COMMUNITY HEALTH IV

DIPLOMA IN CLINICAL MEDICINE & SURGERY

KMTC

3RD YEARS [YEAR 3 SEMESTER 1]

MODULE 49: COMMUNITY HEALTH IV

Code: CHE 313; Hours - 30; Credits – 3

Pre-requisite(s): Community Health III 1
Module Competence

 ThisModule is designed to enable

the learner acquire knowledge on
application of concepts of
demography, OHS and skills to
address drugs and substance
abuse.

2
 Module Outcomes

 By the end of this module the learner

should: -
1. Apply concepts of demography in
planning health services.
2. Demonstrate knowledge in
management, prevention and control
of common occupational health
conditions and hazards.
3. Manage cases of drug and substance
abuse in the community.
3
Module Units

Unit Name
Hours

Theory Practical
1. Occupational health and safety 10
0
2. Demography 10
0
3. Drug and substance abuse 10 0

4
 Module Content

1. Occupational Health and safety: Historical

background, principles, of occupational
classification of occupational hazards, control and
prevention, occupation related diseases,
occupational Health and safety Regulations
2. Demography: Definition of terms, population
pyramids, dependence ratio, world population
trends, Kenya population trends, sources and uses
of demographic data, census, types, limitations of
census data, population measurements in health
and migration, planning for health services.
3. Drug and substance abuse: definition, commonly
abused drugs and substances, health effects,
management, abuse of prescription drugs, alcohol
control Act and NACADA Act. 5
Teaching Strategies

1. Interactive lecture
2. Small groups discussions
3. Power point presentation
4. E-learning
5. Problem based learning
6. Study guides

6
 Reference

1. Green & Judith Ottoson (2001) Emerging

Theories in Health promotion Practice &
Research: Strategies for Improving Public
Health (Health Systems Management)
Jossey-Bass Publishers
2. Taylor, R. & Taylor, B. (2006) AUPHA Manual
of Health Services Management, Jones and
Burtlett Publishers
3. Heymann, D (Ed) (2004) Control of
communicable diseases manual,
Washington, DC: American Public Health
Association 7
 Reference – Continued

4. Nordberg, E & Kingondu, T (2007) Communicable

diseases (4th Ed) Nairobi: AMREF
5. Afubwa, S.O & Mwanthi, M.A. (2014)
Environmental Health and Occupational health &
safety: Nairobi: A crocodile publishing Ltd
6. Tranter, M. (2004): Occupational Hygiene and Risk
Management, Allen & Unwin
7. Lewis, J. & Thormbory, G. (2006), Employment
Law and Occupational Health: A Practical
Handbook, Blackwell
8. Staren S. Sadhra, K. (1999), Occupational Health
risk assessment Occupational & Environmental
Medicine, (4th Edition). 8
Week Dates Unit
From To
Week 1: Occupational Health and safety; Historical
background, principles, of occupational health and
safety
Week 2: Definitions of terms
Week 3 control and prevention, occupation related diseases,
Week 4 occupation related diseases Health promotion in work
place
Week 5: Occupational Health and Safety Regulations.
Week 6: Demography, definition of terms, population
pyramids,
Week 7: dependence ratio, world population trends,
Week 8: Kenya population trends, sources and uses of
demographic data
Week 9: CATS
Week population measurements in health, migration,
10: planning for health services.
Week Drugs and substances abuse; definition, commonly
11 abused drugs and substances,
Week health effects of drugs and substance abuse.
12: addiction
Week Signs and symptoms of drug and substances use
13:
Week management, abuse of prescription drugs, alcohol 9
 QUICK MENTAL QUIZ
 Generally what is the scope of community
health as a clinician?
 Who is responsible for the control of

country’s population growth?

 Who is in charge of drug abuse control in a

person’s life?
 Personal protection against any harm in

workplace is the responsibility of who?

 Does studying of community health benefit

you as a clinician?

10
Introduction:
Occupational Health and safety
TOPIC OUTLINE:
 Historical background
 Describe occupational health
 Terms related to occupational health
 Describe the aims and objectives of
occupational health services
 Describe occupational health hazards and

their management
 Understand in general the function, duties

and role of an clinician in occupational

health & safety
11
 Demography

TOPIC OUTLINE:

 Define various terminologies and

concepts
 Review history of demography
 Outline the branches of demography
 Explain the main concepts in
demography
 Planning for health services 12
 Drug and Substance Abuse

TOPIC OUTLINE:

 Objectives of Drug and Substance Abuse

 Definitionand terms
 commonly abused drugs
 Abuse of prescription drugs
 Alcohol control act
 NACADA Act

13
OCCUPATIONAL HEALTH
AND SAFETY

14
 OCCUPATIONAL HEALTH AND SAFETY
Introduction
 OHS is an extensive multidisciplinary field that focuses on

the recognition, monitoring, measurement and control of a

hazard that includes risk minimization.
 Workplace-related health impairments, injuries and
illnesses cause great human suffering and incur high costs,
both for those affected and for society as a whole.
 Occupational safety and health, also commonly referred to

as occupational health and safety, occupational health, or

occupational safety, is a multidisciplinary field concerned
with the safety, health, and welfare of people at occupation
 OHS, or Occupational Health and Safety, is a
multidisciplinary practice dealing with all aspects of health
and safety in the workplace, with a strong focus on
preventing workplace hazards
15
 Examples of occupational health and safety can include
responsibilities of workers in workplace like using personal
protection and safety equipment as required by the
employer, following safe work procedures, etc.
 Occupational Safety and health programs help
organizations:-
 Prevent workplace injuries and illnesses
 Improve compliance with laws and regulations
 Reduce costs, including significant reductions in workers'

compensation premiums
 Engage workers
 Enhance their social responsibility goals
 Increase productivity and enhance overall business

operations
 Workers require knowledge and skills to protect themselves

and others from the occupational risks they encounter, so

that they can work safely and effectively. 16
In 1950, the Joint ILO/WHO Committee on OH stated
that OH should aim at the:
a) promotion and maintenance of the highest
degree of physical, mental and social well-being
of workers in all occupations
b) prevention amongst workers of departures from
health caused by their working conditions
c) protection of workers in their employment from
risks resulting from factors adverse to health
d) placing and maintaining the worker in an
occupational environment adapted to his
physiological and psychological capabilities”

17
Occupational health is considered to be multidisciplinary
activity aiming at:
i. Protection and promotion of the health of workers by
preventing and controlling occupational diseases and
accidents and by eliminating occupational factors and
conditions hazardous to health and safety at work
ii. Development and promotion of healthy and safe
work, work environments and work organizations
iii. Enhancement of physical, mental and social well-
being of workers and support for the development
and maintenance of their working capacity, as well as
professional and social development at work
iv. Enablement of workers to conduct socially and
economically productive lives and to contribute
positively to sustainable development
18
 Definitions of terms
Occupational Health and safety
The joint international labor organization (ILO) committee on
Occupational health, 1950 defined Occupational Health as;
“The highest degree of physical, mental and social well-being of
workers in all occupations.”
Occupational health (OH) is the
 This is the promotion and maintenance of the highest

degree of physical, mental and social wellbeing of workers

in all occupations by preventing departures from health,
controlling risks and the adaptation of work to people and
the people to their jobs (ILO/WHO, 1950)
 Identification and control of risks arising from physical,

chemical, and other workplace hazards in order to sustain

and maintain a safe and healthy working environment.
19
 Science of designing, implementing and evaluating
comprehensive health and safety programs that
maintain and enhance employee health, improve
safety and increase productivity in the workplace.
 Outcome of adequate protection for a worker from
sickness, injury and disease arising from work (ILO).
 Occupational Health is the science of designing,
implementing and evaluating comprehensive health
and safety programs that may maintain and enhance
employee’s health, improve safety and increase
productivity in the work place.
 Occupational health is the physical, mental and social
well being of a person in relation to their work and
working environment, as well as their adjustment to
work and the adjustment of work to them. 20
 Occupational safety and health (OSH) is generally
defined as the science of the anticipation, recognition,
evaluation and control of hazards arising in or from the
workplace that could impair the health and well-being of
workers, taking into account the possible impact on the
surrounding communities and the general environment.
 Occupation: a persons’ principal work or business
especially as a means of earning a living or an
activity that serves as one’s regular source of
livelihood, a vocation.
 Occupational injury: bodily damage resulting

from working (usually the spine, hands, the head,

lungs, eyes, skeleton and skin)
 Risk: the probability of occurrence of an event

e.g. Risk of a fall, drowning 21

 Occupational illness/disease: a condition that
results from exposure in a workplace to a physical,
chemical or biological agent to the extent that the
normal physiological mechanisms are affected
and the health of the worker is impaired.
 Hazard: anything (including a work practice or

procedure) that causes, or has the potential to

cause, injury, harm or illness
 Work: any activity that man performs the

transformation of nature in order to improve the

quality of life
 Health: a state of complete physical, mental,

social, economic and spiritual wellbeing and not

only in the absence of disease 22
 Other terms
 Risk Assessment: process of determining the
potential of a hazard to cause injury or illness and the
potential severity of that injury or illness
 Risk management: overall process of identifying
hazards, assessing the risk of those hazards,
eliminating or controlling those hazards and
monitoring and reviewing risk assessments and
control measures.
 Risk Control: process of controlling risks associated
with hazards by using the hierarchy of control
 Risk Factor: An element, phenomenon or human
action that may cause damage to the health of
workers, equipment or facilities. Example, on physical
effort, noise, monotony 23
 Incident: Any unplanned event resulting in, or having
the potential for, injury, illness, ill health, damage or
other loss. An undesired event that under different
circumstances, could have resulted in injury to persons
or facilities. That is almost an accident. Such a trip or a
slip
 Working environment: the set of conditions
surrounding the person who directly or indirectly affect
their health and their working lives.
 Accident of work: this is a sudden event that occurs
as a result or in connection with the work and
producing damage to the health worker (an organic
lesion, a functional disorder, disability or death).
 Consultation: process of communication and
participation between staff and management on issues
affecting health and safety in the workplace 24
 Key Strategy Principles
Key strategy principles of international and national OHS safety
policies are:
i. Avoidance of hazards (primary prevention)
ii. Safe technology
iii. Optimization of working conditions
iv. Integration of production and health and safety activities
v. Government’s responsibility, authority and competence in the
development and control of working conditions
vi. Primary responsibility of the employer and entrepreneur for
health and safety at the workplace
vii. Recognition of employees’ own interest in occupational health
and safety
viii. Cooperation and collaboration on an equal basis by employers
and workers
ix. Right to participate in decisions concerning one’s own work
x. Right to know and principle of transparency
xi. Continuous follow-up and development of occupational health
and safety 25
 Historical background (History Of OH&S)
1. Contributors
1. Hippocrates (460-377 BC)
 Described symptoms of lead poisoning among
miners and metallurgists
2. Pliny the Elder (23-70 AD) – Roman Senator
 Wrote about workers who protected themselves
from dust by tying bladders over their mouths
 He also noted hazards of asbestos and cinnabar
(mercury ore).
3. Ulrich Ellenborg (1473)
 German Physician who recognized the dangers of
metal fumes, described symptoms and preventive
measures 26
4. Paracelsus (1493-1541) – Swiss Physician
 Wrote a treatise on occupational diseases.
 Described lung diseases among miners and attributed the

cause to vapours and emanation from metals

 Paracelsus is best known today as the “Father of Toxicology”

because of his observations of dose and response

 “All substances are poisons; there is none which is not a

poison. The right dose differentiates a poison and a remedy.”

5. Georg Bauer/Agricoloa (1494-1555) – Physician
 Wrote De Re Metallica, a comprehensive discourse
addressing every aspect of mining, smelting and refining.
 He noted the need to provide ventilation for miners, and
described “asthma” among workers who toiled in dusty
mines

27
6. Bernardino Ramazzini (1633-1714) - Italian
physician
 Known as the “patron saint of industrial medicine”.
 His book De Morbis Artificium Diatriba (The Diseases
of Workmen) described the symptoms of mercury
and lead poisoning and other occupational diseases
 He wrote about the pathology of silicosis and
recommended precautions to avoid hazards
 Advised physicians to learn about occupational
diseases by studying the work environment, and
exhorted them to always ask their patients “Of what
trade are you?”
7. Sir George Baker (1722-1809)
 Discovered that “Devonshire colic” was caused by
lead contamination in cider 28
8. Percival Pott (1714-1788) –
 London Physician who was the first to link occupational

exposure to cancer - scrotal cancer among chimney

sweeps, caused by soot
9. Sir Humphrey Davy (1788-1829)
 Investigated problems of mine explosions and
developed the first miner’s safety lamp
10. Dr. Alice Hamilton (1869-1970)
 First woman faculty member at Harvard University

(1919).
 A social activist who worked to improve occupational

health and safety

 Her autobiography “Exploring the Dangerous Trades”

details her experiences in the mines and mills across

America (for example, she writes of deplorable
conditions in Salt Lake City area mines). 29
2. Tragedies
1. Workplace Disasters of the early 1900s
 Outrage over catastrophic events often led to legislation to protect
workers
 The Triangle Shirtwaist Fire probably was the most important event
leading to the regulation of occupational safety
2. 1911 - Triangle Shirtwaist Company
 The Triangle Shirtwaist Company was a New York City “sweatshop”
where dozens of mostly young female immigrant workers crowded
together to cut and sew shirtwaists
 Shirtwaists were a popular ladies garment of the time, especially
for working women
 Sweatshops workers are paid low wages as they work excessively
long hours in unsanitary and unsafe conditions
 146 workers died from fire in the upper floors of this “fireproof”
building
 Fire exits were inadequate or locked
 Many victims jumped to their deaths
 The tragedy led to 36 laws reforming the state labour code 30
3. 1930 - Gauley Bridge Disaster (Hawks Nest tragedy)
 America’s worst industrial disaster where construction of the
Hawks Nest tunnel near Gauley Bridge, West Virginia,
caused massive exposures to silica dust leaving at least 476
men died and 1500 disabled by silicosis
 Pneumatic drilling equipment and rock high in silica content
magnified the risk
 Economic factors of the Great Depression forced the men to
work in unhealthy conditions
 Many victims were African-American men given the
undesirable work in the tunnel
 Silica exposures were so high men were dying from acute
silicones from only two months’ exposure
4. Kenya Tragedies
 Gold mine accidents in Migori and Kakamega; Nakumatt
Downtown fire; Kapedo massacre; Kyanguli and Bombolulu
schools fire tragedy 31
3. Social Changes and other Factors
1. Progressive Era
 In the U.S., much progress toward occupational health

and safety occurred during the “Progressive Era” of the

1890s through the 1920s.
2. Organized Labour
 Labour unions did much to influence improvements in

workplace health and safety by influencing legislation

as well as forcing concessions from management e.g.
example, the International Ladies Garment Workers
Union (ILGWU), established 1900, pushed for
comprehensive safety and workers’ compensation laws
3. 1914 - Studies in New York City and Youngstown, Ohio
 Revealed unsanitary conditions and tuberculosis among

workers, leading to the abolishment of “sweat shops.”

