INFLUENCE OF DRUGS AND SUBSTANCE ABUSE ON REPRODUCTIVE

HEALTH IN NZAMBANI SUB COUNTY, KITUI COUNTY, KENYA

BY

MUVENGEI PHILOMINAH MUVAI

INDEX:3083

A RESEARCH PROJECT SUBMITTED IN PARTIALFULFULMENT OF THE

AWARD OF CERTIFICATE IN SOCIAL WORK AND COMMUNITY DEVELOP
MENT IN THIKA TECHNICAL TRAINING INSTITUTE

NOVEMBER 2021
DECLARATION
This thesis is my original work and has not been presented in any other institution.
 ii

Signature …………………………….. Date ………………

MUVENGEI PHILOMINAH MUVAI

Signature............................... Date..........................
DANIEL K WAHUNGU

DEDICATION
To my lovely mum mary,who has been my great source of inspiration and
streagth.Has offered me unconditional support and encouragement . To
 iii

my siblings, lucy and Tom for being there for me and encounraging me
to work hard.
 iv

ACKNOWLEDGEMENT
First and foremost I give honour and glory to the Almighty God for giving me the

strength, health, ability and peace throughout my studies, without which, I could not

have accomplished this research.

I would like to recognize the continued support and guidance of all my lecturers who

took me through the various courses and programs that enabled me to accomplish this

research.

I am also indebted to my supervisor,Daniel k wahungu,Thika technical for his academic

guidance , constructive criticism , supervision , motivation and encouragement . The

unconditional sacrifices you made towards the success of this work are highly

appreciated.

I also extend special recognition to all the chiefs, assistant chiefs and religious leaders

without whose cooperation, data collection would not have materialized, and also to all

the respondents for accepting to participate in the study.

I acknowledge with gratitude the support I received from my lovely mum and siblings

for their prayers and encouragement.

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TABLE OF CONTENTS

DECLARATION ........................................................................................................ ii
DEDICATION ...........................................................................................................
iii
ACKNOWLEDGEMENT ......................................................................................... iv
TABLE OF CONTENTS .............................................................................................
v
LIST OF TABLES ..................................................................................................... ix
LIST OF FIGURES ....................................................................................................
xi
DEFINITION OF OPERATIONAL TERMS ...........................................................
xii
ABBREVIATIONS AND ACRONYMS ................................................................ xiv
ABSTRACT ...............................................................................................................
xv
1.0 INTRODUCTION ..................................................................................................
1
1.1 Background to the study .........................................................................................
1
1.2 Statement of the problem .......................................................................................
5
1.3 Research Objectives ...............................................................................................
6
1.3.1 General Objective ................................................................................................
6
1.3.2 Specific Objectives ..............................................................................................
6
1.4 Research questions .................................................................................................
7
1.5 Hypotheses of the study .........................................................................................
7
1.6 Justification and Significance of the study .............................................................
8
1.7 Scope and limitations of the study .........................................................................
9
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2.0 LITERATURE REVIEW .....................................................................................

11
2.1 Introduction ..........................................................................................................
11
2.2 The concept of drugs and substance abuse ...........................................................
11
2.3 The Drug-Circle Syndrome ..................................................................................
12
2.4 Global trends of substance abuse .........................................................................
13
2.5 Substance Abuse Situation in Africa ....................................................................
14
2.6 Substance abuse situation in Kenya .....................................................................
16
2.7 Factors contributing to substance abuse ...............................................................
18
2.8 Effects of substance abuse on reproductive health ...............................................
19
2.9 Summary of Literature Review ............................................................................
22
2.10 Theoretical framework .......................................................................................
23
2.11 Conceptual framework .......................................................................................
23
3.0 RESEARCH METHODOLOGY .........................................................................
26
3.1 Introduction ..........................................................................................................
26
3.2 Research design ....................................................................................................
26
3.3 Site of the Area .....................................................................................................
26
3.4 Study population ..................................................................................................
28
3.5 Sampling techniques and sample size ..................................................................
29
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3.5.1 Sample Size Determination ...............................................................................

29
3.5.2 Sampling procedure ...........................................................................................
30
3.6 Research instruments ............................................................................................
31
3.6.1 Questionnaire ....................................................................................................
31
3.6.2 Interview ............................................................................................................
32
3.6.3 Focus Group Discussion ....................................................................................
33
3.7 Validity and Reliability ........................................................................................
34
3.8 Data collection ......................................................................................................
34
3.9 Variable selection, Data Collection and Data Analysis Method ..........................
36
3.10 Ethical Considerations ........................................................................................
37
4.0 DATA ANALYSIS, PRESENTATION AND INTERPRETATION ..................
38
4.1 Introduction ..........................................................................................................
38
4.2 Instruments return rate .........................................................................................
38
4.3 Respondents socio-demographic characteristics ..................................................
39
4.3.1 Distribution of respondents by location ............................................................
39
4.3.2 Distribution of respondents by sub locations ....................................................
39
4.3.3 Distribution of respondents by gender ..............................................................
41
4.3.4 Distribution of respondents according to age ....................................................
42
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4.3.5 Distribution of respondents according to marital status ....................................

43
4.3.6 Distribution of respondents’ marital status by their age groups ........................
44
4.3.7 Respondents religious preference ......................................................................
45
4.3.8 Distribution of respondents by educational levels ............................................
46
4.3.9 Respondents occupation ....................................................................................
47
4.4 Types, sources and drug use .................................................................................
48
4.4.1 Awareness of drugs and substances ..................................................................
48
4.4.2 Commonly used and abused drugs and substances ...........................................
49
4.4.3 Drug abuse prevalence and extent .....................................................................
50
4.4.4 Sources of drugs ................................................................................................
51
4.4.5 Respondents utilization of drugs and substances ..............................................
52
4.4.6 Reasons to engage in drugs and substance use and abuse .................................
53
4.5 Influence of Drugs and Substance Abuse on reproductive health........................
55
4.5.1 Influence of drugs and substance abuse on marriage ........................................
55
4.5.1(a) Relationship between drugs and substance abuse and marital status ...........
56
4.5.1(b) Influence of drugs on spouse ........................................................................
57
4.5.2 Influence of drugs and substance abuse on sexual activity ...............................
61
4.5.2(a) Frequency of sexual intercourse per month at the start of marriage .............
61
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4.5.2(b) Present frequency of sexual intercourse per month ......................................

62
4.5.2(c) Reasons for reduced sexual activity ..............................................................
63
4.5.3 Influence of drugs and substance abuse on fertility ..........................................
66
4.5.3(a) Desired number of children at the start of marriage .....................................
66
4.5.3(b) Present number of children in marriage .......................................................
67
4.5.3(c) Reasons for not having the desired number of children ...............................
69
4.6 Interventions .........................................................................................................
72
5.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS ........................
73
5.1 Introduction ..........................................................................................................
73
5.2 Summary ..............................................................................................................
73
5.2.1 Objective 1: To identify the types and sources of drugs and substances abused
in Gatanga Sub County ..............................................................................................
73
5.2.2 Objective 2: To determine the reasons for the use and abuse of drugs and
substances in Gatanga Sub County ............................................................................
74
5.2.3 Objective 3: To investigate the perceptions of people concerning the influence
of drugs and substance abuse on marriage, sexual activity and fertility ....................
75
5.2.3 (a) Influence of drugs and substance abuse on marriage ..................................
76
5.2.3(b) Influence of drugs and substance abuse on sexual activity ..........................
76
5.2.3(c) Influence of drugs and substance abuse on fertility ......................................
77
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5.3 To identify interventions that can be put in place to deal with causes and
consequences of drugs and substance abuse in Gatanga Sub County ........................
77
5.4 Conclusion ............................................................................................................
78
5.5 Recommendations ................................................................................................
81
5.6 Recommendations for further research ................................................................
82
REFERENCES ...........................................................................................................
83
APPENDICES ............................................................................................................
87
Appendix I: Gatanga Sub County Map ......................................................................
87
Appendix II: Approval of Research Proposal ............................................................
88
Appendix III: Research Authorization from Kenyatta University .............................
89
Appendix IV: Research Authorization from NACOSTI ............................................
90
Appendix V: Household Head Questionnaire ............................................................
91
Appendix VI: Interview guide/schedule for key informants ......................................
98 Appendix VII: Focus group discussion guide for the locals ....................................
100
LIST OF TABLES

Table 3.1: Nzambani Distri ct administrative units by Division……………………....

27Table 3.2: Nzambani District Population and densities by Division………………

....28

Table 3.3: Sampling strategy for households in the study area…………………......30

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Table 3.4: Variables used in the research, Data Collection instruments and Data
Analysis Methods…………………………………………………………………...36

Table 4.1: Respondents by locations……………. .........................................……...39

Table 4.2: Respondents by sub- locations……………....................................…….40

Table 4.3: Respondents mental status by age groups....................………….……...44

Table 4.4: Respondents awareness of types of drugs.........................................…...48

Table 4.5: Commonly used and abused drugs and substances.................……….…49

Table 4.6: Is there drug abuse in your location?........................................................50

Table 4.7: Extent of drug abuse………………………………...…………………..50

Table 4.8: Have you ever taken any of the above drugs?………………….……….52

Table 4.9: Reasons encouraging drug abuse................... ..……………..

…………...53 Table 4.10: Influence of drug and substance abuse…….

…………………….……..55

Table 4.11: Relationship between drugs and sub stance abuse and marital

status….56 Table 4.12: Is your spouse affected by

drugs…………………………………….....57

Table 4.13: Influence of drugs and substance abuse……………………………......58

Table 4.14(a): Cross tabulation of effects of drugs and substance abuse against
marital status ………………………………………………………………………..59
Table 4.14 (b): Chi square test of effects of drugs and substance abuse and marital
status………………………………………………………………………………...60
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Table 4.15: Frequency of sexual intercourse at the start of marriage ……………...61

Table 4.16: Present frequency of sexual intercourse per month …..……………….62

Table 4.17: Reasons for reduced sexual activity …………………………………...63

Table 4.18 (a): Cross tabulation of effects of drugs and substance abuse against

present frequency of sexual intercourse per month ………………………………...64

Table 4.18 (b): Chi square test of effects of drugs and substance abuse and sexual

activity……................................................................................................................65

Table 4.19: Desired number of children at the start of marriage…………………...66

Table 4.20: Number of children in the marriage …………………………………..67

Table 4.21: Are these the preferred number of children?…………………………..68

Table 4.22: Reasons for not having the preferred number of children …………….69

Table 4.23 (a): Cross tabulation of drugs and substance abuse against the number of

children in marriage………………………...……………………………………….70

Table 4.23 (b): Chi square test of effects of drugs and substance abuse and

fertility………………………………………………………………………………71

Table 4.24: Measures to solve drug problems ……………………………………..72

LIST OF FIGURES

Figure 2.1: The drug circle syndrome………………..……………………………..13

Figure 2.2: Cause and effect relationship on drugs and substance abuse……...…...25

Figure 4.0: Distribution of respondents by gender ………………………...………41

Figure 4.1: Age of respondents….…………...…………………..…….…………...42

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Figure 4.2: Respondents’ marital status ………………………………………..…..43

Figure 4.3: Respondents’ religious preference …………………………...……….45

Figure 4.4: Level of education of respondents …………………………………….46

Figure 4.5: Distribution of respondents by occupation ……………........................47

Figure 4.6: Sources of drugs ……………………………………………………….51

Figure 5.1: Reproductive health problems …………………………………...….....75

DEFINITION OF OPERATIONAL TERMS

Alcohol: Refers to a pure, rectified spirit, a volatile intoxicating fermentation

product contained in wine, beer spirits or other distilled or fermented liquors.

Bhang (Cannabis Sativa): Dried leaves and small stalks from the cannabis plant

which have an intoxicating effect.

Drug: A chemical substance which when taken changes the functioning of the body.

Drug use: Refers to using a drug for its intended purpose.

Drug abuse: This is the overuse of any substance whether legal or illegal for the

purpose of altering the functioning of the body.

Fertility: Ability to perform the function of reproduction.

Illegal drugs: Drugs or substances that are socially rejected and their use, possession

or sale constitutes a criminal offence.

Infertility: Inability to perform the function of reproduction because of physical,

mental or hormonal problem.

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Legal drugs: A drug that is potentially dangerous but the government allows its use.

These include alcoholic beverages, tobacco and miraa.

Narcotics: Refer to powerful painkilling drugs which produce pleasurable findings

and induce sleep.

Reproductive health: In this study it refers to people’s ability to have a satisfying

and safe sex life and that they have the capability to reproduce and the freedom to

decide if, when and how often to do so.

