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Why life's short in not so poor Kenyan counties

Monday March 10 2014
mothers

Mothers and their new-borns in hospital. Life expectancy in some Kenyan counties has declined. FILE

Kenya’s lowest life expectancy is not to be found in remote, arid and food-insecure places such as Turkana, Mandera or Marsabit: It is in three counties on the shores of Lake Victoria, where rainfall is abundant, food is relatively plentiful and the nearest health centre is often just a short bicycle ride away.

A new report by the Kenya Institute for Public Policy and Research (Kippra) shows that children in Homa Bay, Kisumu and Siaya can expect to live a mere 40 years under today’s social, economic and health conditions, a staggering 16 years shorter than Kenya’s average of 56.6 years, and more than a quarter century shorter than those in longest-living Bomet County, who can expect to live to 66.

Ironically, Homa Bay, Kisumu and Siaya score high in many other socio-economic indicators. They have fewer people living below the poverty line compared with the national average, more people with access to improved sanitation, and lower levels of economic inequality.

But HIV/Aids looms large in those counties, and its impact is not just felt in the number of patients lining up for anti-retroviral treatment at local hospitals.

The HIV prevalence is estimated at 20 per cent (compared with a national prevalence of 6.2 per cent), and the ever-present threat of infection and death has a deeper, more insidious effect to the community psyche.

Risky behaviour

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Attending funerals of one’s agemates before 30 — the time when most of life’s big decisions are made — ends up snuffing out ambition, encouraging risky behaviour and pushing young people to shun school and start adult life early, before “time runs out.”

Life expectancy at birth is the number of years that a child born today can expect to live under the prevailing health, social and economic conditions.

“The formula used to calculate life expectancy at birth considers very many factors —nutrition, poverty, diseases, access to social services and many others.

But added weight is given to HIV/Aids prevalence, because of the impact that the disease has on the health status,” says David Muthaka, a research analyst at Kippra.

At Usoma beach in Kisumu, Maurice Onyango Okumu carts away load after load of sand, his face that of a middle-aged man, not the 25-year-old that he is. Mr Okumu, who contracted HIV aged 17, while still in high school, said he is “not very confident” of the future.

“I always ask myself every morning, what if I stop taking the daily medication, will I see my biological children?”

At 17, Mr Okumu had dreams of becoming a member of parliament. But today, he has scaled down his ambitions considerably. “My only wish before I die is to marry and have children who can fulfil my dreams,” he said.

Life expectancy in Kisumu county is estimated at 40.4 years, and Mr Okumu says not a single weekend passes without burying a peer.

“I’m not sure if my peers, especially those who earn their income around the lake, may even live to see 40,” he said.

“When you see your peers dying in early adulthood it definitely acts as a demotivator,” said Prof Edward Mburugu, a demographics sociology expert at the University of Nairobi.

“It kills ambitions for further education and investment, because the question that keeps arising is, ‘Will I live long enough to enjoy this wealth?’ People become risk-averse in that sense; it may even effect of limiting economic growth in those areas.”

A society which loses many of its people in young adulthood places a premium on “leaving a legacy” in the form of children, Prof Mburugu added.

“Recent research has found that fertility levels in Nyanza were not on a downward trend as much as expected. It was found that young women were having children earlier, and more than expected. The attitude is ‘let me capitalise on time; I never know when this disease will strike me.’ It’s a rational response to that kind of situation.”

Data from the Society for International Development seems to corroborate this argument. A 2013 report on income inequality from SID found that the counties where the population had no education at all were remote and marginalised places such as Turkana, Wajir, Garissa and Marsabit.

The counties where the population had a secondary education or higher were urban areas such as Nairobi, Kiambu, Mombasa and Nyeri.

But areas where the population tended to terminate their education at primary level included counties where the threat of HIV looms large: Migori, Siaya and Homa Bay.

“This could be the result of two things: One, the death of the primary breadwinner, which means that children do not advance their education, but importantly, there could also be pressure to get married and start a family, so that at least you ‘leave something’ in case you die young,” said Prof Mburugu.

Interestingly, Nairobi’s life expectancy of 57 years is nearly the same as that of Turkana, at 56.9 years, but very different factors are at play “Nairobi has a much higher HIV prevalence than Turkana, and has higher incidence of malaria and pneumonia.

The majority of Nairobians live in slums where poor sanitation also means many child deaths from diarrhoea. But in Turkana, although there may be drought, poverty and food insecurity, people have coping mechanisms, such as moving from place to place,” said Mr Muthaka.

Health services have been devolved to counties, but Dr Sultani Matendechero, secretary-general of the Kenya Medical Practitioners Pharmacists and Dentists Union, says the roll-out of devolution has been haphazard.

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