32
4. 1923 - Studies of the “dusty trades”
 Led to the development of industrial hygiene sampling

equipment
5. Professional organizations
 American Society of Safety Engineers, 1911; National

Safety Council, 1913

 American Industrial Hygiene Association, 1939

6. Economic factors
 The Great Depression, 1929 through the 1930s -
Government established labour standards and
encouraged unions through President Roosevelt's “New
Deal”
 World War II
o Ended the Great Depression and started a period of
industrial growth
o Some gains of recent years were lost due to the need to
maximize wartime production 33
7. Environmental and social activism of the 1960s and
1970s
 Laws protecting workers as well as the environment
were passed during this socially active period
8. Kenya
 Trade unions and labour movement – COTU, KNUT,
KUPPET, KUDHEA,
 Inspectorate Unit in the Ministry of Labour and
Manpower Development

4. Laws and Regulations

Kenya
 Occupational safety and health Act; Children’s Act;

Workman Compensation Act; The Factories Act;

Insurance Act; Kenya Bureau of Standards Act; Public
Health Act 34
5. Organizations Involved In OSH
 UN agencies – ILO, WHO, Labour organizations, Governments

and Government agencies, Employers, Welfare societies,

Trade Unions, Employees, Lobby and Advocacy groups; Civil
societies

6. ILO – Functions, Conventions and Recommendations

Objectives for ILO Formation

i. Full employment and the revising of standards of living
ii. The employment of workers in the occupation in which they
can have the satisfaction of giving the fullest measure of
their skill and make their contribution to the common
wellbeing,
iii. The provision, as means to the attainment of this end, and
under adequate guarantees for all concerned, of facilities for
training and the transfer of labour, including migration for
employment and settlement. 35
iv. Policies in regard to wages and earning forms and
other conditions of work. Calculate to ensure a just
share of the fruits of progress to all, and a minimum
living wage to all employed and in need of protection.
v. The effective recognition of the right of collective
bargaining, the co-operation of management and
labour in the continuous improvement of productive
efficiency and the collaboration of workers and
employers in social and economic measures,
vi. The extension of social security measures to provide
a basic income to all in need of such protection and
comprehensive medical care,
vii. Adequate protection for the life and health of workers
in all occupations,
viii. Provision for child welfare and maternity protection.
36
Functions of ILO
1. Establish international labour and social standards
2. Development and promotion of standards for
national legislation to protect and improve working
conditions and standards of living
3. Provide technical assistance in social policy and
administration and in workforce training
4. Foster cooperative organizations and rural
industries
5. Compile labour statistics and conduct research on
the social problems of international competition,
unemployment and underemployment, labour and
industrial relations, and technological change
6. Help to protect the rights of international migrants
and organized labour. 37
Key Issues (addressed by ILO)
1. Basic Human Rights - Freedom of Association, Forced Labour and
Equality of opportunity and treatment
2. Employment of Women - Night and underground work (Women)
3. Children and Young Persons - Minimum Age, night and
underground work
4. Social Security - Workmen’s Compensation (Occupational
diseases), equality of treatment (Accident compensation)
5. Labour Administration/ Labour Inspection - Labour Inspection,
tripartite consultation and labour standards and statistics
6. Conditions of work/ conditions of Employment - Hours of work,
weekly rest, minimum wage-fixing machinery, marking of weight
and protection against accidents
7. Migrant Workers - Inspection of Emigrants
8. Particular Occupational Sector - Seamen’s Articles of Agreement
9. Employment Service and Agencies/ Employment Policy
10. Protection against Specific Risks - Radiation Protection and
Benzene Convention
38
 Principles of Occupational Safety and Health
(Core OSH principles)
 Occupational safety and health is an extensive
multidisciplinary field, invariably touching on issues
related to scientific areas such as medicine – including
physiology and toxicology – ergonomics, physics and
chemistry, as well as technology, economics, law and
other areas specific to various industries and activities.
 The basic principles of Occupational health and safety

are: -
1. All workers have rights: Workers, as well as
employers and governments, must ensure that these
rights are protected and must strive to establish and
maintain decent working conditions and a decent
working environment.
39
More specifically:
 Work should take place in a safe and healthy working
environment;
 Conditions of work should be consistent with workers’
well-being and human dignity;
 Work should offer real possibilities for personal
achievement, self fulfilment and service to society (ILO,
1984).
2. Occupational safety and health policies must be
established. Such policies must be implemented at
both the national (governmental) and enterprise
levels. They must be effectively communicated to all
parties concerned.
3. A national system for occupational safety and
health must be established. Such a system must
include all the mechanisms and elements necessary
to build and maintain a preventive safety and health
culture. The national system must be maintained,
progressively developed and periodically reviewed. 40
4. A national programme on occupational safety and
health must be formulated. Once formulated, it must be
implemented, monitored, evaluated and periodically
reviewed.
5. Social partners (that is, employers and workers) and
other stakeholders must be consulted. This should be
done during formulation, implementation and review of all
policies, systems and programmes.
6. Occupational safety and health programmes and
policies must aim at both prevention and protection.
Efforts must be focused above all on primary prevention at
the workplace level. Workplaces and working environments
should be planned and designed to be safe and healthy.
7. Continuous improvement of occupational safety and
health must be promoted. This is necessary to ensure
that
41
national laws, regulations and technical standards to prevent
occupational injuries, diseases and deaths are adapted
periodically to social, technical and scientific progress and
other changes in the world of work. It is best done by the
development and implementation of a national policy,
national system and national programme.
8. Information is vital for the development and
implementation of effective programmes and
policies. The collection and dissemination of accurate
information on hazards and hazardous materials,
surveillance of workplaces, monitoring of compliance with
policies and good practice, and other related activities are
central to the establishment and enforcement of effective
policies.
9. Health promotion is a central element of
occupational health practice. Efforts must be made to
enhance workers’ physical, mental and social well-being. 42
10. Occupational health services covering all workers
should be established. Ideally, all workers in all categories
of economic activity should have access to such services,
which aim to protect and promote workers’ health and
improve working conditions.
11. Compensation, rehabilitation and curative services
must be made available to workers who suffer
occupational injuries, accidents and work related
diseases. Action must be taken to minimize the
consequences of occupational hazards.
12. Education and training are vital components of safe,
healthy working environments. Workers and employers
must be made aware of the importance of establishing safe
working procedures and of how to do so. Trainers must be
trained in areas of special relevance to particular industries,
so that they can address the specific occupational safety and
health concerns.
43
13. Workers, employers and competent authorities have
certain responsibilities, duties and obligations. For
example, workers must follow established safety procedures;
employers must provide safe workplaces and ensure access to
first aid; and the competent authorities must devise,
communicate and periodically review and update occupational
safety and health policies.
14. Policies must be enforced. A system of inspection must be
in place to secure compliance with occupational safety and
health measures and other labour legislation.

NB: Clearly, some overlap exists among these general principles.

For example, the gathering and dissemination of information on
various facets of occupational safety and health underlies all the
activities described. Information is needed for the prevention as
well as the treatment of occupational injuries and diseases. It is
also needed for the creation of effective policies and to ensure that
they are enforced. Education and training demand information.
44
 CLASSIFICATION OF OCCUPATIONAL HAZARDS,
CONTROL & PREVENTION
 Hazard - Potential source of harm or adverse health
effect on a person or persons’
 Exposure to a hazard may produce immediate
(acute), medium or long- term (chronic) effects.
 Some occupational diseases may take long to
manifest e.g. Mesothelioma due to asbestos
Hazard Categories (Types / Classification)
1. Biological
2. Chemical
3. Physical
4. Ergonomic
5. Mechanical
6. Psychosocial 45
1. Biological Hazards
 Biological hazards (biohazards)-are substances

that pose a threat to the health and safety of

humans, animals and environment.
 E.g. medical waste or body fluids containing

microorganism, or toxin (from a biological source)

 Exposure to biological agents resulting in illness
 Types of biological agent include bacteria, viruses,

fungi
Mode of Exposure and Effects
 Contact (direct or indirect): touching a person

or contaminated surface, sexual contact.

Examples : haemorrhagic fever virus, enteric
pathogens, Ebola, HIV, HBV 46
 Droplet: infected droplets come into contact with
eyes, nose or mouth.
Examples: influenza and rubella viruses,
corynebacterium diphtheria
 Airborne: residue from infected droplets or

contaminated dust particles remain in the air for

long periods of time and enter the body through
the respiratory tract.
Examples : TB including MDR TB, chicken pox, and
measles
 Fecal-Oral route: organisms infect the digestive

system through contaminated food or water.

Examples : salmonellosis, cholera, typhoid fever,
hepatitis A 47
 Vector: capable of transmitting disease, such as,
mosquitoes, and fleas.
Examples : malaria, yellow fever, dengue fever.
 Percutaneous: (needle stick/sharp injuries) and
Mucocutaneous route: splash of body fluids into the
eyes, nose or mouth.
Examples: human immunodeficiency virus (HIV), hepatitis
B (HBV) and hepatitis C (HCV).
Prevention and Control of Biological Hazards
 Implementation of Standard Precautions (hand hygiene,

handling of sharps, decontamination of instruments)

 Immunization against hepatitis B, influenza, yellow

fever, typhoid,
 Proper management of waste materials
 Provision of appropriate and proper use of PPE
 Post Exposure Prophylaxis (PEP) 48
 Summary - Control of biological hazards in healthcare settings

Standard
Training Precautions Immunisation /
(recorded) Vaccination

Hand / Waste
Respiratory Infection
Management
Hygiene Control

Personal
Protective
Cleaning &
Equipment Safe use Disinfection
of Sharps
[Link]
Examples of Biological Hazard Signage
2. Chemical Hazards
 Are substances that can cause harm or damage to the

body, property or the environment.

 Can be either natural or man made.
 Classified as solids, liquids, gases
 Health care environment houses a vast array of

chemicals.
 Examples: formaldehyde, ethylene oxide, phenol,
and peracetic acid; anaesthetics gases, laboratory
reagents
 Include liquids, fumes, mists, vapours, gases, dusts,

photocopy fumes, mercury, office agents

Mode of Exposure and Effects
 Inhalation: gases, dust, vapour, fumes, aerosols or

mists.
Examples: xylene, formaldehyde, acetone 51
 Ingestion/swallowing: via contaminated foods or
drinks, touching mouth with contaminated hands, or
inhaling airborne particles
 Topical (skin) – chemicals such as acids or alkalis can

corrode or burn the skin.

Example: organic solvents can penetrate through the skin
causing systemic damage. Others cause allergic reactions.
 Ocular (eye): Splash, contact – irritation, ulceration,

loss of eye sight.

 Injection: sharp objects contaminated with chemicals

can penetrate the skin and cause damage.

Chemical exposure can have severe effects to other
body systems.
 Examples: respiratory, nervous, skin and reproductive

etc. other effects include cancers, tumors and

mutations. 52
Prevention and Control of Chemical hazards
 Availability and use of Material Safety Data Sheet

{MSDS}
 Availability of chemical Safety Policies and SOPs
 Provision and Appropriate use of PPE
 Management of exposures and first aid
 Emergency shower and Eye wash station

Examples for Chemical Signage

53
3. Physical hazards
 Are conditions or situations that can cause the

body physical harm or intense stress

 Can either be natural and/or human made.
 Example: extreme temperature and pressure,

noise, vibration and radiation (ionizing and non-

ionizing) that can be harmful to workers if not
properly controlled.
 Include radiation, noise, vibrations, extreme of

temperature, humidity, fire, electricity

 Harmful energy absorbed by the body’s structure
 Energy derived from mechanical sources e.g. noise,

vibration, injuries, fractures; radiation sources e.g.

Ionising, non-ionising and thermal sources, dust
54
 Mode of Exposure and Effects
Thermal Conditions
1. Heat - come about when temp and/or humidity are unusually high or
exposure to high radiant heat
Effect
 Heat stroke.
 Heat exhaustion
 Heat rash
 Heat cramps
 Decreased work morale and inability to concentrate

2. Cold
When the temp are usually low and when high wind speed in
background of low temp.
Effects:
 Hypothermia
 frostbite
 cold burns
 Reduces sensitivity of the fingers
 Extremes of Pressures - Caison’s syndrome or decompression
diseases 55
Noise - Unwanted sound
Effects:
1. Acoustic trauma: Very high sound e.g.. Bomb
Blasts,
Sudden hearing damage caused by short burst of
extremely loud noise such as a gun shot.
2. Tinnitus: Ringing or buzzing in the ear
3. Temporary hearing loss: Temporary Threshold
Shift (TTS) occurs immediately after exposure to a
high level of noise.
4. Permanent hearing loss
Permanent Threshold Shift (PTS)
5. Interferes with communication
6. Sleep disturbance and fatigue 56
Vibration
 Mechanical oscillation of a surface around its reference point.
 Whole body vibration (WBV) -tractor, lorry
 Segmental vibration-eg hand transmitted vibration-vortexing,

drilling
 Effects: Disorders in musculoskeletal (Tendons, muscles and

joints) and the nervous system

 Hand-Arm Vibration Syndrome (HAVS).
 The symptoms of VWF are aggravated when the hands are

exposed to cold.
Workers affected by HAVS commonly report:
 Attacks of whitening (blanching) of one or more fingers when
exposed to cold
 Tingling and loss of sensation in the fingers
 Loss of light touch
 Pain and cold sensations between periodic white finger attacks
 Loss of grip strength
 Bone cysts in fingers and wrists
57
Prevention and Control of Vibration
 Proper installation and maintenance of machines
 Remote operation of equipment
 Correct handling and use of hand tools
 Proper adjustment of seating and working positions
 Early reporting of symptoms

Radiation
 Is the emission or transmission of energy in the form

of waves or particles through space or through a

material medium.
 Ionising radiation- Source are x-ray machines,
fluoroscope and CT Scan, radioactive drugs, Machines
used in radiotherapy
 Non- ionising e.g. Ultraviolet - Sun light, Fluorescent

lamps, Electric arc welding, Germicidal lamps 58

Effects:
 Reaction in the skin to produce Vitamin D that prevents rickets
 High dose of UV causes - sun burn – increased risk of skin cancer
 Pigmentation that results in suntan
 Suntan lotions contain chemicals that absorb UV radiation
 Strongly absorbed by air – thus the danger of hole in the

atmosphere

LASER - Light Amplification by the Stimulated Emission of Radiation

 Used as reference lines in
 Surveying
 Instrumentation
 Alignments
 As A heating agent in welding
 As A cutting instrument in micro electronics and microsurgery
 Functions in communications
 In military.