Substance: A chemical or drug which when they enter into the body cause changes.

Tobacco: A preparation of the dried leaves of the plant nicotianatubacum which is

smoked in pipes, cigarettes and cigars for its pleasantly relaxing effects. It can also

be taken as snuff or chewed.

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ABBREVIATIONS AND ACRONYMS

ADA - Alcohol and Drug Abuse

AIDS - Acquired Immune Deficiency Syndrome

DSA - Drugs and Substance Abuse

DTT - Demographic Transition Theory

FGD - Focus Group Discussion

HIV - Human Immune Deficiency Virus

KDHS - Kenya Demographic and Health Survey

KNBS - Kenya National Bureau of Statistics

NACADA -
National Authority for the Campaign against Alcohol and

Drug Abuse

RSA - Rapid Situation Assessment

SPSS - Statistical Package for Social Sciences

TFR - Total Fertility Rate

UN - United Nations

UNIDCP - United Nation’s International Drug Control Programme

UNODC - United Nations Office on Drugs and Crime

UNODCCP - United Nations Office on Drugs and Crime Control
 xvi

Programmes

WHO - World Health Organization

ABSTRACT

Drug and substance abuse is one of the most critical challenges facing Kenya today
and is fast assuming alarming proportions among the young adults. A report on the
findings of the 2019 rapid situation assessment of substance abuse in Kenya found
that young adults had the highest substance abuse prevalence . This study was
motivated by the fact that previous studies on the magnitude and impact of drugs and
substance abuse have mainly focused on the youth in learning institutions; yet there
is unquestionable evidence of rampant drug use and abuse among the young adults.
The main objective of the study was to investigate the influence of drugs and
substance abuse on reproductive health in Nzambani Sub County, Kitui County. The
researcher adopted descriptive survey research design . The researcher used
questionnaires and interview schedules as instruments of data collection . With a
target population of 484 households , purposive and simple random sampling
techniques were used to select the respondents . The questionnaires were
administered to 352households’ heads. Interview schedules targeted key informants
as well as the focus group discussants. Three focus group discussions, one mixed sex
, one for women and one for men were held separately . Data was analyzed both
qualitatively and quantitatively . Content analysis was used for qualitative data.
Quantitative data was analyzed by use of statistical package for social sciences
( SPSS) computer software version 21.0. Chi square correlation was used to test the
hypotheses i.e. assess the degree and nature of association between drugs and
substance abuse and marital status, sexual activity and fertility . The results were
presented in frequency distribution tables, percentages , figures, pie charts and
graphs. The research revealed that the commonly abused drugs included alcohol,
cigarettes, bhang and khat. Kiosks/small shops were reported as the main sources of
drugs . The study further revealed that easy availability of cheap drugs and
substances, peer pressure, unemployment and dysfunctional families contributed to
drug abuse. The study further established that drugs and substance abuse is on the
increase. This indicates that efforts put in place to fight drugs and substance abuse
has not been working effectively . The study therefore recommends that the
government comes up with more effective strategies of fighting drugs and substance
abuse.
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1.0 INTRODUCTION

1.1 Background to the study

Drug and substance abuse is a problem that has raised concern the world over. The

past two decades have seen the use of illegal substances spread at an unprecedented

rate and has reached every part of the globe. According to the World Health

Organization (WHO) as at 2004, there were about 2 billion (35%) of people

worldwide who consumed alcoholic beverages (WHO, 2004). Globally, the United

Nations Office On Drugs and Crime (UNODC, 2009) estimated that in 2009,

between 149 and272 million people or 3.3-6% of the world’s total population aged

15-65 years had used illicit substances at least once in the previous year. The main

substances abused worldwide are cannabis sativa which was consumed by between

125-203 million people in 2009, followed by stimulants, opiate and cocaine. The

United Nations Agency reported that cannabis remains by far the number one

produced and consumed illicit substance worldwide (UNODC, 2009).

The United Nations Office on Drugs and Crime Control Programmes (UNODCCP,

2002) cited substance abuse as a grave threat to the health and well-being of

mankind, the independence of countries, democracy, the stability of the nations, the

structure of all societies, and the dignity and hope of millions of people and their

families. A drug like cannabis sativa affects the male sexual hormone and the

amount of sperm cells (Kyalo, 2010).While substance use has stabilized in the

developed world, there are signs of an increase in drug use in the developing

countries. This is the case in Africa which has been experiencing an escalating
 2

problem with substance use and trafficking (Abdool, 2004). The poor youths in

African cities and towns abuse among others, cheap and legal substances like

inhalants (UNODC, 2009).

Additionally, abuse of illegal substances such as cocaine and heroin is increasing

among young people. Further, the report attributes the increase in substances abuse

in Africa to the stress and economic hardships coupled with the breakdown of

traditional systems of community and family support, which in the past might have

helped individuals to meet their needs in a healthier way.

According to a report by the International Narcotics Control Boards (INCB, 2006),

the East African region has become a fallback for drug dealers. Frank Njenga, the

National Authority for the Campaign against Alcohol and Drug Abuse (NACADA)

chairman, speaking during the 2012 NACADA conference, raised concern about the

high rate of illicit drug use in Africa and attributed it on the continent being used as a

transit route for drugs to European countries. He pointed out that most African

countries had been turned into transit points by international drug dealer’s en route to

western markets (NACADA, 2012).

Trafficking of substances has not spared Kenya. There is evidence that Kenya is a

transit point for hard drugs from Columbia heading to European capitals (Doherty,

2008). The port of Mombasa and Jomo Kenyatta International Airport are believed to

be exit and entry points for drugs destined for other countries especially in European
 3

and Asian continents. According to a study carried out by NACADA, substance abuse

is becoming an increasing social problem in Kenya (NACADA, 2007). The report

found out that young adults (15-30years) have the highest drug and substance abuse

prevalence (NACADA, 2007). Further, the report identified alcohol as the most abused

mind altering substance. On the other hand, bang tops the list of the most abused

narcotic drugs, followed by heroin and cocaine. Consumption of tobacco products, as

well as khat and its variant called muguka, is also on the increase (NACADA, 2004).

Frank Njenga, the Nacada chairman, speaking during the 2011 international day

against drug abuse and illicit trafficking in Naivasha on 26th June 2011, admitted

that substance abuse was a major concern in the country (NACADA, 2011). He

challenged the government to declare substance and alcohol abuse a national tragedy.

Catholic Auxiliary Bishop David Kamau of Nairobi Archdiocese also raised concern

over heavy alcohol drinking culture among residents of central province leading to

most young people in the region not being interested in marriage. While the habit is

making young people not to marry, it is already causing a lot of problems in the

family unit where most men have become sexually inactive. As a result, women in

former Central Province divorce or look for other men out of the region who can sire

children with them. Reports indicate that fertility in central province is on the decline

because alcoholism among men has led to rising impotence. Women in the region

have in recent months held demonstrations and raided drinking dens to

stop brewers from selling their toxic waste to their husbands (Cotran, 2008). Kitui
County is among areas informer Central Province worst affected by substance abuse,

especially among the young adults. It is a region where men, in particular, are known
 4

to be overtaken by alcoholism to an extent that they care no more for their families and

instead derive solace in the excessive drinking of alcohol (Ambasa -Shisany ,

2009). The region has in the recent past received unparalleled media coverage with

several reports of substances related deaths as well as reports about women in parts of
the region protesting about neglected sex roles by their alcoholic spouses ( NACADA
, 2011 ). Findings of a Central Province baseline survey research

conducted by NACADA in 2010, reported numerous cases of marital breakdown,

reduced interest in sexual activity among married couples and fertility . The high

proportions reporting on reduced sexual activity and infertility was supported by the

many protest matches held in various parts of Kitui County by women claiming

their spouses and sons are no longer sexually functional (NACADA , 2010).

Statistics from national census indicate the population growth in central Kenyan had

declined from 1.8 % in 1999 to 1.6% in the latest census of 2009. Enrolment in

schools was also on a downward trend due to reduced birth rate. A new trend of

women headed households has emerged. The men no longer make sound

judgements and decisions and, therefore, are no longer able to head their homes

(NACADA, 2012).

1.2 Statement of the problem

Substance abuse is a problem that has raised concern all over the world. In Kenya in

the recent past, the media has repeatedly carried stories on the negative effects of

substance abuse. A summary report of morbidity and mortality caused by alcohol

 5

consumption in various parts of the country by NACADA from 6th – 11th May 2014

reported 105 deaths and 133 hospital cases (NACADA, 2014).This despite the fact

that the government has put up strategies to deal with the problem of drugs and

substance abuse.

Very few people seem to be aware of the influence of drugs and substance abuse. To

be more effective in regulating drugs and substance abuse there should be more

emphasis on the influences. This will provide critical information thus empowering

the community members to make informed decisions. Specifically, the study

undertook to investigate the influence of drugs and substance abuse on marriage,

sexual activity and fertility in Nzambani Su bCounty, Kitui County, Kenya.

1.3 Research Objectives

1.3.1 General Objective

The general objective of the proposed study is to investigate the influence of drugs and

substance abuse on reproductive health in Nzambani S ub County , Kitui

County, Kenya.

1.3.2 Specific Objectives

1. To identify the types and sources of drugs and substances commonly abused in

Nzambani Su b County, Kitui County.

2. To determine the reasons for the use and abuse of drugs and substances in

Nzambani Sub County, Kitui County.

 6

3. To investigate the perceptions of people concerning the influence of drugs and

substance abuse on reproductive health in Nzambani Sub County, Kitui County.

4. To identify interventions that can be put in place to deal with drugs and

substance abuse and its consequences.

1.4 Research questions

a) What are the types and sources of the most commonly abused drugs and

substances in Nzambani Su b County ?

b) What are the reasons given for adults in Nzambani Sub County to engage in

drugs and substances use and abuse?

c) What is the influence of drugs and substances abuse on reproductive health in

Nzambani Su b County ?

d) What measures can be put in place to address the problem of drugs and

substance abuse?

1.5 Hypotheses of the study

Ho1: There is no significant relationship between influence of drugs and substance

abuse and marital breakdown in Nzambani Sub County.

Ho2 There is no significant relationship between influence of drugs and substance abuse

and reduced sexual activity in Nzambani Sub County.

 7

Ho3: There is no significant relationship between influence of drugs and substance

abuse and infertility in Nzambani Sub County.

1.6 Justification and Significance of the study

Population growth in Central Kenya had declined from 1.8 to 1.6 in 2009 (KNBS,

2010).Reports indicates that fertility in Central Kenya is on the decline because

alcoholism among men has led to rising impotence. Many families have broken up

due to alcoholism as well as escalating cases of family conflicts and violence. The

magnitude of the problems arising from drugs and substance abuse have been

amplified by women who have staged protest marches against the vice claiming that

drugs have left their men impotent or impaired (Cotran, 20 counties)Kitui County is
among areas in Central Kenya worst affected by drugs and substance abuse . A

summary report of morbidity and mortality caused by alcohol consumption in

various parts of the country by NACADA between 6th and 11th May 2014 ranked

Kitui County as number five. The eight deaths reported in the County came from

Nzambani and MutomoSub Counties.

Previous studies have mainly focused on the youth in learning institutions; yet there

is unquestionable evidence of drug use and abuse among out of school youth.
 8

No study of this kind has been done in Nzambani Sub County.

It is anticipated that this study will provide valuable information on the effects of

drugs and substance abuse on reproductive health. This will form a basis for the

development of intervention strategies.

The findings from this research will be of immense use to policy makers when

formulating policies geared towards dealing with drugs and substance use and abuse.

Further the study will contribute to the existing literature in the field of drugs and

substance abuse and its influence on reproductive health.

1.7 Scope and limitations of the study

The research study was carried out in Nzambani S ub Coun ty in Kitui County with a

population of 113094 persons for the reason that it is among areas in Kitui county

worst affected by drugs and substance abuse. In Nzambani Sub County, the adverse

effects of drugs and substance abuse have led to a myriad of complaints by residents

especially women who are overwhelmed by the family burdens; they provide for the

family, and more so the inability of men to fulfill their matrimonial functions .

As a result cases of domestic violence and divorceare on increase in the SubCounty(

Babor, 2010).

The respondents were the residents of Nzambani Su b Count y.

This was an academic research expected to be completed within a given time limit.
 9

Due to this, the research was concentrated only in Nzambani S ub Cou nty of Kitui

County .This was because the whole of Kitui County was very large with very many

Sub Counties. Hence, time and financial constraints could not allow for a study of

the whole county . The researcher countered this limitation by maximizing collection

of information from a sample of 352 households in Nzambani S ub Coun ty in Kitui

County.

order to save on time and finances, thereafter; generalization was done for all the

households in Muranga County.

