It all began when Elizabeth* (not real name), a four-year-old girl, moved with her family from her rural home to live in Nairobi.
A few months later, she would suffer from persistent nightly coughs occasioned by an irritable airway. Her parents took her for a medical check-up, where she was diagnosed with mild persistent asthma.
Treatment was commissioned immediately but her condition only worsened, despite being on maximal doses of medicine that she had even started reacting to with side-effects, such as jitteriness and heart palpitations.
*Elizabeth’s family lived in Industrial Area, downwind of a factory known to produce plumes of noxious smoke.
She represents over 700,000 children under 10 in Nairobi exposed to high levels of outdoor air pollution in their day-to-day lives. Fortunately for her, she was able to escape her dangerous living circumstances.
“After lengthy discussions and multiple consultations, I was able to persuade the family to seek a home in a different location away from the factory. Her recovery was dramatic and she no longer requires the chest medicines,” said Dr David Githanga, the paediatric cardiologist who treated her in Nairobi Hospital.
Unicef reports that air pollution can impact a child’s developing brain by impeding the child’s ability to develop the connections in their brain that ensure continued learning as they age.
This means that if Elizabeth was not saved in time, she was at risk of having her mental ability to grasp concepts permanently stunted. It would have also increased her susceptibility to psychological problems such as attention deficit hyperactivity disorder (ADHD), anxiety and depression, leaving her at a disadvantage compared to her peers globally.
Air pollution is associated with some of the biggest killer diseases of children under the age of five years, such as pneumonia, which, according to the Economic Survey of 2018, remains the deadliest disease in Kenya since 2015.
These and other diseases associated with air pollution such as bronchitis, asthma and other respiratory infections and diseases can be debilitating, force children to miss school, and even cause long-lasting damage to their health and wellbeing.
Dr Githanga says the situation is worse than most people are aware of. “Information collected from hospital cases have time and again shown that we have an increase in respiratory illnesses, which are largely worsened by poor air quality. Children residing near major roads with heavy vehicular air pollution are known to suffer more often from asthmatic attacks compared to those farther away,” he told the Star.
HOW BAD IS IT?
Outdoor air pollution is measured in terms of particulate matter (PM) of toxic substances in the air, such as ash, soot and fumes generated by vehicle exhausts, factories, burning firewood, among others. There are two types of PM. The larger PM10 are particles with a diameter of 10 microns (µ). This is roughly 10 times smaller than a human hair. There are also PM2.5, which are particles with a diameter of 2.5 microns (µ), 40 times smaller than a human hair. Because PM2.5 are smaller, they are more dangerous as they can penetrate deeper into the lungs.
The small size of these particles is directly linked to their potential for being a health hazard, as once they are inhaled, they can stick in the walls of the airway or worse, get deep into the lungs. Once gas exchange has occurred in the lungs, the smallest of the particles can get into the bloodstream within minutes.
Code for Africa, a people-driven movement that aims to empower active citizenry started the sensors.AFRICA project by placing 22 low-cost air quality sensors (and are set to release more) throughout Nairobi that have been collecting data on PM10 and PM2.5 levels around the clock since mid-November 2017. Some of these sensors were placed within primary schools, namely: Muthurwa Primary school, Catholic Parochial Primary School and St Scholastica Primary School.
Around the time children are making their way to school during rush hour between 5am and 9am, the data suggests PM2.5 concentrations are highest in all schools, with Muthurwa Primary and Catholic Parochial suffering the most at an average of 40 μg/m3. This can be compared to a child essentially smoking two cigarettes, just from making the journey to school each day in the morning. For all schools surveyed, weekdays present the highest pollution because of increased vehicular movement.
“On one side of St Scholastica Primary School are the Mathare slums, on the other are various industries like the East Africa Breweries Limited. This makes the level of pollution rise higher,” said Mr Eric Nzioka, a teacher at the school. “Within the school’s clinic, we have noticed that quite a few students have been suffering from infections related to air pollution, especially during the dry season.”
This is compounded by the fact that children’s lungs are still growing. Because children breathe twice as fast as adults, with every breath, they take in more air per unit of body weight than adults. By extension, when air is toxic, they take in more toxic air per unit of body weight than adults.
WHAT CAN BE DONE
Despite the fact that, according to the State of Global Air 2018, Kenya is faring better than her neighbours, what hope do children like Elizabeth have of escaping the effects of Nairobi’s high levels of air pollution?
Unicef recommends that the most important task is to help families reduce their children’s exposure to air pollution. This means reducing the time spent in areas where pollution is high, such as near or around areas of severe traffic congestion or sources of industrial pollution. Where possible, travelling during times of day when air pollution is lower can help reduce exposure.
However, several schools in Nairobi, such as Muthurwa Primary School, are located in the centre of several bus terminals and markets. The exhaust fumes and open burning of garbage from the market release toxic chemicals directly into the children’s lungs. Data collected from the school indicates that on average, the children are exposed to air pollution, which is equivalent to smoking a cigarette a day for the eight hours they are in school!
“We need to be able to get mass transport,” says Prof Kung’u, Dean School of Environment in Kenyatta University. “I do not understand why, in Nairobi, we do not have electric trains. This would carry many people, reducing the need for more cars on the road.”
Parents and families should have access to information about the air quality in their homes and communities, because ‘knowing your air’ is often a first step for action.
“We can start having what we call carpooling. Rather than driving alone to town, you can talk to your neighbours to be using the same car, and that way, the cost of transport is going to go down,” says Prof Kung’u.
He also urges people to walk and cycle rather than use matatus, which are a large contributor to the foul air in the city.
Urban tree planting is one of the low-cost solutions to ‘cleaning’ the air. Trees not only take in carbon dioxide, a major component in particulate matter, but some species can absorb as much as 50 per cent of the particulate matter generated by cars.
A 2016 study Planting Healthy Air by the Nature Conservancy, which analysed the role of urban trees in addressing particulate matter pollution and extreme heat, noted that the few remaining large expanses of tree cover in Nairobi — Kisembe Forest, which is in the southern fringes of the Langata Forest and the Nairobi National Park — served an important role as the “lungs of the city”.
The forest and the entire park are, however, threatened by the rapid and largely unplanned expansion of Nairobi. Sections of the forest and the park have been sliced to make way for the standard gauge rail.
James Chege, a technologist attached to Code for Africa’s sensors.AFRICA project, says the aim of having air quality sensors is to enact policies that can save lives. “We want to work with the government in using this data and validating this data so we can know where to place interventions and how to strategically do that.”