59
 Effects - mutation, cancers, burns,
 Non-ionising Radiation - UV -cataracts
 Light- glare eye strain
 Electrical energies- electrocution, electric fog

Signage for Radiation

60
Electrical Hazards
 The major hazards associated with electricity are

electrical shock and fire.

The severity and effects of shock depend on:
 Pathway through the body
 The amount of current
 The length of time of the exposure
 Whether the skin is wet or dry.

Effects
 The effect of the shock may range from a slight

tingle to severe burns to cardiac arrest.

 Sparks can serve as an ignition source for

flammable or explosive vapors or combustible

materials 61
Prevention and Control
 Inspection of wiring of equipment
 Replacement of damaged or frayed electrical cords

immediately.
 Information of specific location shut-off switches and/or

circuit breaker panels.

 Limit the use of extension cords,
 Multi-plug adapters must have circuit breakers or fuses
 Minimize the potential for water or chemical spills on or

near electrical equipment.

Prevention and control of Physical Hazards
 Noise – noise minimization through muffling, use of

acoustic materials and signage.

Noisy equipment should be appropriately sited and
isolated. Hearing conservation programme for noisy
areas. 62
 Ionising radiation
 Time, distance, shielding, monitoring
 Light
 Adequate and avoid glare
 Extreme hot temperatures
 PPE, time (shifts), personal clothing (cotton, light and
loose fitting), rehydration (water avoid beverages),
ventilation (spot cooling fans, air conditioning),
monitoring, permit to work
 High Pressures – decompression camps, permit to
work
 Low Pressures - time
 Electrical energies – Earthing, fusing, de-energize
equipment, circuit breakers, appropriate wiring,
insulation, PPE, permit to work. 63
4. Ergonomic Hazard
 An ergonomic hazard is a physical factor within the

environment that harms the musculoskeletal system.

 Ergonomic hazards include themes such as repetitive

movement, manual handling, workplace/job/task

design, uncomfortable workstation height and poor
body positioning.
 Concerns the physical, physiological and
psychological relationships between people and work
 Examples include body position, repetitive actions,

work pressure, display screen equipment

 Specific areas include perceptual responses, work

rates and fatigue, man-machine interface and

anthropometrics
64
Mode of Exposure and Effects
 Healthcare personnel are exposed to many

ergonomics risk factors due to the nature of their

work.
 Examples of risk factors are found in jobs

requiring repetitive, forceful, or prolonged

exertions of the hands; frequent or heavy lifting,
pushing, pulling, or carrying of heavy objects; and
prolonged awkward postures
Prevention and Control in Ergonomic Hazards
 Mechanization (equipment and assist devices),

proper work station design, use of appropriate

tools, proper lifting procedures, adequate staffing,
training 65
 The application of ergonomic principles to workstation
design can result
 In increased effectiveness,
 Work quality,
 Health and safety,
 Job satisfaction
DO:
 Push rather than pull.
 Keep a good grip.
 Maintain clear vision between

the object and your destination.

 When lowering an object, try and keep the natural curve

of your back.
 Place the load on the edge (tailgate) and push it back.

DON’T:
 Lift above shoulder height.
 Catch falling objects. 66
5. Mechanical Hazards
 A mechanical hazard is any hazard involving a machine

or process.
 Equipment used in healthcare facilities if not properly

installed and maintained may pose mechanical hazards.

 Compressed gases or liquids can also be considered a

mechanical hazard.
 Filing Cabinets; Mercury Torn Carpets; Trailing Flexes;

Mobile Furniture, etc.

Mode of Exposure and Effects
 Dangers in machinery are divided into
 Continuing danger – the danger that occur during the

normal operation of the machinery such as dust, heat,

fumes etc.
 Contingent danger - the danger which is as a result of

failure of a guard or a safety device. 67

  Effects – being struck by
– being trapped between ejected flying
fixed and moving parts particles
of machines – Friction (abrasion)
– entanglement – Cutting
– struck by moving parts
– Shearing
– Crushing
– striking fixed/and or – Puncture
moving parts

Prevention and Control

 Training of operators to get competent persons
 Incorporating machinery safeguards in design
 improvisation/modification where necessary
 Maintenance of machines
 Use of suitable PPE
68
6. Psychosocial Hazards
 Psychosocial hazards include but aren't limited to

stress, violence and other workplace stressors.

Examples;
 unsatisfactory work environment such as “work

overload, lack of control over one’s work, non-

supportive supervisors or co-workers, limited job
opportunities, role ambiguity or conflict, rotating shift
work, and machine-paced work.”
 However, may be anything that conflicts with an

employee’s social and mental well-being.

 Workplace violence
 e.g. stress, emotional breakdown, violence, bullying,

sexual harassment, anxiety, depression, drug and

substance abuse, working alone and security 69
Mode of Exposure and Effects
Stress
 Stress is the “wear and tear” our minds and bodies

experience as we attempt to cope with our

continually changing environment – lead to fight or
flight
 NEGATIVE STRESS: It is a contributory factor in

minor conditions, such as headaches, digestive

problems, skin complaints, insomnia and ulcers
 Excessive, prolonged and unrelieved stress can

have a harmful effect on mental, physical and

spiritual health
 POSITIVE STRESS: Stress can also have a positive

effect, spurring motivation and awareness, providing

the stimulation to cope with challenging situations. 70
Main causes of stress at work are
 Shift work
 Work overload/underload (quantitative and qualitative)
 Lack of task control/role ambiguity
 Working alone
 Drug and alcohol abuse
 Violence
 Working with terminally ill
 Poor work relationships
 Unfair management (bossy)
 Financial and economic factors
 Conflict between work, family roles and responsibilities
 Lack of opportunity for growth and promotion
 Bullying
 Sexual harassment
71
Effects:
 Burnout
 Irritability
 Depression
 Anxiety
 Absenteeism/ presenteeism
 Insomnia, headache, stomach upsets, loss of
appetite,
 High blood pressure, ulcers, neurosis, stroke

Prevention and Control of Psychosocial Hazard

 Work Schedule should be compatible with demands

and responsibilities outside the job. When schedules

involves rotating shifts the rate of rotation should be
stable and predictable 72
 Work load: demands should tally with the
capabilities and resources of individual
 Contents: jobs should be designed to provide
meaning, stimulation and an opportunity to use
skills
 Participation and control: workers should be given
the opportunity to have input on decision that
affect their jobs
 Work roles: roles and responsibilities at work
should be well defined
 Social environment: opportunities for personal
interactions both for purposes of emotional support
and help as needed in accomplishing assigned
tasks (sports club, family fun days, open events)
73
 Job
future: career development and job
security
 Counseling,
 Psychotherapy
 Developing employees assistance
programme
 Seek medical advice
 Relaxation, yoga, meditation, massage,
aromatherapy, floatation, homeopathy
 Use of the “right based approach”

74
Examples of Signage
 Emergency Information
Signs
 These signs indicate the location
of, or directions to emergency
related facilities (exits, first aid,
safety equipment, etc.). Feature
a white symbol and/or text on a
green background.

 Prohibition Signs
 These signs that specify
behaviour or actions which are
not permitted. The annulus and
slash is depicted in red over the
action symbol in black. Sign
wording, if necessary, is in black
lettering on a white background.
75
  Danger Signs
These signs provide
warning when a hazard or
a hazardous condition is
likely to be life threatening.
The word Danger is
featured inside a red oval
inside a black rectangle.
 Warning Signs
 These signs warn of hazards or a
hazardous condition that is not
likely to be life-threatening. The
hazard symbol is black on a yellow
background and a triangle is
depicted around the hazard symbol.
Sign wording, if necessary, is in
black lettering on a yellow
76
  General Information
Signs
 They communicate
information of a general
nature and often refer to
Housekeeping, Company
Practices and Logistics

 Mandatory Signs
 These signs specify an
instruction that must be carried
out. Symbols (or pictograms)
are depicted in white on a blue
circular background. Sign
wording, if necessary, is in
black lettering on a white
background
77
Protective, Preventive and Control Measures
 Prevention means avoidance of the risk or hazard while control
is the term to describe mitigation activities where the risk
cannot be prevented.
 Workers have a right to reduction in ill health and accidents
given that these things can be reduced / prevented if risk
assessment and risk management are done
 Personnel are obliged to wear the prescribed personal
protective gear.

78
General Principles of Prevention and Control
i. Prevention of risks
ii. Protection of safety and health, assessments of
risks
iii. Elimination of risks and accidents
iv. Informing, consultation, balanced participation in
accordance with national laws and/or practices
v. Training of workers and their representatives
vi. General guidelines for the implementation of the
said principles
vii. Obligations of employers, employees and other
groups

79
Principles of Prevention
1) Avoiding risks
2) Evaluating the risks which cannot be avoided
3) Combating the risks at source
4) Adapting the work to the individual, especially as regards the
design of work places, the choice of work equipment and the
choice of working and production methods, with a view, in
particular, to alleviating monotonous work and work at a
predetermined work rate and to reducing their effect on health
5) Adapting to technical progress
6) Replacing the dangerous by the non-dangerous or the less
dangerous
7) Developing a coherent overall prevention policy which covers
technology, organization of work, working conditions, social
relationships and the influence of factors related to the working
environment
8) Giving collective protective measures priority over individual
protective measures
9) Giving appropriate instructions to the workers.
80
Preventive and Protective Measures
Should be implemented in the following order of priority
1) Elimination of the hazard/risk;
2) Control of the hazard/risk at source, through the use
of engineering controls or organisational measures;
3) Minimisation of the hazard/risk by the design of safe
work systems, which include administrative control
measures;
4) Where residual hazards/risks cannot be controlled by
collective measures, provision by the employer of
appropriate personal protective equipment, including
clothing, at no cost, and implementation of measures
to ensure its use and maintenance.

81
 The STOP principle contains a step-by-step description of the
procedure aimed at protecting employees from harmful
substances:
 S – Substitution:
 Replace harmful substances with less harmful ones
 Involves early integration of occupational safety-related aspects
during the research and development of products and production
methods
 T - Technical measures: Collective technical measures used to
detect, limit and divert hazardous gases, vapours and aerosols
 O - Organisational measures:
 Presence in a work environment with potential exposure should
be limited with respect to time and number of employees
 Employees must receive specific training
 P - Personal protective measures:
 Select adequate protective equipment must be selected
 Strictly consider PPE as an add-on measure to the collective
protective measures mentioned above
82
Strategies for Principles of Prevention and
Control (PPC)
1) Communication
2) Disability management
3) Emergency planning
4) PPE
5) Preventive measures
6) Training
7) Work ability
8) Workplace health promotion

83
 PERSONAL PROTECTIVE EQUIPMENT (PPE)
 A personal protective equipment is a device that is worn
by a worker in order to prevent any part of his body from
coming into contact with hazards present at his/her place
of work.
 The material of PPE’s chosen must be able to withstand
the specific hazard prevailing in a given work place.
 PPE is the last means of hazard control
 Must be carefully selected
 Good fit is important
 Does not make wearer invincible
 Only works if worn correctly

TYPES OF P.P.E
 There are various types of P.P.E depending on the type of
hazards prevailing in any given place of work.
 P.P.E act as barriers between the worker and the hazard
and include;- 84
 Head gear(helmets and caps
 Ear protectors or defenders (ear muffs and ear
plugs)
 Face shields
 Goggles
 Safety spectacles
 Masks (dust, fluids)
 Respirators
 Safety shoes/boots
 Gloves/Mittens
 Aprons
 Overalls
 Dust coats
 Safety harnesses
 Safety belts 85
PROTECTION OF THE VARIOUS PARTS OF THE BODY
HEAD PROTECTION
 NB: Although workers should be encouraged to use

their heads to absorb knowledge, they should not use

them to absorb blows.
 The head is protected by use of head gears.

ROLE OF HEADGEARS INCLUDES:-

 Protects the head from injury on impact by falling

objects. Here helmets (hard hats) are used.

 Prevents the entanglement of hair in machinery. Here

fabrics cap (soft caps) are used

 Prevents foodstuffs from contamination by hair and

dandruff
 Protects the head from splashes of corrosive
chemicals. Here plastic or P.V.C caps are used.
86
Helmet and a Cap

EYE AND FACE PROTECTION

 The eyes are protected by use of eye protectors which

include:-
 Clear plastic or glass goggles with side shields for

protecting the eyes from flying objects

 Safety spectacles with toughened lenses and side shields

for workers with eyes defects and who are exposed to

flying objects. 87
The eyes and face are protected by use of:-
 Clear or transparent plastic face shields or visors

for protecting persons from corrosive chemical

splashes.
 Tinted (darkened) glass goggles or face shields for

protecting persons from harmful radiation(light)

emitted by welding processes
Goggles

88
EAR PROTECTION
 The ears are protected by use of ear defenders or

protectors
 The ears are protected from dangerously high

noise levels
 There are two types of ear protectors
 Ear muffs
 Ear plugs

Ear muffs and Ear plugs

89
RESPIRATORS
 The objective of respiratory system protection is to

prevent contaminated air from getting into the

respiratory system.
 Air contaminants include dusts, vapours, gases and

fumes
 The respiratory system is protected by use of

respirators.
TYPES OF RESPIRATORS
 Air-Purifying Respirators
 Air-Supplying Respirators
 Air purifying respirators: forces contaminated air
through a filtering element
 Disposable Respirators (includes N95, N100)
 Powered Air Purifying Respirator (PAPR) 90
 Respirator and Dust mask

AIR- SUPPLYING RESPIRATORS

 Are used where a person has to work in an oxygen

deficient environment e.g.

 During fire fighting
 Carrying out repairs in confined spaces
 Research in space and under water
 Carrying out research operations (rescuing drowning

people or people in a burning building) 91

AIR- SUPPLYING RESPIRATORS:

HAND / ARM PROTECTION

 The hand and arm is protected by use of gloves
 There are various types of gloves depending on the type of

hazard at a given place of work

TYPES OF GLOVES
 Heavy duty gloves: thick rubber gloves for handling contaminated

instruments equipment patients and other items. These can be

reused after cleaning.
 To make selecting the right medical glove even more interesting

they are also available in powdered, non-powdered, sterile,

nonsterile, textured, coated 92
 Gloves and Mittens

FOOT PROTECTION
 Various types of footwear are used depending on the prevailing

hazard at a given place of work

TYPES OF FOOTWEAR
 Safety shoes or boots fitted with metal toe caps for use when

exposed to falling objects

 Safety gumboots for use when exposed to wet and corrosive

chemicals
 Safety shoes/boots with oil resistant or heat resistant soles for

use when exposed to organic compounds or when working on

hot floors 93
 Safety Boots and shoes

MAIN BODY PROTECTION

 The main body is protected by use of overalls, dustcoats

and aprons. 94
 Overalls, dustcoats and aprons protect the wearer’s
home clothes against contamination by work place
hazards such as dusts, dirt, chemicals etc.
 Overalls minimize the risk of entanglement of home

clothes by machinery
 The material of the overall will depend on the nature of

hazard at the work place e.g.