During the study, the researcher faced difficulty in getting respondents to answer

questions due to the sensitivity and privacy of the questions. Some of the respondents

could not open up fully for fear of victimization or being exposed. This led to the

findings missing some information. However, the respondents were guaranteed of

total anonymity and confidentiality throughout and after the research. The researcher

also created a good rapport with the respondents so as to solicit the required

information. This enhanced optimal disclosure and free participation in the research.
 10

2.0 LITERATURE REVIEW

2.1 Introduction

This chapter contains reviewed literature from different authors on studies done on

drugs and substance abuse. It includes the concept of drugs and substance abuse, the

drug-circle syndrome, global trends of substance abuse, substance abuse situation in

Africa, substance abuse situation in Kenya, factors contributing to substance abuse

and effects of substance abuse on reproductive health. It also provides a theoretical

framework and conceptual framework in a narrative and diagrammatic form.

2.2 The concept of drugs and substance abuse

A drug is any substance which when introduced into the body will alter the normal

and psychological functioning of the body especially the central nervous systems

(Escandon & Galvez, 2006). NACADA defines a drug as any substance capable of

altering the mind, body, behavior or character of any individual and includes

alcoholic drinks, lawful drugs or narcotic drugs and psychotropic substances. In

general, the term drug will include all the substances that will alter the brain

functions and create dependence.

Drug use means using a drug for its intended purpose, for example, use of

antimalaria tablet to treat malaria and panadol to relief pain (NACADA, 2012).

According to WHO (2003), drug abuse is the self-administration of any substance in

a manner that deviates from approved medical or social patterns within a given

culture. This agrees with NACADA (2012) definition that drug abuse is the use of a
 11

psychoactive substance for purpose other than medicinal purposes which impair the

physical, mental, emotional or social wellbeing of the user. Different substances

abused produce adverse negative effects within the body. Drugs abused that impact

on the psyche of the individual are normally referred to as psychoactive substances.

This definition includes both legal and illegal substances.

The legal or licit drug and substances are socially accepted, and their use does not

constitute any criminal offence or breaking the laws of the state. Some of the legal or

licit substances include alcohol, miraa (khat) and tobacco (NACADA, 2012). Illegal

or illicit substances are legally rejected; their use, possession or sale constitutes a

criminal offense. Among the illicit substances are bhang (cannabis sativa), heroin,

cocaine, chang’aa and mandrax (NACADA, 2012).

2.3 The Drug-Circle Syndrome

According to Karechio (1994) there is a drug- circle syndrome. He claims that one

joins the circle when one becomes a drug user. The circle consists of four main

groups namely, the manufacturers that supply the dugs to the traffickers. The

traffickers move the drugs and supply to peddlers. The peddlers consists the third

group, and they peddle the drugs to the market. The drug pusher pushes the product

to the consumers. Finally is the consumer who keeps the circle going as he gets

drugged and is the main target as he provides money to all these groups. This is

illustrated in Figure 2.1 below.

 12

Manufacturers

Consumers Traffickers

Drug peddlers/pushers

Source: Adapted from Karechio (1994).

Figure2.1.The Drug Circle Syndrome

2.4 Global trends of substance abuse

The past two decades have witnessed the use of illegal substances spread at an

unprecedented rate and has penetrated every part of the globe. According to the

United Nations Drugs Control Programme, (UNDCP,2006), the menace of drugs is

assuming worrying proportions the world over and negligible headway is being

achieved in elimination, owing partly due to lack of serious commitment from

governments or the sophisticated nature of drug business presently. The report

further paints a gloomy picture of how more and more countries are being affected

by the vice unlike some ten years ago when drug business was restricted to a few

countries.

A world drug report noted that there are about 200 million people (5% of global

population) who take illegal substances at least once a year (UNODC, 2006). This
 13

number could be even bigger if all other substances of abuse, including legal

substances in different countries would be considered. Cannabis sativa has been

considered to have the largest drug market in the world (UNODC, 2006). The World

Health Organization (WHO) however estimates that there are about two billion

(33%) people worldwide who consume alcoholic beverages and 76.3 million with

diagnosable alcoholic use disorders (WHO, 2004), making alcohol the most widely

used and abused substance world over (Basangwa et al, 2006).

2.5 Substance Abuse Situation in Africa

There may have been a time when the use or abuse of substances was considered as a

problem escalating only to the western world. Today, it has become an African

problem to the extent that hardly a month passes without media reports on large

quantities of drugs having been intercepted in some African cities and towns

(Doherty, 2008). Since the early nineteen eighties, Africa has been experiencing an

escalating problem with substance abuse and trafficking (Abdool, 2004). Production,

trafficking and consumption of illegal drugs have been on the increase in SubSaharan

Africa (Needle et al, 2006). Many parts of Africa have become a global highway for

illegal substance trafficking (Tabifor, 2000).

During trafficking and transport in Africa, new substances are introduced to new

geographic areas, the domestic market is expanded, and new people are introduced to

the substance (Needle et al, 2006). The World Health Organization

(WHO,2004),cites the Eastern and Southern Africa regions as having the highest

consumption of alcohol per drinker in the world and the prevalence of hazardous
 14

drinking patterns such as drinking a large quantity of alcohol per session or being

frequently intoxicated, as being second only to Eastern Europe (Needle et al ,2006).

According to a report by the International Narcotics Control Board (INCB,2006),

the East Africa region has become the fall back for drugs peddlers following

increased control of traditional routes; the Netherlands and Spain.

Dr. Frank Njenga, chairman of NACADA, making a presentation during NACADA

conference in 2012, lamented the high rate of illicit drug use in Africa and attributed

it to the fact that the continent is being used as a transit route for drugs to Europe. He

pointed out that most African countries had been turned into to exit points by

international drug dealer’s en route to western markets. The phenomenon is even

more acute in conflict and post- conflict countries with populations experiencing

high stress level while child soldiers are provided with substances to enable them to

fight (NACADA, 2007).

2.6 Substance abuse situation in Kenya

Just like any other country in Africa, Kenya has been experiencing a rapid increase in

production, distribution and consumption of multiple substances of dependence.

The United Nations International Drug Control Programme (UNDCP, 2006) ranked

Kenya among the top four nations notorious for consumption of narcotics. The port

of Mombasa was noted to be a major point for drug traffickers in Africa (Onyango,

2002).Trafficking of hard drugs has not spared Kenya and it is abundantly clear that

Kenya is a transit point for hard drugs from Columbia heading to European capitals

(Doherty, 2008).
 15

Drugs and substances abused, both legal and illegal are forming a subculture in

Kenya according to a report by NACADA (2007). The use of legal (licit) drugs tends

to pave way for experimentation with hard drugs. Many young people start to

experiment bhang smoking, consumption of chang’aa, cocaine and heroin in

addition to use of alcohol, tobacco and miraa. The study also established that the

young adults have the highest drug and substance abuse prevalence (NACADA,

2007). Drugs in Kenya are classified as illegal drugs, and others are not considered

illegal. It is, therefore, difficult to control the use of substances not considered

illegal. The legalized drugs in Kenyan include alcohol, cigarettes and khat (miraa)

Of late, Kenya has received unparalleled media coverage with stories and

documentaries on substance use and abuse, highlighting what looks to be a deep

rooted problem. Half of drug abusers in Kenya are aged between 10-19 years with

over 60% residing in urban areas and 40% in rural areas. Findings from a country-

wide rapid assessment survey conducted in 2007(NACADA,2007,2008) identified

alcohol as the most abused mind altering substance; about 14.2% Kenyan population

aged 15-65 years from all the provinces except North Eastern with male consumption

being 22.9% and female consumption being 5.9%. Other rates of consumption were

rural13.0%, urban 17.7%, legal/packaged alcohol 9.1%, traditional liquor 5.5% and

chang’aa 3.3%.Disaggregating by province, the lowest use was found in North

Eastern (0%) and Western Provinces (6.8%) while the other six provinces were

comparable with a range of 13%-19%(i.e. Rift Valley 12.5%,

Eastern 14.5%, Nyanza 17.0%, Central, 17.7%, Coast 18.6%, Nairobi18.6%.

 16

The widespread use of alcohol is fueled by ease of its production, processing (i.e. a

plain process of fermentation achieved by yeast acting on sugar) and multiple daily

use for recreation, curative and religious purposes (NACADA, 2010). However, a

more worrying trend is the increasing penetration of second generation brands that

are eating into the market of the first generation alcohol. The findings reveal that

second generation alcohol is the most available, affordable and accessible type of

alcohol in most parts of Kenya. The second generation alcohol and chang’aa are

most lethal because of high potency and adulteration with dangerous unhygienic

substances. The high potency and adulteration of these types is motivated by their

commercialization (unlike traditional liquor that is often consumed in social

functions like wedding) and little or no government regulation or self regulation on

the part of the markets (as opposed to the first generation alcohol), (NACADA,

2010). Additionally, unlike the first and second generation brands, chang’aa and

traditional liquor are processed, marketed and consumed with some secrecy.

Other commonly abused substances in Kenya include bang which tops the lists of the

most abused narcotic drugs; it is used by approximately 1% of the population aged

15-64 years, heroine (0.1%) and cocaine (0.2%). Lifetime use of tobacco products

stands at 2.2 % while miraa/khat and its variant called muguka stand at 5.5%. Hard

drugs such as cocaine and heroin which are more costly are less accessible

(NACADA, 2007). However according to a report by NACADA (NACADA, 2007),

38,000 Kenyans were using heroine while 400,000 were on cannabis sativa (bang).
 17

The NACADA chairman Frank Njenga, speaking during the 2011 international day

against drug abuse and illicit trafficking in Naivasha on June 26, admitted that

substance abuse was a major concern in the country and challenged the government

to declare substance and alcohol abuse as a national tragedy.

2.7 Factors contributing to substance abuse

The Modified Social Stress Model (Rhodes and Jason, 1988) maintains that there are

factors that encourage substance abuse called risk factors. Factors that make people

less likely to abuse substances are called protective factors. The World Drug Report

2000, (UNDCP, 2000), lists various contributing risks factors namely: Family risk

factors (family disruption , criminality and substance abuse in the family, ineffective

supervision);Peer networks (friends and peers are important in providing opportunities

for substance use and supporting this behavior); social factors (poor school

attendances, poor school performance, early drop out), environmental influences

(availability of drugs, social rules, values and norms regarding substances abuse),

individual factors (low self esteem , poor self control , inadequate social coping skills,

sensation seeking depression, anxiety and stressful life events).

Protective factors include; Family factors (bonding and positive relationships with at

least one caregiver outside the immediate family, high and consistent parental

supervision); Educational factors (high education aspirations, good teachers-student

relationship); Individual characteristics (high self esteem, low impulsivity, high

 18

degrees of motivation); Personal and social competence (feeling in control of one’s

life, optimism, willingness to seek support), (UNDCP 2000).

2.8 Effects of substance abuse on reproductive health

According to World Health Organization (WHO), reproductive health implies that

people are able to have a satisfying and safe sex life and that they have the capability

to reproduce and the freedom to decide if, when and how often to do so.

Reproductive health also refers to the diseases, disorders and conditions that affect

the functioning of the male and female reproductive systems. Disorders of

reproductive health include birth defects, development disorders, low birth weight,

reduced fertility, impotence and menstrual disorders.

When different substances are abused, they produce negative effects within the body.

This is reflected in the immediate and long-term effects on the individuals and

families concerned as well as the entire society. Substances modify the behavior of

the people who abuse them (Tony 2000). For instance abuse of alcohol leads to lack

of self control such that behavior which is normally held in check is expressed.

According to a baseline survey on alcohol use in Central Province by NACADA

(NACADA, 2010) alcohol was found to have several adverse effects on the

individuals, the household and the community. Such effects include having multiple

sex partners, domestic violence among others. Barlow (2000) cited alcohol as a

threat to family life and harmonious interpersonal relations. Alcohol is linked to

 19

crime, broken homes, poor workmanship, unemployment and a host of other social

evils. According to this report, drug abuse is regarded as a threat to family stability.

Drug related problems are the strongest predictors of domestic violence. Spousal

abuse which is a major cry of society has resulted to broken families; interfering with

the functioning of the homes. The result is that families have broken up as wives

leave their alcoholic and irresponsible husbands. A new trend of women headed

households has emerged as men are no longer able to head homes. The men no

longer make sound judgment and decisions (NACADA, 2012).

