reduce khat caused insomnia, as well as, amphetamines for additional stimulus and to cough syrups containing codeine to reduce pain and induce drowsiness (Mwenesi Abdullah Halima 1995).

COSTS AND CONSEQUENCES OF ABUSE

According to a 1994 rapid assessment, abusers reported strained relations with family and friends and family break up (200 out of 383), decline or failure in school, loss of employment (52 out of 383), medical complications and legal problems (about 191 out 383) (Mwenesi Abdullah Halima 1995).

            According to a 1990 study conducted among 306 drug abusers in treatment in psychiatric treatment, 13.8 per cent reported having been incarcerated, 5.2 per cent attempted suicide before commencing drug abuse and 5.6 per cent, in conjunction with drug abuse. Further, 32.2 per cent reported psychiatric hospitalization before using drugs and 33.6 per cent in association with drug abuse (Facy F. and Delile J.M. 1990).

            Among khat chewers, a large proportion of the income is spent on khat and the divorce rate is higher that among other groups. Further, khat abuse is associated with problems which lead to divorce, insomnia, poor health, bad teeth, anorexia, poor work performance and absenteeism and sexual permissiveness (Haji A.R.J.1983).

NATIONAL RESPONSES TO DRUG ABUSE

National Strategy

According to a 1993 report to the Demand Reduction Forum held in Nairobi, there is no national body responsible for the coordination of a national drug strategy. However, the development of a national drug policy and the formation of a multi-disciplinary task force are planned in relation to legislation awaiting ratification by the parliament (Baya, C.K. 1993).

            Notwithstanding the above, existing supply and demand reduction programmes are managed by law enforcement and the Ministry of Health independently. In the area of demand reduction, programmes are centrally coordinated by the Preventive Health Education Against Drug Abuse unit in the Ministry of Health (Baya, C.K. 1993).

  ACTIONS TAKEN TO IMPLEMENT THE INTERNATIONAL DRUG CONTROL TREATIES**

                                                                      Treaty Adherence

Kenya is party to the 1961 Convention as amended by the 1972 Protocol and the 1988 Convention.

            Legislative and administrative measures for the control of psychotropic substances are limited and not enforced effectively. Under these circumstances and given the reports that licit drugs are traded in market places without prescription, diversion of licit drugs from the pharmaceutical industry is likely (INCB 1992; Wasunna and Wasunna 1973 in Acuda, S.W. and Yambo, M. 1983).

                                                    DEMAND REDUCTION ACTIVITIES

Primary Prevention

According to a 1994 rapid assessment, representatives of education authorities reported that they do not have clear policies as to how to deal with drug abusers within the educational system, except by dismissing them from their institutions. Most report being constrained by lack of information, training and funds (Mwenesi Abdullah Halima 1995).

            Some aspects of drug education are covered in subjects such as Home Education (Dullin Eberhard 1994).

            Further, there is evidence that some health NGOs are involved in prevention activities (Preventive Health Education Against Drug Abuse Programme, Undated).

Treatment and Rehabilitation

According to a 1994 rapid assessment, treatment is offered by social and health services practitioners within the framework of existing general health services. In general, it is considered inadequate.  Most clients in treatment are alcohol dependent, 43 out of 97 were admitted to treatment involuntarily by relatives, police, NGOs courts or community or provincial officials. Treatment is funded by the government in most cases (66%), but funds are limited. Some treatment services are free but others are based on a fee for service basis and paid for by the client in need of treatment. Counselling appears to be the most frequent treatment, but it is lacking due to lack of privacy during counselling. "Detoxification" is provided to 21 out of 50 clients. The use of methadone is rare. Further, representatives of prison authorities acknowledge that not much is done in prisons to treat drug dependent inmates (Mwenesi Abdullah Halima 1995).

References and Notes

The reliability of the information in this report is subject to high variability. However, the information reviewed suggests that Kenya does have qualified researchers and practitioners in relevant social and health services, who could assist UNDCP in improving the current assessment of the drug situation, as well as contribute to the development of a comprehensive and balanced drug strategy in Kenya.

Baya, C.K. 1993 "Kenya: Country Drug Profile" presented at the Demand Reduction Forum for the East and Southern Africa sub region, November 1993, Nairobi, Kenya.

Dullin Eberhard 1994 "Curriculum Development for the Drug Preventive Education in East and Southern Africa" report submitted to UNDCP, Nairobi, Kenya

Facy F. and Delile J.M. 1990.  "Toxicomanes pris en charge en Afrique: enquךte epidemiologique, rיsultats provisoires".  Resultats provisoires Juin 1990.

Haji A.R.J. 1983 "A Brief Summary of the Objectives, the methodology and Findings of the Study on the Socio-Economic Aspects of Khat use and Abuse in Garissa Town, Kenya", Department of Sociology, University of Nairobi.

INCB 1992 "Report of Discussions with the Authorities of Kenya" E/INCB/1992/CRP.12

Mwenesi Abdullah Halima 1995 Rapid Assessment of the Drug Abuse in Kenya: A National Report. Prepared for UNDCP.

Preventive Health Education Against Drug Abuse Programme, Undated, "What Every Parent Ought to Know About Drugs" Leaflet.

Wasunna and Wasunna 1973 in Acuda, S.W. and Yambo, M. 1983 "The Epidemiology of drug Abuse in Kenya: A National Baseline Survey". University of Nairobi, November 1993.

Notes:
** The Legal, Administrative and Other Action Taken to Implement the International Drug Control Treaties section was prepared by the Secretariat of the Commission on Narcotic Drugs.  No completed annual reports questionnaires have been received from Kenya since 1986.