 For corrosive chemicals (use plastic or P.V.C type)
 For cold environments (cold rooms) use Eskimo suits
 For hot environments use asbestos overalls or leather

type
Overall, Apron and Dust Coat

95
Benefits and consequence
 Reduced insurance premiums, reduced long term

health care costs, reduced legal costs

 Reduced morbidity, mortality and fatality.

Consequences
 Non use of PPE could lead to disciplinary action
 Continue Non use of PPE could lead to dismissal.

PERSONAL HYGIENE
 A worker is supposed to leave work as clean and

free from work place contaminants as when he or

she arrived for work
 Workers should therefore wash and change before

leaving for home to avoid taking work place

contaminants to their dependants back home. 96
ROLE OF MANAGEMENT
 Management must provide free of charge the correct P.P.E by

taking into account the nature of hazard at their premises

 demonstrate how to use the P.P.E
 inspect P.P.E regularly before and after use
 ensure P.P.E are cleaned dried and stored in a clean place

after use.
 issue the P.P.E individually and ensure that no sharing takes

place.
 Ensure PPE is not taken home
 Employers are required to train each worker required to use

personal protective equipment to know:

 When it is necessary
 What kind is necessary
 How to properly put it on, adjust, wear and take it off
 The limitations of the equipment
 Proper care, maintenance, useful life, and disposal of the
equipment
97
ROLE OF EMPLOYEES
 Must make full use of P.P.E provided
 Must report to the management the loss or

damage of or any defect in P.P.E

 Must take reasonable care of the P.P.E and not

wilful misuse them.

98
 FIRE SAFETY AND MANAGEMENT
FIRE SAFETY:
 Fire is a process of combustion in which energy is

released in form of Heat and Light.

Fire Triangle
 There are three elements of a fire;
 Fuel
 Heat at a minimum temperature
 Oxygen – usually air

99
Classification of Fires and Extinguishing agents
 Class ‘A’ Fires: It involves fires that occur in materials
such as wood, paper, lags and rubbish. Extinguishing
agent – large quantity of water.
 Class ‘B’ This involves fires that occur in vapour mixture

of flammable liquids. G.G. Gasoline, oil, grease, paints

and Thinners. Extinguishing agent – dry chemical,
Carbon dioxide, very fine water spray.
 Class ‘C’ It involves types of fires caused by energized
electrical equipments. Extinguishing agent – dry
chemical, Carbon dioxide, very fine water spray.
 Class ‘D’ it is the type of fires that involves burning of
metals e.g. potassium, titanium, Zirconium, Lithium,
Potassium and Sodium. Extinguishing agent-dry powder.

100
Fire Hazard:
 When fire is uncontrollable or unwanted it is

referred as a hazard, and may result to one/and or

all of the following consequences:
 Loss of life
 Personal injury
 Loss or damage to property

Stages of fire Development

1
• Incipient stage
2
• Smouldering stage
3
• Flame stage
4
• Heat Stage
101
Suppression of Fire
 To suppress fire one of the three components that

support fire must be removed or eliminated by:-

 Cooling – removing heat by lowering temperature
 Smothering – separating oxygen from fuel and heat.
 Starvation – removing fuel.
Fire Risk Evaluation
It may be considered in three major groups:-
 Recognition of hazards and potential dangers
 Evaluate the hazards and expected loses.
 Evaluate the preventive measures required.
 In doing that take into account of the situation of

premises, site, building construction, content,

management factors, people, fire protection
systems and follow up after fire. 102
Factors that contribute to most fires
 This includes; electrical, torching {Behaviour},
smoking, hot surfaces, friction, overheated material,
cutting and welding, open flames, spontaneous ignition,
combustion sparks, molten substances, static sparks,
chemical action and lightening.

Fire Detection
 There are two major facilities:
 Human observer and
 Automatic fire detection systems

Fire Prevention
 Survey the premises or workplace to establish and

record the following observations for the purpose of

instituting remedial measures: - 103
 Fire Load
 Fire hazards
 Fire fighting equipment
 Building fire protection facilities

Fire Fighting Team

 Establish a fire fighting team with well-defined

responsibilities in case of fire.

Fire Preparedness
 The main objective is to prevent, control and

manage fire disaster in the workplace. This may be

achieved through: -
 Fire prevention by controlling fire hazards.
 Establishing evacuation procedures incase of fire.
 Establishing a team to extinguish fires at early

stages. 104
Evacuation procedures
On hearing the fire alarm sound, the following steps are
necessary to observe;
 Stop machine and switch off power.
 Close the doors and windows behind you. Do not lock the

doors.
 Leave the building through the marked fire exists.
 Do not use lifts.
 Use corridors, staircases and external routes.
 Do not panic and do not make unnecessary noises.
 Assist visitors, customers, patrons by leading them through

the fire exists.

 Do not allow people to come back to the building.
 Do not stop to collect personal belongings unless clear escape

is obvious.
 Join the fire fighting team if you are a member and render any

necessary assistance.
 Proceed to the assembly point for roll-call. 105
Fire Safety Programmes
 Fire Safety Programmes must be established to

include inspection, fire drills, training,

management procedures and communication.
 Fire drill is an important exercise for instilling skills

on evacuation procedures in event of fire.

 Remember that fire consequences are completely

avoidable if safety requirements are observed.

Heavy-Duty Emergency Rescue & Evacuation

Signs - Exit with Right Arrow

106
Fire Alarm Signs with Downward Facing Arrow

107
 OCCUPATION RELATED DISEASES
ILO Definitions:
 … “occupational disease” covers any disease

contracted as a result of an exposure to risk

factors arising from work activity’’
Protocol of 2002 to the Occupational Safety and
Health Convention, 1981 (No. 155)
 “…. diseases known to arise out of the exposure

to substances and dangerous conditions in

processes, trades or occupations as
occupational diseases.”
The ILO Employment Injury Benefits
Recommendation, 1964 (No. 121), Paragraph 6(1)
108
Kenya - Definition
 “occupational diseases” means any departure from

health occasioned by exposure to any factor or

hazard in the workplace.
THE FACTORIES AND OTHER PLACES OF WORK ACT
(MEDICAL EXAMINATION RULES), 2005

Occupational diseases
 An acute, recurring or chronic health problem
caused by work conditions or practices
 Any departure of health occasioned by exposure to
any factor or hazard at the workplace
 Any work related diseases are those with multiple
causes where factors in the work environment may
play a role in their progression 109
 An occupational disease is any chronic ailment
that occurs as a result of work or occupational
activity. It is an aspect of occupational safety and
health
 An “occupational disease” is any disease
contracted primarily as a result of an exposure to
risk factors arising from work activity
 “Work-related diseases” have multiple causes,

where factors in the work environment may play a

role, together with other risk factors, in the
development of such diseases.

110
Elements in occupational disease
 Two main elements are present in the

definition of an occupational disease

1. The causal relationship between exposure
in a specific working environment or
work activity and a specific disease; and
2. The fact that the disease occurs among a
group of exposed persons with a frequency
above the average morbidity of the rest
of the population.

111
Classification of Occupational diseases
1. According to causative agent(s)
 Chemical agents- mercury, beryllium, lead
 Physical agents – noise, vibration, radiation
 Biological agents- brucellosis, Hepatitis, HIV, TB,
Anthrax
2. According to target organ systems
 Respiratory
 Skin
 Musculoskeletal
 Mental and behavioural disorders
3. Occupational cancers
4. Others

Classifications of occupational diseases have been

developed mainly for two purposes: (1) notification for
112
labour safety and health surveillance and (2) compensation
Classifications
Class Example Diseases

1 Physical Heat Heat hyperpyrexia, heat exhaustion,

agents heat syncope, heat cramps, burn and
local effects such as prickly heat

Cold Trench foot, frost bite, chilblains

Light Occupational cataract, miner’s
nystagmus
Noise Occupational deafness
Radiation Cancer, leukaemia, aplastic anaemia,
pancytopenia
Mechanical accidents factors
Injuries
Electricity Burns
Pressure 113
Classifications
Class Example Diseases

2 Chemical Gases CO2, CO, HCN, CS2, NH3, N2, H2s,

agents HCL, SO2 these cause gas
poisoning
Dusts Inorganic dusts: - (a)Coal dust -
(pneumoconio Anthracosis (b)Silica - Silicosis
sis (c)Asbestos - Asbestosis, Lung
cancer, (d)Iron – Siderosis; Organic
(vegetables) Dusts: - (a)Cane fibers
Bagassosis (b)Cotton Dust
Byssinosis; Tobacco Tobacossis; Hay
or grain dust Farmer’s lung
Metals and Toxic hazards from lead, mercury,
their cadmium, manganese, beryllium,
compounds arsenic, chromium etc.

Chemicals Acids, alkalies, pesticides 114

Classifications
Class Example Diseases

3 Biological Bacteria Brucellosis, leptospirosis,

agents anthrax, tetanus
Virus Encephalitis
Fungi, actinomycosis, hydatidosis,
parasites psittacosis, fungal infection
4 Occupationa Cancer of skin, lungs,
l cancers bladder
5 Occupationa Dermatitis, eczema
l dermatosis
6 Psychologica Industrial neurosis,
l origin hypertension, peptic ulcer,
etc.
115
Reasons for identifying occupational diseases
 For prevention and control
 For Compensation
 To improve on health surveillance of workers

Factors influencing occurrence of occupational

diseases
(a) Individual susceptibility
(b) Age/Sex
(c) Personal characteristics and social culture factors
(d) Amount of exposure (Dose)
(e) Duration of exposure (Time)
(f) Extent and type of exposure (inhalation, ingestion ,
Skin)
(g) Nutritional status
(h) Prevailing health status 116
Occurrence of occupational diseases
 Work-related diseases are multifactorial and often

occur among the general population

 Examples:
 Hypertension,
 Ischaemic,
 Heart diseases,
 Asthma,
 Chronic non-specific respiratory diseases
 Peptic ulcers
 These may be aggravated/accelerated by
workplace exposures (e.g. noise, chemicals heavy
workload, dust, stress etc.) and may impair
working capacity
117
Examples of Occupational Diseases
(1) Skin disorders - Allergic and irritant contact
dermatitis, anthrax
(2) Respiratory disorders- Asthma, Silicosis,
pneumonitis, TB
(3) Neurological disorders – encephalopathy,
neuritis
(4) cardio-vascular - disorders
(5) Reproductive disorders
(6) Occupational Cancers – mesothelioma,
leukaemia,
(7) Psychosocial factors - Stress at work
118
Prevention of Occupational diseases
(1) Elimination of hazards by substitution or
redesign.
(2) Total/partial enclosure of process.
(3) Ventilation including Local exhaust ventilation
(4) Segregation of process e.g. Noise, radiation,
engineering control.
(5) Limitation of exposure – time factors
(6) Cleanliness of workplaces and personal hygiene.
(7) Appropriate personal protective equipments.
(8) Environment/Biological monitoring of peoples at
greatest risk.
(9) Medical examinations
(10) Health Promotion 119
 Diagnosis of occupational diseases
(1) Occupational history
(2) Thorough medical exam
(3) Investigations should be carried out as
appropriate e.g.
 Lung function
 Blood
 Patch testing (skin test)
 Sweat, saliva
 Urine
 Stool
 X-ray, etc.

(4) Literature search

(5) Appropriate referral 120
Occupational Health and Safety Regulations
 ILO-International Labor Organization.
 EU-European agency for safety and health at work
 WHO Health for all 2000
 Alma Ata(1978): Primary Health Care
 Health sector reform
 Public health policy: Prevent the preventable

Kenya OSH regulatory frame work

1. Constitution of Kenya (2010).
Although the Constitution does not address OSH
specifically, it provides for the rights of every person to:
 Fair labor practices
 Reasonable working conditions, and
 A clean and healthy environment.
121
2. Laws, Acts and regulations
 OSH services in Kenya are governed by two pieces of

legislation:
1. The Occupational Safety and Health Act, 2007 (OSHA
2007)
2. The Work Injury Benefits Act, 2007 (WIBA, 2007).
Purpose of OSHA 2007
–To secure the safety, health and welfare of people at
work
–To protect those not at work from risks to their safety and
health arising from, or in connection with, the activities of
people at work.
Purpose of WIBA 2007
–To provide compensation to employees for work-related
injuries and diseases contracted in the course of their
employment, and for connected purposes. 122
Other regulations and subsidiary laws
that deal with OSH issues:
 The Factories (Woodworking Machinery)
Rules,
 The Factories (Docks) Rules-Apply to process

of handling goods in a dock

 The Factories (First Aid) Rules -Requires

employers to ensure injured employees

receive first aid
 The Factories (Eye Protection) Rules,
 The Factories and Other Places of Work

(Medical Examination) Rules

123
Laws and regulations covering aspects related
to OSH but not issued under Ministry of labor
 The Biosafety Act, No. 2, 2009
 The Public Health Act, Cap. 242
 The Employment Act, No. 11, 2007
 The Energy Act, No. 12, 2006
 The Food, Drugs and Chemical Substances Act,

Cap. 254
 The Mining Act, Cap. 306
 The Pest Control and Product Act, Cap. 346
 The Petroleum (Exploration and Production) Act,

Cap. 308
 The Radiation and Protection Act, Cap. 243

124
The Occupational Safety and Health Act No. 15 of 2007,
Kenya
 An act of Parliament to provide for the safety, health and

welfare of workers and all persons lawfully present at

workplaces, to provide for the establishment of the National
Council for Occupational Safety and Health.
 Act applies to all workplaces where any person is at work,

whether temporarily or permanently.

Purpose of the Act is to:
 Secure the safety, health and welfare of persons at work.
 Protect persons other than persons at work from risks

arising out of the activities of persons at work.

 Provides for duties of occupiers (who include employers)

workers, self employed people, suppliers, designers,

importers, manufacturers.
 Special provisions for health and welfare of workers,

machinery, chemical and safety. 125

The Directorate of Occupational Safety and
Health Services (DOSHS)
 Created by OSHA 2007
 Is a department within Ministry of Labor,
 Responsible for OSH services in the country.

Mandate:
 To ensure compliance with provisions of:

a) OSHA, 2007, which promotes the safety and

health of workers,
b) WIBA, 2007, through the prompt compensation of
employees for work related injuries.
 DOSHS enforces OSHA, 2007, WIBA, 2007, and

other subsidiary pieces of legislation.