Drugs damage one’s ability to act as free and conscious beings capable of taking

action to fulfill their needs, care for others and contribute positively to society

(NACADA, 2011). This can lead to uncontrolled sexual emotions and impaired

judgment which may result to careless sexual behavior and, therefore, vulnerability

to HIV and AIDS. The negative effects that drugs and substance use have on

decision making concerning safe sex, and overall sexual safety, the association of

drug use with commercial sex, sex with multiple partners and bartering sex for drugs

all make drug users prone to higher occurrence of sexually transmitted diseases and

HIV and AIDS (Rhodes, 1996). The regular use of cannabis sativa by males affects

their hormonal and the reproductive system reducing their level of testosterone, the

male sexual hormone and the amount of sperm cells as consumption increases

(Kyalo, 2010).
 20

According to a baseline survey on alcohol use in Central Province by NACADA

(NACADA, 2010), the greatest consensus was in alcohol effects in employability,

attendance in places of worship, marital breakdown, reduced interest in sexual

activity among married couples and infertility. The report observed that alcohol

consumption had led to high proportions of reporting on reduced sexual activity and

infertility as supported by the many demonstrations held in various parts of Central

Province by women claiming that their spouses and children are no longer sexually

active. There have been several media reports about women in parts of Kenya

protesting about neglected sex roles by their alcoholic spouses. As a result, women

divorce or look for men out of the region who can sire children with them (Cotran,

2008).

2.9 Summary of Literature Review

The reviewed literature reveals that reproductive health implies that people are able

to have a satisfying and safe sex life and that they have the capability to reproduce

and the freedom to decide if, when and how often to do so. It also refers to the

diseases, disorders and conditions that affect the functioning of the male and female

reproductive systems. Disorders of reproductive health include birth defects,

development disorders, low birth weight, reduced fertility, impotence and menstrual

disorders.

Previous studies on the magnitude and impact of substances use and abuse have

mainly focused on students and urban areas with much less focus on young adults
 21

and rural areas. Yet, there is unquestionable evidence of rampant substances use and

abuse among adults, and especially the young adults. Little has been done on the

influence of drugs and substance abuse on reproductive health. It, therefore, makes

scholarly sense to study drug and substance abuse among young adults in rural areas

where the bulk of the population lives. The knowledge gap the research intends to fill

is to establish the influence of drugs and substance abuse on reproductive health in

Gatanga Sub County, Murang’a County.

2.10 Theoretical framework

The study was guided by the peer group learning theory. This theory was developed

by Pasche in 1970. He stated that drug abuse is learned and subject to habit strengths

which increase through repetition and reward by peers. Factors like fear of

consequences and moral reservations may reduce the tendency of abusing drugs and

substances. However incentives such as curiosity and desire for peer approval will

interact with these factors so that the potential drug and substance abuser resolves the

approval avoidance conflict in favour of abusing drugs.

2.11 Conceptual framework

Drug and substance abuse (DSA) has a complex cause and effect relationship. The

immediate causes of drug and substance abuse formed the independent variables.

The immediate causes include poverty, peer pressure, limited enforcement of laws

and the breakdown of traditional values leading to dysfunctional families. The high

unemployment levels also contribute to drug and substance abuse as many youths

remain idle and have time to engage in the same (NACADA, 2012).
 22

The dependent variables are the effects of drug and substance abuse on reproductive

health which include marital breakdown, risky sexual behaviors and practices,

including increased exposure to HIV and AIDS, reduced sexual activity and

infertility.
Consequences of DSA at the individual level include damaging one’s ability to act as

free and conscious beings, capable of taking action to fulfill their needs, care for

others and contribute positively to society (Ndetei, 2004).

Intervening variables include funding constraints which lead to weak programmes

and easy availability of drugs and other substances. Since DSA programmes may be

accorded low priority, they are often underfunded. The programmes are also

supported by a weak institutional framework. Appropriate and updated data and

information on DSA also lacks. Hence, evidence based practices and programmes to

address specific DSA problems are not always possible.

 23

Adopted and modified from NACADA, 2012

Fig 2.2: Modified cause and effect relationship on drugs and substance abuse
 24

3.0 RESEARCH METHODOLOGY

3.1 Introduction

This chapter outlines the research methodology which was used to investigate the

influence of drugs and substance abuse in Nzambani S ub County, Kitui County. It

comprises the following topics; the research design, study area, target population ,

sample size and sampling procedure , data collection techniques (research

instruments), and data analysis and data presentation techniques.

3.2 Research design

A descriptive survey design was adopted for this research. According to Flick

(2006), descriptive survey design is flexible and yields the necessary qualitative and

quantitative data for the study and helps in generalizing possible explanations.

Descriptive survey design was used because the research involved collecting

information by interviewing and administering questionnaires to a sample of

individuals from households (Orodho, 2003). Questionnaires and interviews were the

dominant research instruments. Descriptive survey is most suitable when collecting

information about people’s attitudes, opinions and habits and is designed to obtain

information concerning the current phenomena and where possible to draw valid

general conclusions from the facts discussed.

3.3 Site of the Area

The study was conducted in Nzambani Sub County, Kitui County. The Sub County

covers an area of 312.4 km2and borders Nzambani North Sub County to the South,

Chuluni Sub County to the West, Kisasi West Sub County to the East and Mutomo Sub
 25

County to the North. It is located between latitudes 00 045’ and 010015’ South and

longitudes 36045’ and 37025’ East. The Sub County comprises 5 divisions , 15 locations

and 45 sub-locations. The 5 divisions are Nzambani, Nzangathi, Thua, and Inyuu all

with a population of 113,094, according to the 2009 population census

report.

Table 3.1: Nzambani Su b County Administrative Units Area by Division

2
Divisions Area(km ) Locations Sub-locations

.7 4 13

Iyuu 61.9 2 4

Nzangathi 36.9 3 11

Malua 115.6 3 10

Kigoro 45.3 3 7

Total 312.4 15 45

Source: KNBS, 2012, Government Printers, Nairobi.

Nzamabani Su bCounty has a population density of 362 persons per square kilometer.

Nzambani division in more populated with 40,297 people while Samuru is the least
populated division with a total population of 7,494 people (KNBS, 2009).

Table 3.2: Gatanga Sub County Population Distribution and Densities by Division
Division Area 2009

(KM2) Male Female Total Density

Malua 52.7 19,691 20,606 40,297 765

 26

Thua 61.9 40,86 3,408 7,494 121

Nzangathi 36.9 13,229 13,902 2,7131 735

Inyuu 115.6 9,004 9,276 18,280 158

Kigoro 45.3 9,786 10,106 19,892 439

Total 312.4 55,796 57,298 113,094 362

Source: 2009, Kenya Population and Housing Census, KNBS, Government

Printers Nairobi

3.4 Study population

A population is defined as a complete set of individuals, cases or objects with some

common observable characteristics (Flick, 2006). Based on the 2009 census, the

population of Nzambani Sub C ounty stood at 113 ,094 persons and 30,211

households (KNBS, 2010). All the households in the Sub County made up the target

populationforthe study.

3.5 Sampling techniques and sample size

A sample refers to a part of the target population that has been procedurally selected

to represent it for the study (Oso and Onen 2005). Sampling is a process of

identifying the individuals who will participate in the study (Gray, 2009).

3.5.1 Sample Size Determination

Sample size for the study was determined by using the following formula as explained

by Mugenda and Mugenda (2003),

 27

Where; n = the desired sample size (if the target population is greater than

10000) z = Standard normal deviate set at 1.96 at 95% confidence level

(C.I.) p = 0.5 (no prevalence rate available) q = 1- p d = 0.05 (level of

statistical significance)

Since in our case the target population is 30211 households which is greater than

10000 the desired sample size (n) was determined by:

n =(1.96)2 x (0.5) x (0.5)

(0.05)2

= 384.16

Hence, 30,211 households will require a sample size of 384.

3.5.2 Sampling procedure

Multi-stage sampling procedure was employed in selecting representative households.

Nzangathi Division has its administrative boundaries as follows;

Table 3.3: Sampling strategy for Households in the study area

LOCATION SUB-LOCATION

KANDUTI 1:Ndunga
2:Katumbu , 3:
Chomo
KYALELE 1:Mugumoini, 2:Mabanda, 3:Mithandukuini

KIGIO 1:Kigio, 2:Ithang`arari, 3:Gakurari

MALUMA 1:Kiriaini, 2:Mureke, 3:Thare, 4:Gathanji

Source: KNBS, 2012, Government Printers, Nairobi.

 28

Nzambani Sub County has five geographical boundaries called Divisions, namely,

Nzangathi, Malua, Inyuu and Kigoro . These acted as clusters . The clusters were

heterogeneous in nature.

Purposive sampling, a non-probability technique was used to select Nzambani

Division. The selection of Nzangathi Division was due to the large household size

and the fact that it includes both the urban and rural areas. This was done to ensure

that people with different economic and socio -demographic characteristics are

captured. Nzangathi Division was then stratified according to the existing locations

and sub- locations (Table 3.3). In the final stage, simple random sampling was used

to sample

384 households distributed proportionally across each of the thirteen sub locations

(Table 4.1 and 4.2).

3.6 Research instruments

The study utilized both primary and secondary data sets. The first stage involved an

exhaustive review of literature on substance use and abuse. Secondary data was

sought from the library, archival studies, academic journals, and internet and from

other resources to establish the background information of this problem. Primary

data was collected using different forms of data collection methods, namely

questionnaires, interviews schedules and focus group discussions (FGDS).

 29

3.6.1 Questionnaire

Orodho (2009) points out that questionnaires are advantageous in that it takes less

time, energy and are less expensive to administer to respondents scattered over a

large area. Also, questionnaires give respondents freedom to express their views and

opinions and also make suggestions while maintaining their anonymity. The

questionnaires contained both open ended and closed questions. The questionnaires

were administered to the 384 household heads (man or woman) aged between 15 and

49 years to gather basic demographic information on respondents perceptions,

attitudes and behavior related to drug and substance use and abuse. They also

gathered information on types of drugs commonly abused, sources of these drugs,

availability and use of different drugs, reasons for their abuse, extent of drug and

substance abuse, influence of drug and substance abuse on marriage, sexual activity

and fertility and measures that can be taken to curb drug and substance abuse. One

household head was interviewed per household giving a total of 384 respondents.

The households were randomly chosen.

3.6.2 Interview

Since in some cases the questionnaires are limited in comparing the real situation and

experiences, personal interview schedules targeting key informants were conducted.

An interview guide was used for this exercise. Purposive sampling was used to

obtain a sample of four chiefs and three religious leaders who were the key

informants.
 30

An interview schedule is considered appropriate when the sample is small since the

research is able to get more information from respondents than would be possible

using a questionnaire. According to Gray (2009), interviewing is appropriate because

it ensures a higher response rate and the interviewer is able to probe deeper into the

response given by the interviewee. This method allows greater flexibility as the

opportunity to restructure questions is always there and the language of the interview

can be adapted to the ability of educational level of the person interviewed and as

such misinterpretations concerning questions can be avoided. The interview

schedules were used to solicit information on commonly abused drugs, sources of

these drugs and extent of drug and substance abuse. Other information collected

included, influence of drug and substance abuse on reproductive health and measures

that can be taken to curb drug and substance abuse.

3.6.3 Focus Group Discussion

Three Focus Group Discussions each consisting of 9 members were held; one mixed

sex FGD and one FGD for women and men separately. The men and women focus

groups were made up of one elder, one drug abuser, one young adult, a professional

from the local health centre, chief, police officer and three religious leaders, each

from Catholic, Protestant and Muslim religions. The mixed focus group comprised of

two elders (one male and one female), two young adults (a male and female), two

drug abusers (one male and one female) and three religious leaders each from

Catholic, Protestant and Muslim religions. The discussants were purposively

sampled.
 31

The discussion was facilitated by the researcher and the proceedings were recorded

on tapes or notes were taken. The FGDs had discussion guides. According to

Krueger and Casey (2000), FGDs allows for a variety of views to emerge, while

group dynamics can often allow for stimulation of new perspectives. Groups were

established in convenient centers like schools and chiefs camps where FGDs were

held.

3.7 Validity and Reliability

Mugenda and Mugenda (2003), defines reliability as the degree to which a research

instrument yields consistent results or data after repeated trials.

Before undertaking the collection of data, piloting was conducted in three sub

locations of the neighboring Kihumbuini Division. The questionnaires were pretested

and revised to cater for the observations made during piloting.

Validity is the degree to which results obtained from the analysis of the data actually

represents the phenomena under investigation (Orodho,2009).The researcher used

content validity i.e. validity of the instruments was tested by discussing their contents

with other colleagues and further scrutinized by my university supervisors as

recommended by Orodho (2004).

To ensure validity, data was collected using different forms of data collection methods

i.e. questionnaires, interviews and focus group discussions.

 32

3.8 Data collection

Data analysis deals with the organization, interpretation and presentation of collected

data (Oso and Onen, 2005). The data collected, being descriptive in nature, used both

qualitative and quantitative approaches.

The process began with scrutiny of questionnaires, interview notes and FGDs to

establish if there is any missing information. This was done so as to identify

inconsistencies and outliers. All collected questionnaires were then coded for

purposes of analysis. Qualitative data was analyzed by content analysis by

identifying and classifying themes that relate to the research questions. Descriptive

statistics including the use of percentages, frequency counts, measures of central

tendency (mean, mode, median) and standard deviation were used to analyze

quantitative data. Descriptive statistics help to present the results of the analysis

quantitatively (Grix 2009). This was accomplished by use of Statistical package for

social sciences (SPSS) version 21.0 computer programme. SPSS was used to

perform the analysis as it aids in organizing and summarizing the data by the use of

descriptive statistics.

Data collected during interviews and focus group discussions was transcribed after

which chi-square test was used to test the hypotheses i.e. reveal the association

between the various variables. Chi square is a statistical technique which attempts to

establish the relationship between two variables which are categorical in nature. The

technique compares observed data with data one would expect to obtain according to
 33

specific hypotheses. Chi test was used to assess the degree and nature of association

between the independent and dependent variables i.e. relationship between influence

of drugs and substance abuse and reproductive health (marital breakdown, reduced

sexual activity and infertility).

The final results of data analysis were summarized and presented by use of figures,

frequency tables, charts and graphs for easy understanding.

3.9 Variable selection, Data Collection and Data Analysis Method

Table 3.4: Variables used in the research, Data Collection Instrument and Data
Analysis Method
Variable Data Collection Instrument Data Analysis Method
Types of drugs and • Questionnaires • Cross tabulation
substances commonly • Interview schedules-key • Frequencies
abused informants • Percentages
• Focus group discussion
Sources of drugs and • Questionnaires • Cross tabulation
substances • Interview schedules-key • Frequencies
informants • Percentages
• Focus group discussion
Reasons for abusing • Questionnaires • Cross tabulation
drugs and substances • Interview schedule-key • Frequencies
informants • Percentages
• Focus group discussion
Influence of drugs and • Questionnaires • Cross tabulation
substance abuse on • Interview schedule-key • Frequencies
marriage informants • Percentages
• Focus group discussion • Chi square
Influence of drugs and • Questionnaires Cross tabulation
substance abuse on • Interview schedule-key • Frequencies
sexual activity informants • Percentages
• Focus group discussion • Chi square

Influence of drugs and • Questionnaires • Cross tabulation

substance abuse on • Interview schedule-key • Frequencies
fertility informants • Percentages
• Focus group discussion • Chi square
 34

Interventions • Questionnaires • Cross tabulation

• Interview schedule-key • Frequencies
informants • Percentages
• Focus group discussion
 35

4.0 DATA ANALYSIS, PRESENTATION AND INTERPRETATION

4.1 Introduction

This chapter presents qualitative and quantitative data analysis using statistical

package for social sciences (SPSS) computer software version 21.0.Analysis was

done using chi-square to assess the degree and nature of relationship between drugs

and substance abuse and marital status, sexual activity and fertility. The results are

presented in form of tables, figures, graphs and text forms. Socio-demographic

characteristics of the respondents are presented first followed by the main findings of

the study.

4.2 Instruments return rate

Completion rate is the proportion of the sample that participated as intended in all the

research procedures. The research study had targeted 384 household heads, four

chiefs, three religious leaders and three FGDs. From these samples, the researcher

managed to gather information from 352 household heads which translates to

91.7%.All the chiefs, religious leaders and FGD participants (100%) responded to

the questions.

According to Mulusa (1990), 50% return rate is adequate, 60% is good, and 70% is

very good. The return rate was hence considered to be within the acceptable range

hence provided the required information for the purpose of data analysis and

interpretation.
4.3 Respondents socio-demographic characteristics

4.3.1 Distribution of respondents by location

 36

Table 4.1 below summarises the respondents return rate.

Table 4.1: Respondents by location

Location Frequency Percent Valid Percent Cumulative Percent
Kanduti 90 25.6 25.6 25.6
Kyalele 83 23.6 23.6 49.2
Thua 88 25.0 25.0 74.2
inyuui 91 25.8 25.8 100.0
Total 352 100.0 100.0

Table 4.1 shows how the respondents were distributed across the four locations of

NzambaniSubCounty. The table reveals that the respondents were distributed almost

equally across the four locations. Kanduti location accounted for 25.6% of the

respondents , Inyuu 25.6%, Kigio 25.0, while Thua accounted for 23.6%.This

makes the sample representative of the whole district.

4.3.2 Distribution of respondents by sub locations

According to Table 4.2, there were disparities in the number of respondents across

the sub locations. While Ndunga, Katumbu , Chomo, met the expected number of

respondents (8.5%), Mureke realized the lowest number of respondents (4.5%).

This, however, did not in any way affect the validity of the sample.
 37

Table 4.2: Respondents by sub-locations

Sub-location Frequency Percent Valid Percent Cumulative

Percent

Gatanga 30 8.5 8.5 8.5

Kirwara 30 8.5 8.5 17.0

Chomo 30 8.5 8.5 25.6

Mugumoini 24 6.8 6.8 32.4

Mabanda 30 8.5 8.5 40.9

Mithandukuini 29 8.2 8.2 49.1

Kigio 28 8.0 8.0 57.1

Ithangarari 30 8.5 8.5 65.6

Gakurari 30 8.5 8.5 74.1

Kiriaini 25 7.1 7.1 81.3

Mureke 16 4.5 4.5 85.8

Thare 24 6.8 6.8 92.6

Gathanji 26 7.4 7.4 100.0

352 100.0 100.0

 38

4.3.3 Distribution of respondents by gender

Responses were sought from the respondents to indicate their gender .The results of the

findings are summarized in figure 4.0.

Figure 4.0: Distribution of respondents by gender

Figure 4.0 show how the respondents were distributed across different genders.

Majority of the respondents, 57.7% were male with 40.3% being female. This shows

that there was near gender parity since all genders were well represented. Gender is

an important factor in determining fertility as fertility rate is determined by the

average number of children that a woman would have in her reproductive period,

usually 15-49 years.

 39

4.3.4 Distribution of respondents according to age

Responses were sought from respondents about their ages .The respondents provided

information as presented in figure 4.1.

Figure 4.1: Ages of Respondents

Figure 4.1 show how the respondents were distributed across different age groups.

Majority of the respondents 35.2% were between 30-39 years, 32.1% were between

40-49 years, while 27.8% were between 20-29 years. Notably, 4.8% of the

respondents were between 15-19 years. The statistics show that most of the

respondents were young adults between ages 20-39 years.

 40

4.3.5 Distribution of respondents according to marital status

Respondents marital status was categorized into married, never married, widow/er,

separated and divorced.

Figure 4.2: Respondents marital status

Figure 4.2 indicates that majority of the respondents were in union, ( 61.4% ) with a

substantial proportion having not entered in marital union,( 19.0%). Separated and

divorced were 11.1% and 3.4% respectively.

4.3.6 Distribution of respondents’ marital status by their age groups

Respondent’s marital status was compared to their age groups as shown in table 4.3

below.
 41

Table 4.3: Respondents’ marital status by age groups

AGE MARITAL STATUS

Married Never Widow/er Separated Divorced Total

Married
15-19 0.5% 19.4% 5.6% 5.1% 0.0% 4.8%

20-29 20.8% 55.2 33.3% 12.8% 41.7% 27.8%

30-39 38.4% 17.9 33.3% 46.8% 33.3% 35.2%

40-49 39.8% 7.5% 27.8% 35.9% 25.0% 32.1%

Total 61.4% 19.0% 5.1% 11.1% 3.4% 100%

According to table 4.3, majority of the respondents, 61.4% were in union. The results

show that in early years of their lives (20 years), most respondents opt not to get

married, but as they grow older, most decide to get married. Separation and divorce

information from the results showed that majority of the separated respondents were

in 30-39 age group, 46.8%, while divorced were in the age group 20-29, 41.7%.The

age and marital status factor meant that the sample was representative and that the

respondents were mature and capable of making informed decisions.

4.3.7 Respondents religious preference

Responses were sought from the respondents about their religious beliefs as shown in
figure 4.3 below.
 42

Figure 4.3: Respondents Religious preference

From the findings in figure 4.3, the respondents were predominantly Christians. 52%

were Catholics while 44.3% preferred Protestants churches. There were few Muslims

accounting for 0.3% of the respondents.

4.3.8 Distribution of respondents by educational levels

Responses were sought from respondents on their level of education. The summary of

the findings is enumerated in figure 4.4.

 43

Figure 4.4: Respondents level of education

Figure 4.4 show the level of education of the respondents. 42% of the respondents

had secondary level of education as their highest level of education.30% had primary

level of education while only 3% had attained university level of education Studies

show that there is a direct relationship between drug and substance abuse and

reproductive health.

4.3.9 Respondents occupation

The study required that respondents to state their occupation .The findings of the

respondent’s occupation are summarized in figure 4.5.

 44

Figure 4.5: Distribution of respondents by occupation

According to Figure 4.5 majority of the respondents are farmers as the District is

solely an agricultural region with numerous agricultural activities, for example,

cultivation of cash crops such as tea coffee and horticultural crops. There are many

plantations growing coffee and flowers. 26.7%. 23.6% and 23.9% were engaged in

small businesses or were formally employed respectively.

4.4 Types, sources and drug use

4.4.1 Awareness of drugs and substances

The respondents were asked to indicate their awareness on different types of drugs and

substances.
 45

Table 4.4: Respondents’ awareness of types of drugs

Percent Valid Percent Cumulative Percent

Alcohol 24.1 24.1 24.1

Cigarettes 24.0 24.1 48.2
Khat/Miraa 19.1 19.1 67.3
Bhang 20.6 20.7 88.0
Cocaine 6.0 6.0 94.0
Heroine 5.1 5.1 99.1
Others 0.9 0.9 100.0
Total 99.7 100.0
N/R 0.3
Total 100.0

The results revealed a high level of awareness of alcohol, cigarettes, bhang and khat.

Out of 1405 response cases of awareness of drugs and substance, 24.1% were aware

of alcohol, 24.0% cigarettes, 20.6% bhang, and 19.1% khat/miraa. Very few

responses were aware of hard drugs such as cocaine at 6.0% and heroine at 5.1%.

This prompted the researcher to ask the respondents the commonly abused drugs and

substances.

4.4.2 Commonly used and abused drugs and substances

Having ascertained that respondents and discussants were aware of different types of

drugs and substances, the researcher was prompted to ask the respondents the

commonly abused drugs and substances.

 46

Table 4.5: Commonly used and abused drugs and substances

Drug Highly Abused Commonly Rarely Not Abused
Abused Abused
Alcohol 63.9% 32.1% 2.6% 0.9%

Bhang 28.4% 40.6% 23.0% 3.7%

Cigarettes 56.3% 36.6% 3.4% 1.7%

Cocaine 2.0% 2.3% 15.1% 35.2%

Heroine 0.6% 0.6% 13.6% 38.6%

From the results of Table 4.5, alcohol, 63.1%, and cigarettes, 56.3%, are the highly

abused drugs with bhang, 28.4% coming a distant third. This agrees with the

findings of Nacada, (2004) that showed that alcohol (second generation and

changaa), cigarettes and bhang were the most abused drugs due to their relative

availability. The hard drugs such as cocaine and heroin which are more expensive

and, therefore, less available are rarely abused.

4.4.3 Drug abuse prevalence and extent

The respondents were asked to indicate their opinion on the prevalence and extent of

drug abuse. The summary of the responses are summarized in table 4.6 and 4.7.

Table 4.6: Is there drug abuse in your location?

Percent Valid Percent Cumulative Percent
YES 96.6 96.6 96.6
NO 3.4 3.4 100.0
100.0 100.0
 47

Table 4.7: Extent of drug abuse

Extent Percent Valid Percent Cumulative Percent
Very High 0.3 0.3 0.3
High 69.0 69.0 69.3
Very Low 2.6 2.6 71.9
N/A 28.1 28.1 100.0
Total 100.0 100.0

According to table 4.6, 96.6% of the respondents concurred that there was drug

abuse which according to table 4.7, 69.0% of the respondents supported the fact that

the extent of drug abuse was high. There was a strong consensus among the

respondents that alcohol, cigarettes and bhang abuse was a major problem owing to

the high level of usage, increasing trend, ease of availability, affordability and

accessibility. Findings from the key informants and the discussants were in

conformity to those of the respondents.