126
Functions of DOSHS
 Inspecting workplaces to ensure compliance with OSHA 2007;
 Investigating occupational accidents and diseases to prevent

their recurrence;
 Measuring workplace pollutants in order to institute control

measures;
 Carrying out medical examinations and surveillance of

workers’ health;
 Providing training on OSH;
 Disseminating information on OSH to employers, employees

and other interested persons;

 Approving architectural plans of workplace buildings
 Ensuring employees injured in the course of their
employment are compensated in accordance with WIBA 2007
 Instituting and conducting legal proceedings against those

responsible for non-compliance with the provisions of OSHA

2007.
127
The National Council on Occupational Safety and Health
(NACOSH)
•Created by OSHA 2007,
•Advises labor Cabinet secretary on matters such as:
1. Formulating and developing a national OSH policy;
2. Legislative proposals on OSH, including ways and means to ;
•Give effect to ILO Conventions, other international
conventions and instruments relating to OSH,
•Compensation
•Rehabilitation services;
3. Strategic ways to promote the best OSH practices;
4. Establishing, developing and maintaining a preventive safety and
health culture;
5. Reviewing the provisions of OSHA 2007, rules and regulations,
standards, and industry codes of practice;
6. Statistical analysis of work-related deaths and injuries;
7. Any other matters affecting OSH as it considers desirable in the
interests of improving the quality of working life in Kenya.
128
Safety and health committees
 Created by OSHA 2007 and the Safety and Health

Committees Rules.
 Employers who regularly employ 20 or more

people to have a safety and health committee in

the workplace.
 Committee has equal representation from
management and workers.
 Committee may interview anyone with
information relevant to OSH matters affecting the
workers.

129
Elements of OSH Management
System

130
130
DEMOGRAPHY

131
 DEMOGRAPHY
Introduction
 Demography studies population development, that is, the

number of births, deaths and migration and other

phenomena influencing population change, such as the
marriage and divorce rates of the population.
 Demography also examines what kinds of effects changes

in population have on the economic and social

development of society.
 In language “demos” means people and “graph” means

shape or description. So demography is the science that

studies human population from different aspects.
 Demography is very important for health planning,

recruitment and allocation of resources. Demography may

describe population from three main aspects, namely
size, composition and distribution
132
 Demographers seek to understand population dynamics
by investigating three main demographic processes:
 Birth
 Migration
 Aging (including death)
 All three of these processes contribute to changes in
populations, including how people inhabit the earth, form
nations and societies, and develop culture.
 Today demography encompasses the determinants and
consequences of population change and is concerned
with virtually everything that influences or can be
influenced by population size, growth or decline,
processes (levels and trends in mortality, fertility and
migration that are determining population size and
change), characteristics (education, religion, or ethnicity)
and structure (how many by age) 133
Definition:
 Demography is the science of populations
 Demography is derived from two Greek words - demos

(people) and graphy (branch of knowledge regarding a

particular science in this case, human populations). It is ‘the
mathematical knowledge of populations, their general
movements, and their physical, civil, intellectual and moral
state’ (Guillard 1855).
 Demography is the study of development of population, its

size and structure and changes in population. The changes

relate to people's births, marriages, divorces, migration and
deaths. Demography also examines the mutual interaction
of these phenomena and their connection to economic and
social life
 Demography is the scientific study of human populations,

primarily with respect to their size, their structure and their

development. 134
 Is the study of a population in its static and dynamic
aspects
 The static aspects are the characteristics at a point in
time e.g. composition by age, race, sex, marital status
and economic characteristics
 The dynamic aspects include fertility, mortality,
nuptiality, migration and growth
 Human population is dynamic thus the need for all
this information and can also be defined from 2
perspectives: - narrow and wide definition.
Narrow Definition (formal demography)
 Concerned with: - the size of the people, distribution

and biological composition (age and sex) and

focuses on three demographic variables (fertility,
mortality and migration). Balancing
equation/simple demographic equation. 135
Wide definition
 Considers additional characteristics of the
population such as income, ethnicity, mother
tongue, literacy, marital status, occupation,
religious affiliation and nationality
 It depicts population change on one hand vis-à-vis

development - many issues e.g. population versus

urbanisation, population versus income
distribution and population versus environmental
degradation

136
Aspects of Demography

137
 Main Branches of Demography
 Demography can be divided into two main branches: descriptive

demography and mathematical/formal demography

Descriptive demography
 Looks to other traditional disciplines such as sociology, economics,

social policy, etc. - in its search for answers to changes in

population phenomena
 Aims to find out why the number of births has decreased, why the

number of divorces is higher than in many other countries, and why

people move from rural into urban areas.
 Changes in demographic phenomena can be explained on the basis

of changes taking place in society: for example, how does the level
of education influence the number of children born, do women with
more education have fewer children than women with a lower level
of education? On the other hand, researchers may also be
interested to study the impacts of demographic phenomena on
society: for example, how does high population growth influence
socio-economic development, does migration into urban areas
support development in these areas, what are the effects on the
countryside? 138
 Mathematical or formal demography
 Employs mathematical formulae and models to

describe population changes (demometry) or

the measurement of demographic phenomena
 Most common approach is to compare some

vital events to the size of the population

 Demography is largely an exercise in calculating

various ratios and in comparing these ratios

with one another either at a certain point in
time or within a certain period of time

139
Basic equations of Demography
Suppose that a country (or other entity) contains Populationt
persons at time t. What is the size of the population at time t +
1?

Natural increase from time t to t + 1:

Net migration from time t to t + 1:

 The population pyramid is typical of developing countries

where fertility is high and mortality is also high.
 It depicts age, sex composition in relation to
fertility and mortality.
140
 History of Demography:
 Throughout history, rulers have been interested in the
number of population for the important purposes of
taxation, resource distribution, power and war (a large
number of men fit for military service) while many
philosophers pondered about the meaning of the number
and3000
Egypt structure of population.
 “Census” every other year
B.C.  List of families and other occupants of houses for certain
particular cases (e.g., soldiers)
Greece Count of males 18 years and older
Rome Enumeration of every family every five years for taxation
purposes
Confucius  Suggested restricting the number of population because
(551-479 the environment did not guarantee sufficient subsistence
BC) to the ever-growing population
China  Cultivation methods were so underdeveloped that the
excessive population growth often caused shortage of
food
 As a result of this, people moved long distances to141gain
Plato  Put forth 5,040 as the number of populations for his ideal
(429-347 city
BC)  Was more concerned about the quality of the population
than their number
 Carey Francis Okinda Page 4
 Based his ideal number of populations on the fact that the
figure 5,040 was divisible by all figures up till nine
 In Plato's opinion, tax collection and military recruiting would
be thus made easier
Aristotle  Plato's student described the relation between population
(384 - 322 growth and environment (thought excessive population
BC) growth caused poverty, which was followed by rebellions and
crime)
Augustus  Roman Emperor was concerned about the corruption of his
(63 BC - 14 people's family life
 Enacted the laws - Lex Julia and Lex Papia - which restricted
AD) polygamy and supported the growth of birth rate
 He ordered the most important census in world history
 The Romans needed information for tax collection and thus
Joseph and Maria went from Nazareth - their town of domicile -
to Bethlehem where their family lived
John  Was interested in lists of baptisms and burials
 Published his study entitled "Natural and Political Observations
Graunt
Mentioned in the Following Index, and Made upon the Bills of
(Father of Mortality, with Reference to the Government, Religion, Trade,
demograph 142
Growth, Air, Diseases and the Several Changes of the Said City".
1600  Modern census format emerged gradually around
1600s in Europe, Quebec 1666
Edmund  Examined lists of deaths in Bleslau (present Polish
Halley town of Wroclaw)
(1656-1742)  These lists were more complete than those used in
London at the time as they also indicated the age
and gender of the deceased person
 Based on this material, Halley calculated life
expectancies using age group specific mortality
rates for the first time ever
 At the time the life expectancy of a new-born baby
was just 30 years
Johann  Prussian clergyman
Peter  In 1741 published a volume “The Godly
Süssmilch Order”, where he demonstrated regularities
(1707-1767)
in different population events in his study of
the population structure and birth and death
rates in different years
Wilhelm  19th century the German mathematician and
Lexis economist who developed the two-
(1837– 1914) dimensional approach that helps temporal
examination of population phenomena 143
Benjamin  English mathematician
Gompertz  In 1825 realised that mortality can also be
(1779-1865)
described by this same geometric growth
(law of mortality)
1800  England 1841 (first real census)
 1850 (first time to list individuals in U.S.)
Alfred Lotka  Examined the relation between the
(1880-1949) birth and death rates and the age
American
biologist and
structure of population
statistician  Proved that population growth in the
USA has been produced artificially by
taking in immigrants
 In contrast, natural population growth
no longer guarantees the growth of
population (in the 1920s) but in the
long run the number of populations
will fall if no immigrants are allowed
into the country. 144
 Definitions of terms:
1) Population
 All of the people inhabiting a specified area
 The total number of inhabitants constituting a particular race, class, or group

in a specified area
 A group of individuals of the same species occupying a particular geographic

area. Populations may be relatively small and closed, as on an island or in a

valley, or they may be more diffuse and without a clear boundary between
them and a neighbouring population of the same species.
 Population refers to the population of some country or area - such as a

municipality.
 Population can be divided into permanent or temporary residents
 Temporary residents live in the area for a certain predetermined time
 A person is considered to live permanently in some area if he or she
intends to live there for over one year
The UN uses two concepts in population statistics:
 De jure population is the population living in the area permanently -

legally.
 De facto population is the actual population of the area including all the

persons living there temporarily (in some countries even tourists are taken in
this group) 145
2) Population group
 The word population is often used to describe an individual population

group sharing a certain feature e.g. the child population, population of

working age or elderly population. In the same context, we often refer
to population a group, which clearly defines the population according to
some special characteristics. These special characteristics can be - as
above - age, but the defining factors can be citizenship (alien
population), refugee status (refugee population) or ethnicity (Sami
population).
3) Population changes
 The size of population is dependent on changes in the number of three

factors - births, deaths and migration

 The number of births increases population, while that of deaths decreases it
 Vital events is often used to talk about births and deaths
 The effect of migration on the size of population can be either increasing or

decreasing
 When examining only the effect of the number of births and deaths on the

size of population, we refer to so-called natural increase or natural

population growth
 When the change in population size is viewed by taking migration into

account as well, we talk about population growth. 146

4) Population status
 In demography the objects of study are factors describing population

status such as the size of population, age, gender and marital status
structure and information on the regional distribution of population
 In addition, population status can also be described according to

nationality, language, and religious group, country of birth,

municipality of birth, education, occupation and source of livelihood.
5) Population density
 The population density is the number of population per unit of total

land area of a country.

6) Vital events
 Include births, deaths and migration; marriages and divorces
 Vital events also have their own "internal" structure according to age

and gender, for example

 The number of deaths can be examined by age and gender, children

born by the age of mother and divorces by the duration of marriage

 Vital events are "age dependent".

147
7) Demographic analysis
 This is the study of components and change in

demographic variables and the relationship between

them
 Also called the formal demographic method

8) Population studies
 Study of relationship between demography variables and

other variables such as social and economic variables

NB: Population changes

148
 PRINCIPLES OF DEMOGRAPHY
 Demography may describe population from three main aspects,

namely size, composition and distribution.

Population Size
 Estimated Population is the number of population of any of the

inter-census (non-census) years

 The methods of estimation include:-

1) Natural increase method:- number of live births minus no. of

deaths in the years following the census year are added to the
census population. It is appropriate for communities with limited
migration and has good records.
2) Arithmetic Method:- From the last two consecutive populations of
the community the mean annual increase is calculated and
multiplied by the years passed since last census and added to its
population, but it is rough, not accurate.
Example Census 1985 = 30,000, 1995 = 40,000 so mean annual
increase
= 40,000 - 30,000 = 1000
10 So the population in 1998 = 43,000
149
3) Geometric Method:-It is the most accurate method. Special
formula is used to find out the annual rate of population growth,
to be applied to the census population to get the estimated
population of the following years.
4) Graphic Method:-Number of successive census population is
plotted on a graph and joined together by straight line, which is
extended over future year.
Composition
 It is description of the quality of the population as shown by

population pyramid (graphical presentation of age and sex

composition of the community)
 The point in the vertical axis of age through which passes the

horizontal line that divides the surface area of the pyramid into
two equal parts (50% younger and 50% older).
Distribution
 How people are distributed in the country by regions,
urban versus rural or desert, natives and foreigners and racial
150
 BASIC CONCEPTS OF DEMOGRAPHY
1) Person
 Demography studies changes occurring to persons, such

as births, deaths and migration

 Information is also collected for statistics on the so-called

individual level, which means that the information

concerns persons
 Persons are examined according to different variables,

such as age, gender, marital status, occupation and

education.
2) Family
 A family is formed by people living together in a married

or cohabiting union and their children, by a mother or a

father with their children, and by married and cohabiting
partners without children
151
 Can at most consist of two successive generations. Thus a father,
a mother and their children constitute a family. If e.g. a
grandmother is living together with the family, she does not
belong to the family according to the concept of demography (see
household, household-dwelling unit). In many cultures the family is
conceived as a much larger unit than the conventional nuclear
family
 The family may include several wives or it is understood as a

broad family composed of relatives

 A family with children refers to a family with at least one child

under the age of 18 living at home.

3) Household
 A household is formed by family members living together and by

other persons who have a shared household. Thus parents, their

children and a grandmother living with them constitute a
household
 Excluded from households are people living in various
institutions and thus in shared households. Examples of such
institutions are old people's homes and prisons. 152
4) Household-dwelling unit
 A household-dwelling unit is formed by all people living

permanently in the same dwelling

 When a household is formed by people with a shared

household, this definition of household-dwelling unit is not

applied.
5) Population size
 Population size varies according to the area in question
 The population of the world (around 6.2 billion) is very

unevenly divided by country

 The over one billion populations of China and India make up

as much as 37 per cent of the population of the world.