4.4.4 Sources of drugs

Responses were sought from respondents on the sources of drugs. The findings are

summarized in figure 4.6.

 48

Figure 4.6: Sources of drugs.

24.1% of the respondents, key informants and discussants reported that drugs were

sourced from peddlers while 19% and 17.9% reported that drugs were accessed from

the local bars and shops respectively. The study, therefore, revealed that the drugs

are readily available from the community where they are accessible. It was evident

that the drugs are acquired from peddlers and sellers. This agrees with the conceptual

framework for this study that easy availability of drugs contributes to drug abuse.

The results also agree with NACADA (2004) findings that kiosks, hawkers and

peddlers as the main sources of drugs.

4.4.5 Respondents utilization of drugs and substances

Respondents were asked if they had used any of the drugs and substances at least ones

in their lifetime.
 49

Table 4.8: Have you ever taken any of the above drugs?
Frequency Percent Valid Cumulative Percent
Percent
YES 195 55.4 55.4 55.4
NO 157 44.6 44.6 100.0
Total 352 100.0 100.0

Table 4.8 shows respondents’ use of drugs and substances. The results reveal that

more than half, 55.4%, of the sampled respondents had at one time or another used

drugs and substances, while 44.6% had not. The high prevalence of drug abuse

possibly reflects the current overall situation of drug abuse in the country. For

example, in 2004, NACADA reported that the national prevalence of substance

misuse was 60% for alcohol, 58% for tobacco, 23% for bhang and 22% for khat.

4.4.6 Reasons to engage in drugs and substance use and abuse

The respondents were asked to indicate their opinion on the reasons that made them

engage in drugs and substance use and abuse. The responses are summarized in table

4.9.

Table 4.9: Reasons encouraging drugs abuse

Reason Percent Valid Cumulative
Percent Percent
Peer Pressure 24.9 24.9 24.9
Curiosity 17.7 17.7 42.6
Influence from family members 6.3 6.3 48.8
Availability 8.1 8.1 56.9
 50

Reduce Stress 14.7 14.7 71.6

Others 0.7 0.7 72.3
N/A 27.7 27.7 100.0
100.0 100.0

24.9% of the respondents were of the view that they engaged in drugs and substance

use due to peer pressure, while 17.7% and 14.7% reported that it was due to curiosity

and to reduce stress respectively. 8.1% reported that it was because of the availability

of drugs and substances, while, 6.3% reported that it was due to influence of family

members. The study revealed that peer pressure was an important contribution to the

dug taking habit. The findings further show that some respondents engaged in drug

abuse to reduce stress caused by lack of employment. Findings from NACADA

(2012) found that one of the most important direct causes of drugs and substance

abuse is easy availability of drugs and substances. Chiefs and religious leaders who

were the key informants also cited peer pressure and influence from family members

as contributing to drug abuse.

 51

4.5 Influence of Drugs and Substance Abuse on reproductive health

The research study considered three indictors of reproductive health, namely marriage,

sexual activity and fertility.

4.5.1 Influence of drugs and substance abuse on marriage

The respondents were asked to indicate their opinion on the influence of drugs and

substance abuse. The summary of their responses is shown in table 4.17.

Table 4.10: Influence of drugs and substance abuse

Frequency Percent Valid Cumulative
Percent Percent
Marital Breakdown 96 27.3 27.3 27.3
Reduced Interest In Sex 81 23.0 23.0 50.3
Hiv and Aids 79 22.4 22.4 72.7
Infertility 66 18.8 18.8 91.5
Others 20 5.7 5.7 97.2
 52

N/R 10 2.8 2.8 100.0

352 100.0 100.0

As indicated in table 4.10, 27.3% of the respondents reported drugs and substance

abuse as having contributed to marital breakdown.23% reported that drugs and

substance abuse had led to reduced interest in sexual activity, while 18.8% were of

the view that infertility was as a result of drugs and substance abuse. 22% observed

that due to irresponsible sexual behaviors emanating from drug and substance abuse,

there was rampant spread of HIV and AIDS.

4.5.1(a) Relationship between drugs and substance abuse and marital status

Opinion was sought from the respondents of different marital status to indicate

whether they had used and abused drugs and substances at least ones in their

lifetime.

Table 4.11: Relationship between drugs and substance abuse and marital status
MARITAL STATUS
Have Married Never Widow/er Separated Divorced Total
you ever Married
taken
YES 64.1% 16.4% 3.6% 12.8% 3.1% 100%
any
drugs
NO 58% 22.3% 7.0% 8.9% 3.8% 1005

Total 61.36% 19.03% 5.11% 11.08% 3.41% 100%

Table 4.11 shows that majority of the respondents in union, (64.1%) had taken at

least one of the stated drugs, while 58.0% had not. Among the separated, 12.8% had
 53

taken drugs, while only 8.9% had not. The number of divorcees, who had taken

drugs, was 3.1%, and those who had not 3.8%.This was almost equal. Marriage is an

important indicator of the regular exposure of women to the risk of pregnancy and,

therefore, important in determining fertility.

4.5.1(b) Influence of drugs on spouse

Respondents were requested to give their opinion as to whether their spouses are

influenced by drugs and substance use and abuse.

Table 4.12: Is your spouse affected by drugs?

Percent Valid Percent Cumulative Percent
NO 33.8 39.4 39.4
YES 52.0 60.6 100.0
Total 85.8 100.0
N/R 14.2
Total 100.0

52% of the respondents indicated that their spouses are affected by their use and

abuse of drugs and substances with only 33.8% reporting that their spouses are not

affected.

In order to determine the influence of drugs and substance abuse on marriage using

the chi-square test, effects of drugs were categorized into three; no effects, less

severe effects and severe effects (Table 4.13).

 54

Table 4.13: Influence of drugs and substances

Effect Severity of the Percent Valid Cumulative
effect Percent Percent
N/A No effect 52.0 52.0 52.0

Irresponsible Less severe 5.4 5.4 57.4

Infertile Severe 0.9 0.9 58.2

Financial Problems Less severe 8.0 8.0 66.2

Lack of Interest of Sex Severe 2.3 2.3 68.5

Loss of Life Severe 0.3 0.3 68.8

Poor Health Severe 3.7 3.7 72.4

Poverty Less severe 2.0 2.0 74.4

Domestic Violence Severe 9.9 9.9 84.4

Family Neglect Less severe 1.4 1.4 85.8

Missing No effect 14.2 14.2 100.0

Total ... 100.0 100.0

From Table 4.13, 9.9% reported that there were cases of domestic violence, 8.0% say

their spouses ran into financial problems, 5.4% of their spouses had become

irresponsible while 2.3% had lacked interest in sex. (Table4.13). All these

compounded; bring about problems in the marriage unit, which may lead to marital

breakdown.
 55

Table 4.14(a) Cross tabulation of effect of drugs and substance abuse against

marital status

To test whether there is a significant relationship between effect of drug and

substance abuse and marital status the contingency table and Chi-square below were
used. The contingency table shows the observed frequencies in every category in the
cross classification.
Marital status

Effect of drug and Married Never Widow/er Separated Divorced Total

substance abuse married

No effect 25.28% 14.77% 3.13% 3.69% 1.70% 48.58%

Less severe 24.15% 4.26% .57% 4.55% .57% 34.09%

Severe 11.93% 0.00% 1.42% 2.84% 1.14% 17.33%

Total 61.36% 19.03% 5.11% 11.08% 3.41% 100.00%

Table 4.14 (a) show that generally, observed frequencies across the row total decreases

even though with one anomaly. The row total changes from 61.36% to

19.03% then 5.11% before increasing to 11.08% and then eventually decreasing to

3.41%. The column total also decreases from 48.58% to 34.09% and lastly to

17.33%. The two total frequencies show that there is a trend in the data concerning

the two variables. It is realized that across the rows and down the columns the

observed frequencies decreases, therefore the severity of effect of drug and substance

abuse and marital status are related. This assertion can also be checked by Chisquare

test.
 56

Table 4.14(b) Chi-square test of effects of drugs and substance abuse and marital

status

The Chi-square test results of the above contingency table are indicated below.

Chi-Square Tests
Value Df Asymp. Sig.
(2-sided)
Pearson Chi-Square 41.979a 8 0.000
Likelihood Ratio 52.836 8 0.000
Linear-by-Linear Association 0.028 1 0.867
N of Valid Cases 352
The Chi-square results show that 𝜒2 value is 41.979 at 8 degrees of freedom and

significance value of 0.000. Since the significance value is less than 0.05 then we

reject the null hypothesis that there is no significant relationship between effect of

drug and substance abuse and marital status. Therefore, the research concludes that

increase in individual’s severity of effect of drug and substance abuse inversely

influences his/her marital status.

4.5.2 Influence of drugs and substance abuse on sexual activity

4.5.2(a) Frequency of sexual intercourse per month at the start of marriage

Respondents were requested to state the number of times per month they were having

sexual intercourse with their spouse at the start of marriage .The responses are

summarized in table 4.22 below.

Table 4.15 Frequency of sexual activity per month at the start of marriage
Frequency Percent Valid Cumulative
Percent Percent
 57

5 Times 9.9 10.5 10.5

6-10 15.9 16.8 27.3
11-15 20.2 21.3 48.6
More than 15 31.3 33.0 81.7
N/R 17.3 18.3 100.0
Total 94.6 100.0
Missing 5.4
Total 100.0

Table 4.15 shows that majority of the respondents were sexually active at the start of

the marriage. 31.3% reported that at the start of marriage, they were having sex more

than 15 times per month. 20.2% were having sex between 11-15 times per month

while15.9% were having sex had 6-10 times. Only 9.9% were having sex 5 times a

month. Sexual activity determines fertility since the probability of pregnancy is

related to the frequency of intercourse.

4.5.2(b) Present frequency of sexual intercourse per month

Responses were sought from the respondents about the number of times per month

they were presently engaging in sexual intercourse with their spouses. The results of

the findings are presented in table 4.16 below.

Table 4.16 Present frequency of sexual intercourse per month

Frequency Percent Valid Percent Cumulative
Percent
Less than 5 Times 21.6 23.9 23.9
 58

5 Times 13.9 15.4 39.3

6-10 15.1 16.7 56.0

11-15 7.7 8.5 64.5

More than 15 8.0 8.8 73.3

N/R 24.1 26.7 100.0

Total 90.3 100.0

Missing 9.7

100.0

Table 4.16 shows a decline in sexual activity from the start of marriage. The

percentage of respondents who had sex for more than 15 times a month at the start of

marriage had fallen to as low as 8% from 31.3%, those who used to have sexual

intercourse between 11-15 times had fallen from 20.2% to a mere 7.7%.

Consequently, at the start of marriage, only 9.9% had sex for 5 times per month but

currently, the number has risen to 45.5%. Comparing sexual activity at the start of

marriage and at present, it is clear that sexual activity is more common among the

newly married. As the couples advance in age, there is a decline in sexual activity.

4.5.2(c) Reasons for reduced sexual activity

The respondents were asked to indicate their opinion on the reasons for reduced sexual

activity. The summary of the responses are presented in table 4.17.

 59

Table 4.17 Reasons for reduced sexual activity

Reasons Percent Valid Cumulative Percent

Percent
After taking drugs 28.4 30.4 30.4
After spouse taking 15.1 16.1 46.5
N/A 9.4 10.0 56.5
Total 40.6 43.5 100.0
N/R 93.5 100.0
Missing 6.5
Total 100.0

According to table 4.17, 28.4% of the respondents reported that sexual activity

started to decline after they started taking drugs while 15.1% attributed the decline to

their spouses’ use of drugs. These findings concur with the fact that most

respondents reported that drug abuse has contributed to them not having the number

of children they purposed to have at the start of marriage.

Table 4.18(a) Cross tabulation of effect of drugs and substance abuse against

frequency of sexual intercourse per month

To test whether there is a significant relationship between effect of drug and

substance abuse and frequency of sexual intercourse, the contingency table and
Chisquare below were used. The contingency table shows the observed frequencies
in every category in the cross classification.

Frequency of sexual intercourse per month

Effect of drug less than 5 5 times 6-10 11-15 more than n/a Total
and substance times 15
abuse
No effect 7.23% 5.35% 7.55% 5.35% 5.66% 17.61% 48.74%

Less severe 10.06% 6.60% 5.35% 2.83% 2.83% 6.92% 34.59%

 60

Severe 6.60% 3.46% 3.77% 0.31% 0.31% 2.20% 16.67%

Total 23.90% 16.41% 15.67% 8.49% 8.81% 26.73% 100.00%

Table 4.18(a) shows that total observed frequencies decrease across the row starting

from 23.9% to 16.41% then 15.67% and 8.49% before slightly increasing to 8.81%

for the applicable responses. Similarly, down the column the observed frequencies

decreases from 48.74% to 34.59% and lastly 16.67%. Therefore, there is a trend

established in the cross classification which suggests that the two variables are

related. This assertion can be checked by Chi-square test. The Chi-square test results

of the above contingency table are indicated below.

Table 4.18(b) Chi-square test of effects of drugs and substance abuse and sexual

activity

The Chi-square test results of the above contingency table are indicated below.

Chi-Square Tests

Value Df Asymp. Sig.

(2-sided)
Pearson Chi-Square 36.129a 10 .000

Likelihood Ratio 38.843 10 .000

Linear-by-Linear Association 25.561 1 .000

N of Valid Cases 352

The Chi-square results show that 𝜒2 value is 36.129, at 10 degrees of freedom and

significance value of 0.000. Since the significance value is less than 0.05 then we
 61

reject the null hypothesis that states that there is no significant relationship between

effect of drug and substance abuse and frequency of sexual intercourse per month.

Therefore, we conclude that as the individual’s effect of drug and substance abuse

increases then the frequency of sexual intercourse per month decreases.

4.5.3 Influence of drugs and substance abuse on fertility

4.5.3(a) Desired number of children at the start of marriage

Responses were sought from respondents on the number of children they desired to

have at the start of marriage. The summary of the responses is enumerated in table

4.19.

Table 4.19 Desired numbers of children at the start of marriage

Desired no. Percent Valid Percent Cumulative

of children Percent
2.00 7.4 8.1 8.1
3.00 10.5 11.5 19.6
4.00 20.2 22.1 41.7
5.00 7.7 8.4 50.2
6.00 5.7 6.2 56.4
N/A 39.8 43.6 100.0
Total 91.2 100.0
Missing 8.8
Total 100.0

Majority of the respondents (57.4%) had desired to have a specific number of

children at the start of marriage. Table 4.26 shows that majority of the couples,
 62

20.2%, had desired to have four children in their marriage.10.5% had desired at

having three children,7.7%, five children, 7.4% two children, while 5.7% had

desired six children.

The National average fertility rate stands at 4.6 children per woman and 3.4 children

per woman in Central province (KDHS, 2008-2009).This means that at the start of

marriage majority of the respondent’s fertility rate was above the national and

provincial average.

4.5.3(b) Present number of children in marriage

Respondents were asked to state the number of children present in their marriage. A

summary of their responses is shown in table 4.20.

Table 4.20: Present number of children in marriage

Number of children Percent Valid Percent Cumulative Percent
None 2.3 2.3 2.3
2.00 43.8 44.4 46.7
3.00 22.2 3.2 49.9
4.00 11.1 11.2 61.1
5.00 8.0 8.1 69.2
8.00 2.6 2.6 71.8
9.00 3.1 22.5 94.2
N/A 5.7 5.8 100.0
Total 98.6 100.0
Missing 1.4
100.0

Table 4.20 indicates a variation in the number of children and preferred number of

children at the start of marriage. For instance, out of the 20.2% who had purposed to
 63

have 4 children at the start of marriage, only 11.1% had met the target. In a nutshell,

those couples who had aimed at getting more children had ended up having less.

50% of the couples concurred with the fact that these were not the number of children

they purposed to have while 46.6% were contented with the number of children they

had. The results of the findings present evidence of fertility decline. At present, average

fertility rate is below the national and provincial average as opposed to the start of

marriage when it was above the national and provincial average.

Table 4.21: Are these the number of children desired?

The respondents were asked to indicate whether the number of children they have is
what they desired to have. Table 4.21 gives a summary of their responses.

Percent Valid Percent Cumulative Percent

No 50.0 51.8 51.8
Yes 46.6 48.2 100
Total 96.6 100
N/R 3.4
100

4.5.3(c) Reasons for not having the desired number of children

The respondents were asked to indicate their opinion on the reasons that made them not

to have the desired number of children. Table 4.22 summarizes their responses.

Table 4.22: Reasons for not having the desired number of children
Reasons Percent Valid Percent Cumulative Percent
No Appetite 2.3 2.4 2.4
 64

Less Libido 0.9 0.9 3.3

Spouse Behaviour 2.0 2.1 5.4
Divorced 1.1 1.2 6.6
Death 2.0 2.1 8.8
Domestic Problems 8.8 9.4 18.1
Drug Abuse 9.1 9.7 27.8
Being Away 2.0 2.1 29.9
Family Planning 7.1 7.6 37.5
Age 7.1 4.8 45.0
Separated 4.5 2.7 49.8
Still New 2.6 47.4 52.6
N/A 44.6 100.0 100.0
Total 94.0
N/R 21 6.0
352 100.0

Reasons for not having the desired number of children were varied. However, drug

abuse topped the list at 9.1%. Domestic problems accounted for 8.8%. Some

respondents attributed this to family planning, 7.1%.Majority of the respondents

expressed dissatisfaction with the fact that they had not realized the desired number

of children.

Table 4.23 (a) Cross tabulation of effect of drug and substance abuse against

number of children in marriage

To test whether there is a significant relationship between effect of drug and

substance abuse and number of children, the contingency table and Chi-square below
were used. The contingency table shows the observed frequencies in every category
in the cross classification.
 65

Number of children in this marriage

Effect of drug none 2.00 3.00 4.00 5.00 8.00 9.00 n/a Total
and substance
abuse
No effect .58% 21.04% 1.15% 5.48% 2.88% 1.15% 10.95% 4.90% 48.13%

Less severe 1.15% 16.14% 1.44% 3.46% 2.02% .86% 8.65% .86% 34.58%

Severe .58% 7.20% .58% 2.31% 3.17% .58% 2.88% .00% 17.29%

Total 2.31% 44.38% 3.17% 11.24% 8.07% 2.59% 22.48% 5.76% 100.00%

Table 4.23 (a) shows that observed frequencies decrease down the columns including

the totals column. The row total frequencies does not show any trend but the column

total shows the frequencies decreasing from 48.13% to 34.58% and lastly to 17.29%.

Therefore, a trend can only be established in the columns which do not guarantee a

relationship between the two variables. To check whether a relationship exists

between the two variables then a Chi-square test is used.

Table 4.23(b): Chi-square test of influence of drugs and substance abuse and

fertility

The Chi-square test results of the above contingency table are indicated below.

Chi-Square Tests

Value Df Asymp. Sig.

(2-sided)
Pearson Chi-Square 25.272a 14 0.032
 66

Likelihood Ratio 26.493 14 0.022

Linear-by-Linear Association 11.365 1 0.001
N of Valid Cases 352

The Chi-square results show that 𝜒2value is 25.272, at 14 degrees of freedom and

significance value of 0.032. Since the significance value is less than 0.05 then we

reject the null hypothesis that states that there is no relationship between effect of

drug and substance abuse and number of children in the marriage

(fertility/fecundity). Therefore, the research concludes that as the individual’s

severity of effect of drug and substance abuse increases, the number of children in

his/her marriage (fertility/fecundity) decreases.

4.6 Interventions

The respondents were asked to give their opinion as a solution to the drugs problem.

Table 4.24 summarizes their responses.

Table 4.24: Measures to solve drugs problems

Percent Valid Cumulative
Percent Percent
Educate People 34.4 39.5 39.5
Heavy Penalty 21.0 24.2 63.7
Rehab Centres 5.7 6.5 70.3
Guidance 8.8 10.1 80.4
Job Creation 6.0 6.9 87.3
Ban Trade 9.9 11.4 98.7
Don’t Know 1.1 1.3 100.0
Total 86.9 100.0
N/R 13.1
 67

Total 100.0

According to table 4.24, majority of the respondents, 34.4%, suggested that the

problem of drugs and substance abuse may be solved by educating the public on the

implications of drugs and substance abuse. Other respondents, 21.0%, were of the

view that heavy penalties should be imposed on the suppliers and the abusers, 9.9%

advocated for a ban on the trade, 8.8% advised on guidance and counseling while

6.0% and 5.7% were for job creation and establishment of rehabilitation centres. This

is in agreement with the views of the key informants as well as the discussants.

5.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

This chapter presents the summary of findings, conclusions and recommendations of

the study. It also presents the proposed future studies. The study sought to investigate

the influence of drugs and substance abuse on reproductive health in Nzambani Sub

County , Kitui County . The study adopted descriptive survey design which enabled

collecting data from various respondents using different instruments. Multistage

sampling was used to select representative households. The sample comprised

352 household heads, four chiefs, three religious leaders, and three FGDs.

5.2 Summary

The summary has discussed the findings of the study with a view to answering the

research questions that were used in the study.

 68

5.2.1 Objective 1: To identify the types and sources of drugs and substances abused

in Nzambani Su b Count y

The study reveals a high level of awareness of alcohol, cigarettes, bhang and khat.

On the types of drugs abused, the findings indicate that alcohol, cigarettes and bhang

were highly abused. The hard drugs such as cocaine and heroin were rarely abused.

The study revealed further that the drugs are readily available in the community where

they are easily accessible. It was evident from the findings that the drugs are acquired

from peddlers, local bars and shops/kiosks. Additionally, the study found out that the

extent of drug abuse level among the respondents was quite high.

5.2.2 Objective 2: To determine the reasons for the use and abuse of drugs and

substances in Nzambani Sub County

On the reasons for the use of drugs and substance abuse, the respondents indicated

that the main reasons that contributed to the use and abuse of drugs and substances

were peer pressure, curiosity, stress, availability of the drugs and influence from

family members.
 69

5.2.3 Objective 3: To investigate the perceptions of people concerning the

influence of drugs and substance abuse on marriage, sexual activity and fertility

This was the main objective of the study.

Figure 5.1: Reproductive health problems

Figure 5.1 gives a summary of the negative influences of drugs and substance abuse.
 70

The findings agree with the conceptual framework that listed infertility, HIV and

AIDS, marital breakdown, and reduced sexual activity as immediate effects of drugs

and substance abuse.

5.2.3 (a) Influence of drugs and substance abuse on marriage

The study reveals that a large percentage of the respondents, discussants as well as

the key informants stated that drugs and substance abuse had a negative influence on

marriage. Most of them reported that their spouses had either become violent,

irresponsible or had run into financial problems which affected the family unit.

Alcohol and bhang users were reported to be the most common causes of domestic

violence. The factor most strongly related to marital violence was husband’s alcohol

use.

According to Table 4.14 (b) Chi-square value is 41.979 at df= 8 and p=0.000.

Therefore, Chi-square analysis reveals that there was a significant relationship

between drugs and substance abuse and marital breakdown. The null hypothesis was

therefore rejected.

5.2.3(b) Influence of drugs and substance abuse on sexual activity

Table 4.16 compares sexual intercourse at the start of marriage and present. The

study reveals a reduction in sexual activity which most of the respondents, 44.5%,

attributed to abuse of drugs either by themselves or their spouses.

 71

Table 4.18 (b) gives Chi-square value (χ^2) as 36.129 at 10 df and p=0.000. Since

pvalue is less than the statistical significance, the null hypothesis was rejected therefore

the Chi-square test revealed a significant relationship between drugs and substance

abuse and reduced sexual activity.

5.2.3(c) Influence of drugs and substance abuse on fertility

Fertility was determined by comparing the number of children a couple desired to

have at the start of marriage and the present number of children in marriage.

Findings in the field indicate that 50% of the couples (Table 4.20) ended up not

having the preferred number of children. Currently, most couples had fewer children

than desired at the start of marriage. Reasons for the variation were many, with drug

abuse leading at 9.1% (Table 4.21).

Chi-square results from Table 4.23 (b) indicate a significant relationship between drugs

and substance abuse and fertility (χ^2) value is 25.272, at 14 df and p=0.032).

The null hypothesis was therefore rejected.

5.3 To identify interventions that can be put in place to deal with causes and

consequences of drugs and substance abuse in Nzambani Su b County

Majority of the respondents’, discussants and key informants suggested that

educating the public on the negative implications of drugs and substance abuse may

be a measure of solving the problem. Other measures include heavy penalties on

 72

suppliers and abusers, a ban on drugs and substances of abuse, guidance and

counseling establishment of rehabilitation centres.