6) Population density
 Population is often examined in proportion to the surface

area of the country

 Populations living in areas of different size can be compared
 The figure obtained is called population density
153
 Population density is calculated per square
kilometre (km²). Either the total area contained inside
the borders of the country (including water systems) or
land area is used. The population density in the world's
most populous country, China, is 132 persons per km2
and in the second most populous country, India, 300
persons per km2.
 Kenya - Population Density for Kenya

154
7) Age
 Age is usually calculated in full years, in which case it

refers to the number of years on the latest birthday

 A child born is 0 years old in the first year of his/her life

and after his/her first birthday he/she becomes one year

old
 Age is a very central concept in demography,
similarly as in life itself
 Demand for various services depends on age and how

many people are at a certain age. In population statistics

age is usually determined at the end of the year or at the
time of some vital event, such as moving. Then the actual
vital event may take place before or after the birthday.
8) Age pyramid
 Age pyramid (also known as the population pyramid)

describes the population by age group

155
 Size of age groups is presented by stacked horizontal bars
where the bars for men are on the left side of the vertical
axis and the bars for women on the right side
 Age is given on the vertical axis so that the youngest age

group is at the bottom (e.g. 0 to 4-year-olds) and the oldest

age group (e.g. over 100-year-olds) is at the top.
9) Gender
 In demography the quantitative differences between

genders are described by calculating women per 1,000

men
 This is naturally due to the fact that women outlive men
 Kuwait is at the other extreme, with just 722 women per

1,000 men.
10) Marital status:-
 Marital status means division of population into
groups according to whether people are unmarried,
married, divorced or widowed 156
 Those who have never been married are unmarried
 Other marital statuses are determined either on the basis of

marriages contracted, divorces granted by courts or death of spouse

 Demography uses the following official classification of marital

status: unmarried, married, divorced or widowed

 Cohabiting unions have become more common especially during the

last few decades. Cohabiting unions are not formalized in the same
way as marriages, but cohabitation is often equated with marriage in
demography - similarly as in ordinary life. In many countries it is
difficult to obtain information about the numbers of people living in
cohabiting unions.
11) Area
 Demography usually makes use of administrative area classifications
 This is because population statistics, like other statistics, are

compiled according the boundaries of administrative areas. All

countries are divided into administrative areas
 In Kenya we have counties, sub counties, divisions, locations, sub

location

157
 POPULATION PYRAMIDS
 The population structure of a country is how it is made up
of people of different ages, and of males and females.
 The common method to show the structure is by a
population pyramid. This diagram is made up by putting
two bar graphs (one for male, one for female) side by side.
 Population pyramids are a useful tool for understanding
the structure and composition of populations because they
graphically portray many aspects of a population, such as
sex ratios and age structure
 Pyramids can give insight into trends in population over
time by their portrayal of the relative number of people in
a particular cohort.
 The population pyramid is drawn as two histograms, one
for each sex with age on horizontal axis while percentage
on vertical one
158
From the shape of the pyramid are concludes:-
1) Sex ratio: Percentage of males and percentage of females.
2) Age structure: Percentage of each stratum.
3) Mortality and emigration: Slope of the sides.
4) Life span: Height of the pyramid and shape of the apex.
5) Median Age:
6) Dependency Ratio:
Population Pyramids Prototypes
 Population pyramids are divided into three prototypical types
useful for general interpretation of conditions, knowledge of
specific characteristics of particular populations
Population Pyramids – Population Transition
 Population pyramids for 4 or 5 stages of the demographic
transition model. While all countries' population pyramids
differ, four general types have been identified by the fertility
and mortality rates of a country.

159
 Stage 1 (Expanding)
 Stage 2 (Expanding/Stable)
 Stage 3 (Stationary)
 Stage 4 (Constrictive) 160
Stage 1 (Expanding) Features
i) Has high CBR and CDR (mainly caused by food
shortages/famines/droughts)
ii) CBR is roughly the same as CDR (so their society does not die out)
iii) High birth rates cause the pyramid base to be huge
iv) High death rate causes the pyramid to look like a J-Curve
v) Low life expectancy
vi) Usually has a low or zero NIR
vii) High IMR
Stage 2 (Expanding/Stable)
i. A population pyramid showing an unchanging pattern of fertility and
mortality.
ii. Features
iii. Death rate drops rapidly (because of the medical revolution and
industrial revolution/second agricultural revolution)
iv. Birth rate is still high (little or no change) - little or no change in birth
rate results in the pyramid still looking huge (wide bottom) lowering of
the death rate removes the J-Curve and make the pyramid triangular
v. Little change in life expectancy
vi. High NIR (due to the death rate dropping rapidly while the birth rate is
still high) 161
Stage 3 (Stationary) Features:
 Death rate drops a little bit more and then stabilize
 Birth rate drops rapidly (so their society would not be over populated)
 Pyramid begins to stabilize (base is much smaller)
 High life expectancy (noticeable difference) - due to more medical

advancements
 Moderate growth due to a lowering of the Total Fertility Rate, a result of

increased education levels, and opportunities for women.

Stage 4 (Constrictive)
 A population pyramid showing lower numbers or percentages of

younger people
 Country will have a greying population which means that people are

generally older, as the country has long life expectancy, a low death
rate, but also a low birth rate.
 Typical pattern for a very developed country, a high over-all education

and easy access and incentive to use birth control, good health care
and few or no negative environmental factors.
Features
 Death rate remains low. little or no change
 Birth rate is low. 162
 SOURCES OF DEMOGRAPHIC DATA
 The main information sources used in demography are current

population statistics and statistics of population changes. The

sources include: -
SOURCES OF DEMOGRAPHIC INFORMATION
1) Primary Sources
a) Census
b) Vital registration/vital statistics – births, deaths, marriages, adoptions,
separations
c) Sample surveys
d) Population registers
e) Administrative data
f) Historical records
2) Secondary Sources - processed data
a) Journals
b) Books
c) Atlas
d) Newspapers
e) Research reports
f) Pamphlets. 163
Types of Demographic Data
 Demographic data refers to data that is statistically

socio-economic in nature such as population, race,

income, education and employment, which represent
specific geographic locations and are often associated
with time
 Demographics is the practice of identifying groups of

people in a population by their characteristics.

 Common types of demographics (demographic data)

include age (date of birth), life stage, gender, sexual

orientation, ethnicity/race, residence, education,
relationship status, family, disabilities, income/household
income, wealth, profession, lifestyle, home ownership
(length of residence, home size, mortgage)

164
SOURCES OF DEMOGRAPHIC INFORMATION – Continued’
PRIMARY SOURCES
1. CENSUS
 The purpose of the population census is to take a census of

the population and gather information on occupations,

sources of livelihood and on the structure of families and
household-dwelling units
 It often includes calculation of dwellings, buildings and real

estate
 They are statutory, they are made every ten years and the

population of the whole country is calculated

 Are carried out in accordance with the recommendations

and instructions drawn up by the United Nations (UN) to

ensure that the data on different countries are mutually
comparable
 The information is collected with a questionnaire filled in by

every adult person. 165

Advantages of census
i) Fiscal support from donors if a country conducts a regular census.
Limitations/ disadvantages of census
i) Cumbersome exercise
ii) Expensive undertaking thus taken once every 10 years
(decennial census)
iii) Census seeks to determine:- age, sex, religion, marriage, head
of family, sanitation and disposal, occupation, education, orphan
hood, water source, electricity source, migration.
iv) Some people are missed.
v) Poor coverage especially in nomadic communities
vi) Analysis – faulty machines (scanners), wrong entry in computer
(human error)
vii) There is a big time lapse between time of census being taken
and release data therefore data become obsolete and outdated.
viii) Under numeration therefore one has conduct a post
enumeration

166
2. SAMPLE SURVEYS
 An interview survey is based on a questionnaire, which is sent

out to be filled in by the people included in the sample.

Alternatively, it is possible to conduct personal interviews
where the interviewer puts the questions directly to the
interviewee.
 Are done more regularly then census.
 The monitors variables e.g. birth, fertility, trend analysis,
labour force, income, unemployment, attitudes, behaviour.
 Examples: Kenya Demographic and Health surveys (KDHS)

under NCPD (National Council for Population and development;

Kenya fertility survey; Kenya contraceptive prevalence survey.
Advantages
i) Generate detailed information
ii) Gain information on sensitive issues (depends on choice of
method)
iii) Flexibility
167
Limitations
i) Lack representativeness as they pay particular attention to a group of
people thus leading to bias
ii) High cost of implementation
iii) Reliability challenges (sampling and interviewing techniques help
improve reliability of interviews).
4. VITAL REGISTRATION SYSTEM
 Registration of births, deaths, marriage, divorce, annulment, baptism.
 Events that occur regularly and require documentation.
 May be incomplete because of inaccurate data.

5. POPULATION REGISTERS
 A population register is often understood to be a computer register

containing the key demographic information on all persons

permanently resident in the country.
 The register is updated regularly by amending the information

(marriages contracted) or by adding (births) and removing (deaths) the

information
Advantages
i) Administrative purposes
ii) Update one’s census. 168
POPULATION AND HOUSING CENSUS
 A population and/or housing census is the total process of

collecting, compiling, evaluating, analysing and releasing

demographic and/or housing, economic and social data
pertaining to all persons and their living quarters (United
Nations, 2007)
 A population census is the total process of collecting,

compiling, evaluating, analysing and publishing or otherwise

disseminating demographic, economic and social data
pertaining, at a specified time, to all persons in a country or
in a well delimited part of a country
Essential features
The essential features of population and housing censuses are: -
a) Individual enumeration
b) Universality within a defined territory
c) Simultaneity
d) Defined periodicity
169
USES
Population census
1. Policy making
2. Planning
3. Administration
4. Management and evaluation of programmes in education, labour
force, family planning, housing, health, transportation and rural
development
5. Administrative (political) use is in the demarcation of
constituencies and allocation of representation to governing bodies
6. Resource for research providing data for scientific analysis of the
composition and distribution of the population and for statistical
models to forecast its future growth
7. Provides business and industry with the basic data they need to
appraise the demand for housing, schools, furnishings, food,
clothing, recreational facilities, medical supplies and other goods
and services.
170
Housing census
1. Uses for development of benchmark housing statistics
2. Uses for the formulation of housing policy and programmes
3. Assessment of the quality of housing
TYPES OF CENSUS
1. The traditional approach
 Comprises a complex operation of actively collecting
information from individuals and households on a range of
topics at a specified time, accompanied by the compilation,
evaluation, analysis and dissemination of demographic,
economic, and social data pertaining to a country or a well-
delimited part of the country.
2) The register-based approach
 The concept emerged in the 2000 round of censuses
 The philosophy underlying this concept is to take advantage of

the existing administrative sources, namely, different kinds of

registers, of which the following are of primary importance:
households, dwellings and individuals.
171
3) The rolling census approach
 Represents an alternative to the traditional model of the census

by means of a continuous cumulative survey covering the whole

country over a long period of time (generally years), rather than
a particular day or short period of enumeration
 Two main parameters of a rolling census are the length of the

period of enumeration (which is linked to the frequency of

updates required) and the sampling rate (which depends on the
available budget and the geographic levels required for
dissemination purposes)
4) Traditional enumeration with yearly updates of characteristics
 This design is a variation on the traditional census design and

focuses on counting the population and collecting only the basic

demographic data in the census year
 A very large household survey collects and tabulates detailed

demographic, social, economic, and housing data every year

throughout the decade, replacing a census-year long form to
collect these detailed data from a sample of the population
172
 The Census Process
 All censuses and surveys share certain major

features that include

(a) Preparatory
(b) Enumeration or collection
(c) Data processing, including data entry (keying or
scanning), editing and tabulating
(d) Databases construction and dissemination
(e) Evaluation of the results
(f) Analysis of the results
Errors in the Census Process
1) Coverage errors
Coverage errors arise from omissions or duplications
of persons or housing units in the census enumeration
173
 Sources of coverage error include incomplete or
inaccurate maps or lists of enumeration areas, failure by
enumerators to canvass all the units in their assignment
areas, duplicate counting, and omission of persons who
are not willing to be enumerated, erroneous treatment
of certain categories of persons such as visitors or non-
resident aliens and loss or destruction of census records
after enumeration.
2. Content errors
(a) Errors in questionnaire design
(b) Enumerator errors
(c) Respondent errors
(d) Coding errors
(e) Data entry errors
(f) Errors in computer editing
(g) Errors in tabulation 174
 Groups Difficult to Enumerate
1) Seasonal migrants
2) Homeless persons
3) Nomads and persons living in areas to which access is
difficult
4) Civilian residents temporarily absent from the country
5) Refugees
HOUSING CENSUS
 The units of enumeration in housing censuses are buildings,

living quarters and occupants of living quarters

 The United Nations has developed a list of the key aspects

of the housing census.

 The topics are shown by type of units of enumeration.
1. Living quarters
2. Location of living quarters
3. Occupancy status
4. Ownership 175
5. Number of Rooms
6. Number of Bedrooms
7. Useful floor space
8. Water supply system and facilities
9. Bathing facilities
10. Toilet and Sewage disposal
11. Availability of a Kitchen
12. Fuel used for cooking
13. Lighting and/or electricity
14. Solid waste disposal
15. Type and Energy used for Heating
16. Availability of Hot water
17. Availability of Piped gas
18. Use of housing unit
19. Number of occupants (core topic)
20. Type of Building
21. Construction material of outer walls
22. Construction material of floor and roof
23. State of repair
24. Characteristics of head or other reference member of household
25. Tenure
26. Availability of Information and communications technology devices
27. Availability of Durable household appliances
28. Availability of Outdoor space 176
 POPULATION MEASUREMENTS IN HEALTH
DEMOGRAPHIC MEASURES
1. Rates
 Measured per period of time usually per year e.g. crude

birth rate
 Rates can be crude, specific or adjusted rates
 Crude rate is a summary rate of the actual number of

observed events in a population over a given time period

 A specific rate refers to a particular segment of the

population. It focuses attention on a more homogeneous

group within the total population and is expressed on the
basis of any characteristic of the population such as age,
sex, marital status, race, etc. Rates may also be made
specific for more than one characteristic of the population,
such as age-, sex-, and race-specific death rates
 Adjusted rates are standardized to a control population
177
Crude rates
 Estimates the burden of disease in a population
 Not useful for making comparisons between groups or examining

changes over time, because it depends largely on population

structure
Specific rates
 Important because outcomes may be profoundly affected by

factors such as age, race, and gender

 More precise indicator of risk than a crude rate as it controls for a

particular characteristic of interest

 Allows for comparisons between strata or between groups

Adjusted(standardized) rates
 Specific rates are standardized to a control population and are

summarized to produce an adjusted rate

 Used to compare rates of entire populations taking into account

differences in population structure (e.g., age, gender, race or

other variables)
 Adjusted rates can be compared if they are calculated using the

same standard population 178

2. Ratio
 Relationship between two parameters e.g. M: F = 1.04: 1.0 at

birth
 Thereafter there is a disproportionally high mortality among

men than women. By 5 yrs M:F = 96:100. It contains

decreasing.
3. Fraction/proportion
 Expressing a parameter as part of a whole …express

proportion with decimals

POPULATION CHANGE FACTORS
 Population momentum is the propensity for a population to

grow for many years after fertility declines to reach the

replacement level of the “two-child family”. (TFR ~2.2 and
NRR=1.0).
 Changes occurring in the population are viewed by means of

population change factors such as births (fertility), deaths

(mortality) and migration (changes of domicile) 179
 Birth (b), Death (d), Immigration (i) and Emigration (e)
are calculated per 1000 people Growth rate = (Birth
rate - Death rate) + (Immigration rate + Emigration
rate) r = (b – d) + (i – e)
 The population change factors have a direct effect on

the development of population size. In demography

births and deaths are also known as so-called natural
population changes (vital events). Other population
change factors are marriages contracted and divorces.
 Population change factors