5.4 Conclusion

Despite the fact that strategies have been put in place to curb the problem of drugs

and substance abuse, there is a general observation of an increase in the number of

drug users in Nzambani Sub County . Very few people seem to be aware of the

influence of drug abuse. To be more effective in regulating drugs and substance

abuse, a number of issues that need attention were identified . These are outlined

under recommendations.

Findings of the study indicated a high level of awareness of the rate of drug abuse

which is increasing day by day. The study also revealed a high level of awareness of

alcohol, cigarettes, bhang and khat. This is the case since alcohol (second generation

and chang’aa), cigarettes, bhang and khat were shown to be the most available and

accessible drugs. Since accessibility also implies cost, hard drugs such as cocaine

and heroin which are more costly are less accessible. One of the most important

reasons for drug and substance abuse is easy availability of cheap drugs and

substances.

tes and khat are cheap and easily available and can be easily accesse

Second generation alcohol, chang’aa, cigaret d from the local community and shops.
This agrees with the proposition in the conceptual frame work for this study that easy
availability of drugs, peer pressure, unemployment and dysfunctional families
contributes to drug abuse. The findings also agree with those of NACADA (2004,
2007), which found that alcohol; khat and cigarettes were the commonly abused drugs.
 73

From the findings, it was also evident the locality was the main source of drugs.

Most respondents indicated that drugs were either sourced from small shops/kiosks,

peddlers or peers. The results agree with NACADA (2004) findings that kiosks,

hawkers, peddlers and family members were the main sources of drugs.

Factors that contributed to drug abuse as revealed by the study include stress caused

by lack of employment. It was noted that people engage in taking drugs because of

idleness. The youth, especially, have no jobs and have a lot of time to idle around.

The hard economic conditions force them to seek solace in drugs and substances.

Peer influence, negative role modeling and parental negligence were also reported to

lead people into taking drugs and substances.

The negative influence of drugs and substance abuse on reproductive health is clearly

identified by the respondents, key informants as well as discussants. Dependants on

drugs and substances lead to negative outcomes such as marital breakdown, reduced

sexual activity and infertility. The findings indicated that drug abuse has a strong

negative effect on marital relationships and family cohesion.

Effects of drug abuse are real with domestic violence and divorce topped the list.
Alcohol and bhang were established to be having the strongest effect on domestic

violence. In a nutshell, drug abuse affects husband-wife relationship in a variety of

ways, including intimate partner violence, increased conflicts and low relationship

satisfaction as well as poor sexual relationship. Consequently, the result is breakup

of families as wives leave their alcoholic and irresponsible husbands.

 74

Kyalo, (2007), points out that a drug like cannabis sativa (bhang), affects the

hormonal reproductive system by reducing the level of testosterone, the male sexual

hormone and the sperm cells. As consumption increases, males experience reduced

sexual activity while may ultimately result to infertility. This is in line with the

conceptual frame work which cites marital breakdown, reduced sexual activity,

HIV/AIDS as well as infertility as immediate effects of drugs and substance abuse.

As a way of regulating drug abuse, the youths are supposed to be provided with

sources of income activities to keep them from being idle. Other measures include

education on the dangers of drug abuse, guidance and counseling, introduction of

huge fines for those found guilty as well as closing companies which process such

drugs and substances. There is a general lack of rehabilitation facilities for drug

addicts and other substance abusers. These centres are largely found in urban centres

and thus out of reach for most of the people. Hospitals and rehabilitation centres are

therefore supposed to be established in the rural areas.

5.5 Recommendations

To effectively address the problem of drugs and substance abuse, the following

recommendations were made:

1) Raising awareness on the effects of drugs and substance abuse. NACADA

should do much campaign and create initiatives enlightening the community.

This could be done through public barazas, opinion leaders and village/group

meetings. Civil society, especially religious leaders, has a role to play.

Religious leaders should include, in their messages, issues touching on drugs

 75

instead of just focusing on spiritual life. They must deal with the real issues

affecting their members. All these will provide critical information, thus

empowering the community members make informed decisions.

2) The study revealed that young adults had the highest drugs and substance

abuse prevalence. The young adults should therefore be provided with sources

of income activities as well as engage them in sporting activities. These will

keep them busy and drive them away from drugs and substance abuse.

3) The government should come up with a clear policy on drug abuse. It was

noted that limited enforcement of laws was one of the immediate causes of

drug abuse. Parliament should enact strict laws on drug abuse. In particular,

more enforcement of the law would ensure total compliance. Enforcement

should involve the community in carrying out policy activities.

4) More rehabilitation centers for helping drug addicts should be set up in order

to help support those who need help. It was observed that there is a general

lack of rehabilitation centers in rural areas. These centers are largely found in

urban centers and thus out of reach for most people. The community in the

rural areas is thus left with no alternative but use whatever means in the

community level such as using elders, church leaders among others.

5) There is also need to involve recovered addicts, for example, NACADA

should use people with real life experiences to sensitize the public on the

negative consequences of drugs and substance abuse.

6) There is need for greater prioritization in both funding and capacity

development. From the conceptual frame work, it is evident that drugs and
 76

substance programs are accorded low priority and therefore underfunded. The

ministry concerned as well as NACADA should advocate for increased

funding to drugs and substance abuse programs. The capacity of families,

communities, learning and faith based institutions should be developed to

sustainably address the problem of drugs and substance abuse.

5.6 Recommendations for further research

1) The study was limited to Gatanga Sub County of Murang’a County. A similar

study could be replicated in other districts of Muranga County.

2) Relationship between drugs and substance abuse and HIV and AIDS

3) The impacts of parents abusing drugs on their children’s prevalence to drugs.

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81
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Appendix V: Household Head Questionnaire

 83

INTRODUCTION

My name is Muvengei Philominah a certificate student of Thika technical institute.

Currently I am conducting a study on the implications of drugs and substance abuse

on reproductive health in Nzambani Su bCounty, Kitui County, Kenya.

Instructions

1. Do not write your name anywhere in the questionnaire.

2. Kindly respond by putting a tick where applicable or filling in the empty

spaces.

3. Please answer all the questions in the questionnaires honestly.

4. The information you give will be treated with utmost confidence

SECTION A: BACKGROUND INFORMATION

1. LOCATION ……………………………….

2. SUBLOCATION ……………………………….

3. GENDER Male Female

4. AGE

(a) 15-19 year

(b) 20-29
years

(c) 30-39
years

(d) 40-49 years

5. MARITAL STATUS

Married never married widow/er separated divorced

 84

6. RELIGION

(a) Catholic

(b)
Protestant

(c) Muslim

Other (specify) …………………………………………………………………..

7. LEVEL OF EDUCATION

Primary Secondary College University

8. OCCUPATION

(a) Formally
employed

(b) Farmer

(c) Business

(d) Housewife

(e) Others

(specify)………………………………………………………………

SECTION B- RESEARCH DATA

1. What type of drugs are you aware of? tick as many as possible

Alcohol

Cigarettes
Khat (Miraa)

Bhang
 85

Cocaine

Heroine

Others specify ……………………………………………………………….

2. Is there drug abuse in your location? Yes No

3. If yes what is the extent of drug abuse?

Very high High Low

Very low

4. In your observation what are the most available and commonly abused drugs within
your location?
Drug Highly abused Commonly abused Rarely abused Not at all

Alcohol

Bhang

Cigarettes

Cocaine

Heroine

Others (specify)

……………………………………………………………………………

5. W hat are the sources of these drugs?

6. Have you ever taken any of the above drugs?

Yes No

7. If your answer in the above question is YES, which of the following drugs have you
tried? Tick as appropriate
 86

Drug Yes No

Alcohol

Bhang

Miraa/Khat

Cigarettes

Cocaine

Heroine

Others (Please specify) …………………………….

8. If you have ever taken drugs and substances, what factors encouraged you to

abuse drugs?

9.

Reasons Tick

(a) Peer pressure

(b) Curiosity

(c) Influence from family members

(d) The drugs are readily available

(e) To reduce stress

Others (Please explain)…………………………………………………….

MARRIAGE
 87

10. Are you living with your spouse? Yes No

11. If no, why? Deceased Divorced Separated

12. If divorced or separated, why?……………………………………………….

12 In your opinion, do you think your spouse is affected by your abuse of drugs?

Yes
No

If yes, how are they affected? Give as many as possible

(i) ………………………………………………………………

(ii) ………………………………………………………………..

(iii) ………………………………………………………………..

(iv) ……………………………………………………………….

(v) ………………………………………………………………

SEXUAL ACTIVIY

13 What was the frequency of intercourse per month at the start of your marriage?

5 times

6-10 times

11-15 times
More than 15 times

14 Has the frequency continued? Yes No 15 If no, when

did the frequency decline?

(i)After I started taking drugs

 88

(ii)After my spouse started taking drugs

(iii) Other, specify ……………………………………………………………..

…………………………………………………………………………………

16 When was the last time you had sexual intercourse in this marriage?

17 What is the present frequency of sexual intercourse per month?

Less than 5 times

5 times

6-10 times

11-15 times

More than 15 times

FERTILITY

18 Did you aim to have a specific no of children from this marriage?

Yes No

If yes how many?

19 How many children have you given birth from this marriage?............................... 20

Are these the preferred number of children from this marriage? Yes No

21 If no what has prevented you from having the preferred number of children?

22. Drug and substance abuse has negative implications on reproductive health.

What is your opinion?

(i) Strongly agree

 89

(ii) Agree

(iii) Don’t Agree

23 What are some of the negative reproductive health problems that people

experience as a result of involvement in drugs and substance abuse? Tick as many as

possible

(i) Marital breakdown…………………………………………

(ii) Reduced interest in sexual activity………………………….

(iii) HIV and

AIDS…………………………………………………

(iv)
Infertility……………………………………………………….

(v) Others (specify)…………………………………………………

24 What do you think should be done to solve the problem of drug use and abuse in

the community?

Appendix VI: Interview guide/schedule for key informants

Introduction

My name is Muvengei Philominah Muvai, a certifacate student of thika technical

institute Currently I am carrying out research on the implications of drugs and

 90

substance abuse on reproductive health in Nzambani Sub County, Kitui County. This

interview seeks to find your opinion and knowledge on the effects of drugs and

substance abuse on reproductive health in your area of jurisdiction. The information

will be used to come up with strategies of minimizing the practice in order to

enhance the health and welfare of the residents. The answers you give will only be

used for research purposes and will be kept confidential.

SECTION A: BACKGROUND INFORMATION

1. Location …………………………….

2. Sub location ……………………………

3. GenderMaleFemale

4. Age ……………..years

5. Length of stay in current station

1 year
2 years

3 years

4 years

5 years

Above 6
years
SECTION B – RESEARCH DATA

1. What is the extent of drug and substance abuse in your location/sub location

Very High High Low Very Low

2. Which drugs and substances are commonly abused?

 91

3. How do people access these drugs and substances?

4. Which gender is most likely to abuse drugs and substances?
5. Which age group is most likely to abuse drugs and substances?
6. In your opinion, why do you think people indulge in drug abuse?
7. Do you think people in your location /sub location are contributing to drug
abuse? How?
8. What problems are experienced as a result of people taking and abusing
drugs?
9. What effect do you think taking and abusing drugs have on:
(a) Marriage
(b) Sexual activity
(c) Fertility
10. How does your office attempt to minimize cases of drug and substance
abuse?
11. What challenges have you encountered while addressing drug related
problems?
12. Give suggestions on how best you think the government can address the
problems of drugs and substance abuse.

Appendix VII: Focus group discussion guide for the locals

INTRODUCTION

My name is Muvengei Philominah Muvai, a certificate student of Thika technical

institute Currently I am carrying out research on the implications of drugs and

 92

substance abuse on reproductive health in Nzambani Sub County , Kitui County ,

Kenya.

The purpose of this focus group discussion will be to seek your opinion and

knowledge on the effect of drugs and substance abuse on reproductive health. The

information you give will be kept confidential.

Instructions

Appoint one member of the group to act as the chairman and another to take down

notes.

Focus group discussion guide

1. Do you understand drug abuse?

2. Which drugs are commonly abused?

3. Where do people get these drugs?

4. Are these drugs socially and legally acceptable in the society?

5. Who are the abusers?

6. Who are the victims of drug abuse?

7. Why do people take and abuse drugs?

8. What problems are experienced as a result of people taking and abusing

drugs?

9. What problems do you think taking and abusing drugs have on husbands and

wives?
 93

10. Tell me about incidences of drug abuse.

11. What are the effects of drug and substance abuse on (a) marriage (b)

sexual activity (c)fertility

12. Suggest the measures that can be taken to discourage drug and substance

abuse.