1) Fertility and Births

2) Mortality
3) Marriage rate
4) Divorce rate
5) Migration rate
180
 MIGRATION
 Human migration (derived from Latin: migratio) is

physical movement by humans from one area to another,

sometimes over long distances or in large groups.
 Movement from one geographical area to another
geographical area crossing the administrative boundaries
for permanent or semi-permanent residence. The starting
place is known “place of origin” whilst the ending place is
called ‘place of destination’.
 Movement of people from one place in the world to
another for the purpose of taking up permanent or semi-
permanent residence, usually across a political boundary.
An example of "semi-permanent residence" would be the
seasonal movements of migrant farm labourers. People
can either choose to move ("voluntary migration") or be
forced to move ("involuntary migration"). 181
TERMINOLOGIES
1. Emigrant - a person who is leaving a country to reside in
another.
2. Immigrant - a person who is entering a country from
another to take up new residence.
3. Refugee - a person who is residing outside the country of
his or her origin due to fear of persecution for reasons of
race, religion, nationality, membership in a particular social
group, or political opinion.
4. Internally Displaced Person (IDP) - a person who is forced
to leave his or her home region because of unfavourable
conditions (political, social, environmental, etc.) but does
not cross any boundaries.
5. Migration Stream - a group migration from a particular
country, region, or city to a certain destination.
182
SOURCES OF MIGRATION DATA
1) Population censuses
2) Population registers
3) Sample surveys
4) International migration statistics records
5) Other sources
THEORIES OF MIGRATION
1. Push and Pull Theory
 Globalization, economic crises, political instability, conflicts, civil

wars, ethnic cleanings, social inequality, the development of

market economy, gender discrimination, the wider processes of
transformation
2. Classical Immigration Theory
 Each migrant rational human being chooses optimum combination

of wage rates, job security, and costs of travel (human capital

approach series of investments in education, skills, material cost of
traveling, maintenance while looking for work, learning new
language/culture, difficulty in experiencing new labour market,
psychological costs cutting old ties, marginal analysis, weighing
costs and rewards). 183
3. Neo-Classical Theory
 Postulated by E.G. Ravestein (1885)
 Demand of Western European countries for foreign
migrant workers; if what counted were wage differentials,
then poorest would want to move first
4. New Economic of Migration Theory
 Migration decisions are not made by isolated
individuals but by larger units of related people-typically
families or households
5. World Systems Theory
 States that international migration has little to do with

wage rates or employment differentials between states but

follows the dynamics of market creation and the structure
of the global economy.
6. Systems and Networks Theory
 Multiple analytical focus on structure, linkage and
process 184
7. Micro theories of migration
 Movement of people at a family level or individual level
8. Macro theories of migration
 The focus is on identifying patterns and trends in migration.
9. Mesotheories of migration
 Tries to integrate micro and macro theory factors.
 Awareness of these broad factors is important in decision
making at any level.
MODELS OF MIGRATION
1) Harris-Todaro model
Migration streams result from actual wage differentials across markets
or countries for our purposes that emerge from heterogeneous degrees
of labour market tightness
2) Lewis Model
Lewis (1954) – explains transition from a stagnating economy based on
traditional rural sector to a growing economy driven by development of
modern urban sector.
3) Pull–Push model
Certain factors at the area of origin, push people and certain factors at
the area of destination pull people 185
 FORMS OF MIGRATION
 Forms of migration include

1) Internal Migration (migration within a country)

 Moving to a new home within a state or country
2) External or International migration (migration between
countries)
 Moving to a new home in a different state,
country, or continent.
 Immigration - moving into a new country
 Emigration - leaving one country to move to
another
Forms of Internal Migration
i) Rural to Urban (Rural – urban migration)
ii) Urban to Rural (Urban – rural migration)
iii) Rural to Rural (Inter- rural migration)
iv) Urban to Urban (Inter – urban migration) 186
Forms of International Migration
i) Developing country to Developed
ii) Developing to Developing country
iii) Developed to Developing country
iv) Developed to developed country
Other Forms of Migration
i) Population transfer
ii)Impelled migration (also called "reluctant" or
"imposed" migration)
iii) Step migration
iv) Chain migration
v) Return migration
vi) Seasonal migration
vii) Long-term Migration.
viii)Temporary Migration. 187
HEALTH CONSEQUENCES OF MIGRATION
1) Immunization
2) Transporting or spreading disease
3) Riots and wars
4) Environmental degradation
5) Interruption of treatment schedules
6) Planning
7) Disease outbreak
IMPACTS OF MIGRATION
 Human migration affects population patterns and

characteristics, social and cultural patterns and

processes, economies, and physical environments.
 As people move, their cultural traits and ideas

diffuse along with them, creating and modifying

cultural landscapes. 188
 Diffusion - process through which certain characteristics
(e.g., cultural traits, ideas, disease) spread over space
and through time.
 Relocation diffusion - ideas, cultural traits, etc. that
move with people from one place to another and do not
remain in the point of origin.
 Expansion diffusion - ideas, cultural traits, etc.,
that move with people from one place to another but are
not lost at the point of origin, such as language.
 Cultural markers - structures or artefacts (e.g.,
buildings, spiritual places, architectural styles, signs,
etc.) that reflect the cultures and histories of those who
constructed or occupy them.

189
 PLANNING FOR HEALTH SERVICES
FAMILY PLANNING
 Family planning was introduced in 1966-67 in Kenya. In the

1950s, private organizations had family planning service mainly

for the expatriates in Kenya. The FPAK (Family Planning
Association of Kenya was introduced in 1957. A family planning
policy was initially introduced by the ministry of economic
planning. The ministry of Health then realized that a high
population growth rate signifies a highly dependent population.
In 1978, the M.O.H trained family planning field educators
approximately 800. Government support was however lukewarm
and the M.O.H could not therefore train individuals effectively.
The guiding principle was to reduce Kenya’s crude birth rate. In
1977/78 a Kenya fertility surveys (KFS) revealed that only 7% of
female were using a form of family planning. The population
growth rate was 4.1% p.a. while TFR was 8.1 children per
woman. Currently population growth rate is 2.9% p.a. and TFR is
4.9. The CPR has increased from 7% in 1978 to 39% in 1998
190
Concepts
1) Unmet needs of family planning
This refers to sexually active people who would like to space their
births or stop but use no method of family planning. - Up to 12% of the
population have unmet needs.
2) Desired fertility
This refers to the number of children a woman would like to have.
Includes both male and female children
Models of Family Planning
 There are the vertical and horizontal models

Vertical
 Seen as one programme on its own and don’t interact with other

programmes
 Use one service, unipurpose and separate funding and administration.
 Other vertical programmes include: malaria, schistosomiasis,
trypanosomiasis, MCH.
Advantages
 Workers in the vertical model become very efficient in dealing with the

programme
 Duties are repetitious and are therefore easy to remember
191
Horizontal
 Programmes are interacted, multipurpose, share same

funding administration and service components.

Advantages
 Both worker and system are used for many
programmes therefore are cost efficient.
 Duties are varied therefore the worker does not get

bored
 Duties are complimentary therefore also easy to

remember
Disadvantages
 Competition between programmes for funds, other

resources
 Internal competition for resources and managerial

infrastructure may become overloaded.

192
Family Planning and Its Influence on Fertility
 Family planning has both direct and indirect

influence on fertility. There is an inverse relation

between family planning and fertility therefore when
family planning increase, fertility decrease. There
are however intermediates e.g. education, age,
marital status, race/ethnicity and sociocultural
factors (occupation, residence) that influence the
use of family planning. Education particularly
influences fertility in inculcating values and
advantage of small families, delaying the age of
marriage and use of effective methods of family
planning.

193
Family Planning Methods
1) Natural methods
a) Cervical-mucous methods
b) Basal-body-temperature (BBT) method
c) Symptom-thermal method (combines BBT and
cervical mucous method)
d) Rhythm (safe period) method
e) Withdrawal(coitus interuptus) method
f) Traditional abstinence after childbirth
g) lactational amenorrhea method(LAM)
2) Mechanical methods
a) Intra-uterine contraceptive device (IUCD)
b) Barrier methods - condoms – male or female,
diaphragm 194
3) Chemical (hormonal)
a) Combined oral contraceptive(COC)
b) Progesterone only pill (POP)
c) Injectables
d) Implants
e) Emergency contraception
f) Spermicides
4) Surgical
a) Female – bilateral tubal ligation (BTL)
b) Male – vasectomy

195
DRUG AND SUBSTANCE
ABUSE

196
 DRUGS AND SUBSTANCE ABUSE
Terminologies:
Drug
 In the broadest terms, a drug is any substance which

changes the way the body functions, mentally,

physically or emotionally.
 This definition does not discriminate between alcohol,

tobacco, caffeine, solvents, over the counter drugs,

prescribed drugs and illicit drugs but rather it focuses
on changes in the body and/or behaviour brought
about through the use of such substances
 These substances are also referred to as psychoactive

drugs, meaning that they affect the central nervous

system and alter mood, thinking, perception and
behaviour 197
Drug Use
 A broad term to cover the taking of all psychoactive

substances within which there are stages: drug-free (i.e.

non-use), experimental use, recreational use and harmful
use (misuse and dependence).
Drug Misuse
 Defined as any taking of a drug which harms or threatens

to harm the physical or mental health or social well-being

of an individual or other individuals or society at large, or
which is illegal.
Substance Abuse
 Use of illegal drugs and other chemicals which are none

drug such as glue, cleaning fluids, petrol and other

chemicals which cause psychological and physiological
effects to an individual
 Abuse: Refers to maladaptive patterns of substance use

that impair health in a broad sense 198

 Described as a: ‘maladaptive’ pattern of substance
use leading to clinically significant impairment or
distress, as manifested by one (or more) of the
following within a 12-month period:
i. Recurrent use leading to failure to fulfil major
role obligations (work, home, school, etc.)
ii. Recurrent use in situations where it is physically
hazardous (e.g. drunk driving)
iii. Repeated substance related legal problems
(repeated disorderly conduct while drunk)
iv. Persistent use despite recurrent
social/interpersonal problems caused or
exacerbated by the effects of a substance (e.g.
arguments with spouse or physical fights) 199
Dependence:
A ‘maladaptive pattern of substance use leading to clinically
significant impairment or distress, as manifested by three (or
more) of the following within a 12-month period:
i. Tolerance
ii. Withdrawal
iii. Substance taken in larger amounts over longer periods than
was intended
iv. Persistent desire or unsuccessful efforts to cut down or
control use
v. Great deal of time spent in activities relating to obtaining
the substance, using the substance or recovering from use
vi. Significant social, occupational or recreational activities are
given up or reduced because of use
vii. Use continued despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to
have been caused or exacerbated by the substance’ use
200
 Dependence: Refers to certain psychological
phenomenon that are induced by the repeated
taking of a substance
1. Strong desire to take substance
2. Progressive neglect of alternative sources of
satisfaction
3. Tolerance
4. Withdrawal state
Tolerance
 A need for increased amounts of a substance to

achieve the desired effect or a diminished effect

with ongoing use of the same amount of substance
 This is a state in which, after a repeated

administration, a drug produces a decreased effect

201
Addiction
 Addiction is a brain disorder characterized by

compulsive engagement in rewarding stimuli

despite adverse consequences
 A physical or psychological need for a habit-

forming substance, such as a drug or alcohol

Withdrawal state:
 A group of signs and symptoms that occur

when a drug is reduced in amount or

withdrawn
Alcohol intoxication:
 A disturbance in behavior or mental function

or after alcohol consumption 202

 EPIDEMIOLOGICAL TRIAD OF DRUG USE
 Different factors that influence the effects of use
 The three factors at play which impact on all stages of

drug use include drug factors, host factors and the

environment factors
 Provides a framework for a more pronounced
examination of how drug use affects us; it depends on
the drug, who is taking it and the context of drug use
Drug Factors
 What drug (or drugs) is taken?
 Is the drug a stimulant, opiate, sedative or

hallucinogen?
 How is it taken, frequently is it used?
 How much is taken?
 What is the strength and purity of the drug?
203
Person Factors
 Age, sex, personality, users’ concept of self, users’ beliefs

and expectations relating to the drug, stage of drug use,

reasons for use and expectations of use
Context or Setting
 The social environment within which the drug is taken;

when the use occurs; with whom use occurs; controls on

that setting and how these are exercised; immediate
specific situation and motivation for drug use
Criteria for substance abuse
 Recurrent substance use resulting in a failure to fulfill major

role obligations at work, school or home

 Recurrent substance abuse in situations that are physically

hazardous
 Continued substance abuse despite having recurrent social

or interpersonal problems caused by or exacerbated by the

effects of the substance use 204
 CAUSES AND RISK FACTORS FOR DSA
Risk Factor Examples
1 Individual Gender, a resilient temperament, a positive social
characteris orientation and intelligence. Intelligence, however does
tics not protect against substance abuse. Constitutional
factors are factors
2 Peer
association
3 Communit Availability of drugs; Community laws and norms
y Risk favourable toward drug use; Transitions and mobility:
Factors even normal school transition predicts increases in
problems behaviours; Low neighbourhood attachment
and community disorganization; Norms; Resources;
Extreme economic deprivation
4 Family Risk Family history of the problem behaviour; Family
Factors management problems; Family conflict; Parental
attitudes and involvement in drug use, crime and
violence
5 School Risk Early and persistent antisocial behaviour; Academic
Factors failure beginning in elementary school; Lack of
commitment to school; Friends who engage in the
problem behaviour; Favourable attitudes toward the
205
problem behaviour; Earlier initiation of problems
 Reasons for Abusing Drugs
1) Peer influence
2) Low self-esteem
3) Media influence (TV, magazines, internet)
4) Rebellion against parents, teachers, religion etc.
5) Curiosity
6) Lack of knowledge of drugs
7) Poor role models
8) Frustrations from home, school, body changes etc.
9) Inability to achieve goals set thus feeling like a
failure
10) False ideas and perceptions. E.g. bhang enhances
academic performance

206
 PATTERNS OF DRUG USE
 Drug use does not automatically lead to addiction nor is it
universally characterised by behaviours associated with
dependent substance use
 Patterns of drug use have been identified are mainly centred
around experimental, recreational, emotional, habitual and
dependent use
i) Drug Free Stage
 Represents a drug status which is aspirational rather

than actual
 A drug free state can be primarily regarded as an

idealised one
ii) Exploratory or Experimental Use
 Is a short-term, learning phase, influenced by culture

and availability
 Characterised by peer group activity and random choice

of drugs 207
iii) Social (Recreational) Use
 Characterised by regular use, group activity and use over a

longer period of time

 The key here is that control is exerted over use, with specific

choices being made in relation to what drugs are used, in

what amount, where they are used (normally in specific
situations) and when
iv) Emotional Use – Generative or Suppressive
 These two patterns of social drug use centre on the

purposeful manipulation of feelings, emotions and behaviour

with an aim to elicit or inhibit certain behaviours and
feelings. With this type of drug use, the adolescent is now
generally seeking the mood swing.
v) Habitual
 An increasing concentration on the drug use at the expense

of other interests which, in turn, can contribute to a range of

problems. 208
 STAGES OF DRUG AND SUBSTANCE ABUSE
1) Experimentation stage
 Alcohol or drug use starts with experimentation or

voluntary use
 Some people in this stage are able to stop using by

themselves. Others, however, who believe their substance

abuse is solving their problems or making them feel better
begin drinking more alcohol or taking more drugs, thereby
moving on to regular use.
2) Regular use (Social) stage
 This stage is characterized by use on a regular basis
 The person may continue to use with friends or

acquaintances or may use the substance while alone

 Regular use does not have to be every day, but is

sometimes continued use in a predictable pattern (every

weekend) or in predictable circumstances (when lonely,
bored, or stressed).
209
3) Problem or risky use
 During this stage, the user begins to suffer legal,

emotional, physical, or social problems

 Adults may drink and drive or have problems at work or

in their relationships.
 Teenagers may have bad grades, behavioural problems,

a significant change in friends, motor vehicle crashes, or

speeding tickets
4) Dependence
 Individual continues to use these substances regularly

despite the harm their use is causing, including bodily

changes causing altered reactions to the substance.
 Can be sudden or gradual depending on the substance,

substance dependence occurs when someone can no

longer stop using a particular substance without
experiencing physical or psychological distress. 210
 There are two types of substance dependence – physical and
psychological dependence
a) Psychological (psychic) Dependence: If the individual suddenly
starts taking less of a drug, or stops taking it completely,
he/she experience psychological symptoms characterized by an
emotional and mental preoccupation with the effects of the
drug and a craving to take it again.
b) Physical Dependence: Some substances create a physical
dependence, in which the body has adapted to the continuous
presence of the drug. When the concentration of the drug falls
below a certain level, the body demands more of it by
displaying various physical symptoms known withdrawal
symptoms or simply withdrawal.
5) Addiction
 Substance use is compulsive and out of control
 A medical condition involving psychological and physical
changes from repeated heavy use of alcohol, other drugs or
both. 211
Drugs and substances of abuse
 Alcohol
 Amphetamines
 Caffeine
 Cannabis
 Cocaine
 Hallucinogen
 Inhalants
 Nicotine/tobacco/opiods

212
CLASSIFICATION – NACADA (Kenya)
Group Action Examples
1 Stimulants Increases Tobacco; Cocaine; Miraa;
activity Nicotine; Cannabis (Hashish,
Marijuana; Heroin; Solvents;
LSD; Mushrooms;
Amphetamines
2 Depressant Decreases Codeine; Diazepam;
s activity Barbiturates; Alcohol; Cannabis
3 Steroids Fosters
formation of
living tissues
increasing
muscular mass
4 Hallucinoge alteration of Cannabis; Hashish; Kuber;
ns perception, Heroin
fantasy, Solvents; LSD; Mushrooms
illusions, being
lost in the world
of dreams 213
 ALCOHOL ABUSE
 Alcohol mainly consist of ethanol and water
 Alcoholic drinks can be divided into six different

categories namely beers (lager, stout, ale, strong beers),

cider, table wines (white, red, rose; champagnes),
fortified wines (sherry, port), distilled spirits (whisky,
brandy, rum, vodka, gin) and liqueurs
 The upper recommended limit per week is 21 standard

drinks for adult males and 14 standard drinks for adult

females
DESIRED EFFECTS
 Alcohol is often thought of as a stimulant rather than a

depressant, as it’s disinhibiting effects tend to make

users more animated and excitable; however, as more
alcohol is consumed, the depressant effects become
more pronounced 214
Behaviour Change
No. Of standard drinks Behavioural, physiological
consumed and psychological changes
Approximately 2 feel relaxed; less inhibited;
standard drinks more talkative

Approximately 3 co-ordination begins to

standard drinks diminish; judgement begins
to diminish; decision making
skills begin to diminish
More than 3 standard Staggering; double vision;
drinks obvious drunkenness;
unconsciousness

215
 Stage of Intoxication
Stage of Intoxication Impact
1st Stage: Happy Talkative, sociable, relaxed, less
inhibited and worried, some loss of
judgement
2nd Stage: Excited Emotional, erratic behaviour,
impaired thinking, slower reactions
slower, poor judgement, loss of
control over actions, driving
impaired
3rd Stage: Confused Staggering, disoriented, moody,
exaggerated emotional reactions
(fear, anger), slurred speech,
double vision
4th Stage: In a Stupor Unable to stand or walk, vomiting,
approaching paralysis, barely
conscious, apathetic and inert
5th Stage: In a Coma Completely unconscious, few or no
reflexes, may end in death from
respiratory paralysis 216
Signs and symptoms
 Breath that smells alcohol
 Blackouts/ seizures
 Enlarged pupils/ eye movements faster than normal
 Fast heartbeat
 Slow breaths
 Loss of balance
 Nausea and vomiting
 Slurred /loud speech
 Mood swings

217
 EFFECTS: Problems associated with alcohol
intoxication
Physical
Short Term RisksSocial Psychological
Accidents; Absenteeism from Anger and fatigue;
Acute alcohol work; Accidents at Anxiety; Amnesia;
poisoning; work; inefficient Depression;
work; Child
Cardiac neglect/abuse;
Impaired
arrhythmia; Criminal damage; interpersonal;
Foetal damage; Domestic violence, relationships;
Failure to take accidents; Drinking Insomnia;
prescribed and driving; Family Attempted
medication; arguments; suicide; Suicide
Homicide; Public
Gout; Gastritis;
drunkenness;
Hepatitis; Assault; Public
Impotence; aggression; Road
Pancreatitis; traffic accidents;
Strokes Sexually deviant
acts; Theft; 218
 Long Term Risks
Physical Social Psychological
Brain damage; Liver Family problems; Anxiety; Changes
damage/Cirrhosis;
Cancer of mouth, Divorce; Fraud; in personality;
larynx, oesophagus; Financial Amnesia;
Cancer of breast; difficulties; Depression;
Cardiomyopathy;
heart disease; Habitual Hallucinosis;
Diabetes; Fatty liver; conviction for Dementia; Misuse
Foetal damage; drunkenness; of other drugs;
Gastritis; Hepatitis;
Infertility; Work difficulties; Gambling;
Neuropathy; Vagrancy; Delirium tremens;
Nutritional Unemployment; Haemopoietic
deficiencies; Obesity;
Pancreatitis; Raised Withdrawal fits toxicity;
blood pressure; Attempted
Reactions with other suicide; Suicide;
drugs; Strokes;
Sexual dysfunction; Dependence;
Malnutrition; Mental Addiction
health disorders 219
 Complications
 Wernickes encephalopathy
 Korsakoff syndrome
 Alcoholic jealousy
 Hepatitis
 Alcohol withdrawal syndrome
 CVS
 Damage to fetus
Alcohol withdrawal
 Mild anxiety
 Tremors , sweating
 Sleep disturbance- insomnia
 Delirium tremens- hallucinations, misperceptions- shadows
seem to move, snatches of music heard, shouting
 The shakes
 Nausea and vomiting
 seizures 220
Alcohol addiction
 Alcoholism: Chronic disease characterized by
uncontrolled drinking and pre occupation with alcohol
Predisposing factors:
 Gender
 Occupation
 Genetic

Tips to stop
 Put in writing reasons for curb
 Set a drinking goal
 Keep diary of drinking
 Don’t keep alcohol in the house
 Drink slowly
 Choose alcohol free days
 Watch peer pressure
 Keep busy 221
 TOBACCO, NICOTINE AND CANNABIS
TOBACCO
 Smoked or administered via smokeless products such as snuff

DESIRED EFFECTS
 Psychological effects

i) Mood regulator and may increase pleasure

ii) Source of relief in highly stressful situations and periods of
strong emotion
iii) Reduces aggression and irritability
iv) Increases performance and concentration on minor tasks as
nicotine is known to stimulate memory and alertness enhancing
cognitive skills particularly in relation to speed, vigilance, reaction
time and work performance
 Physiological effects (nicotine - principal toxic constituent of

smoking has stimulant effects),

i) Increases heart rate, blood pressure and respiration
ii) An appetite suppressant, specifically decreasing the appetite
for sweets and inhibiting the efficiency of food metabolism” 222
SIGNS AND SYMPTOMS OF USE
 Most obvious sign of use is the smell of tobacco include on the breath

of the user, in his or her hair, on their hands and in the fabric of their
clothes
 Long-term use will result in a staining of the teeth and possibly of the

fingers and nails.

HEALTH EFFECTS
Short Term Risks
 Increased risk of dependence; Impact on physical fitness

both in terms of performance and endurance; Rate of lung

growth and the level of lung function (amount of oxygen
available for muscles is reduced)
 Frequent and severe respiratory illnesses
 All of the carbon monoxide, 90% of the nicotine and 70% of

the tar in tobacco

 Smoke is retained in the lungs when inhaled.
 Decreased sense of taste and smell.
 Concomitant use alcohol, marijuana and other drugs 223
Long Terms Risks
i) Increased risk of lung cancer
ii) Increased risk of heart disease, heart attack, blood
clots, strokes, bad circulation, ulcers, lung infection,
bronchitis, emphysema, cancers of the mouth and
throat
iii) Male and female fertility
iv) Pregnancy (on foetus) - increased risk of a
premature birth, stillbirth, neonatal death and LBW
KUBER
Kuber, also known as Khaini, is a smokeless
chewing tobacco popular in India which is
mainly used in place of cigarettes. Contains up
to 25% nicotine, making it highly addictive 224
HEALTH EFFECTS
Short Term Long Term
Delusions hallucinations, Discolouration of teeth,
lowered inhibitions, Holes on the gum line,
dizziness, headaches, Cervical cancer, Infertility,
drowsiness, weak teeth Mouth and throat cancer,
and gum bleeding Addiction

CANNABIS
 Cannabis is obtained from a plant called Cannabis sativa.
There are three types of cannabis – Cannabis indica (from
India), Cannabis ruderalis (from Central Asia and Siberia)
and Cannabis sativa (in equatorial regions – Kenya,
Uganda, Tanzania, Nigeria, Thailand, Colombia among
others
 Commonest form in Kenya is the herbal cannabis
(marijuana), which is usually mixed with tobacco, rolled
into a cigarette and smoked
 It is administered through smoking or ingestion 225
DESIRED EFFECTS
 Cannabis has stimulant, sedative and hallucinogenic

properties
 Elevated mood, a feeling of relaxation and mild euphoria
 Altered perception and thought processes, with time

distortions, aroused appetite and with enhanced sensory

appreciation
 Increased sociability

SIGNS AND SYMPTOMS OF USE

 Bloodshot eyes
 Giggling, especially in early stages of use
 Increased appetite, also known as the “munchies”
 “Bomb” burns on clothes – small multiple burn marks

caused by falling bits of burning cannabis resin or ash

 Paraphernalia associated with making cannabis joints
226
HEALTH EFFECTS
Short Term Long Term
Anxiety and panic The risk of dependence and
reactions; Disrupts the addiction; Increased risk of
control of blood pressure bronchitis and asthma;
leading to an increased risk Physical and mental
of fainting; Heart rate lethargy, apathy and loss
increases within 15-30 of ambition; Slowing of
minutes of inhalation and information processing
remains raised for two (Cannabis is fat-soluble, it
hours or more; Interferes persists in all parts of the
with short-term memory body, including the brain,
and learning abilities; for up to four weeks after a
Ability to drive or use single dose); Psychiatric
machinery is also impaired consequences - a risk
factor for schizophrenia;
Behavioural, family and
school problems 227
 COCAINE AND HEROIN
COCAINE
 Powerful stimulant drug, extracted from the
leaves of the coca plant
 Cocaine is not physically addictive but produces

a severe psychological dependence because of

the strong cravings which lead to compulsive
continuous use
 Can be administered intra-nasally (through the

nose), intravenously (through a vein) or

Smoked.
 Cocaine is usually snorted or sniffed; laid out in

lines and sniffed through a rolled-up piece of

paper, often a bank note, or a straw 228
DESIRED EFFECTS
 Feelings of euphoria, increased self-worth and

emotional disinhibition
 Increased energy
 Increased mental activity and alertness
 A heightened sense of pleasure

SIGNS AND SYMPTOMS OF USE

 Unusual confidence, hyperactivity and insomnia,

being very talkative, nose irritation (it may be runny

or itchy due to “snorting”), dilated pupils, loss of
appetite, track marks on the body and evidence of
injecting equipment.
 Paraphernalia associated with ‘crack’ use includes

improvised pipes made from tin cans, water bottles

or tin foil as well as glass pipes 229
HEALTH EFFECTS
Short Terms
 Smaller doses – insomnia, agitation, anxiety and panic attacks,

hallucinations and blood vessel constriction

 Excessive doses can cause death through heart failure or lung

damage
 Discontinuing regular use - user will experience a ‘crash’ – severe

depression and tiredness, along with excessive eating and sleeping.

Long Term
 Damage to the lining of the nose
 Restlessness
 Insomnia
 Weight loss
 Paranoid psychosis with delusions of persecution
 Violent tendencies
 “Snow lights” (visual disturbances)
 Cocaine bugs” (a feeling of insects crawling under the skin)
230
 HEROIN
 Member of the opiate family, a group of substances derived
from opium, which is a dried milky latex extracted from the
fruit of the opium poppy.”
 Administered intra-nasally (sniffed); Swallowed or dissolved in
water and drunk; Smoked, sometimes referred to as ‘chasing
the dragon’; Injected intravenously (into a vein); Injected
intramuscularly (into a muscle, the usual way in which
medical injections are administered to avoid damage to the
veins); Injected under the surface of the skin (‘skin popping’).
DESIRED EFFECTS
 The ‘heroin rush’ which lasts less than a minute and

includes warm flushing of the skin, sexual excitement,

followed by a dream-like state of peacefulness and
contentment, reduced feelings of pain and reduced
aggressive tendencies and sexual drive
231
 SIGNS AND SYMPTOMS OF USE
 Constricted pupils (pin-point or pin-prick pupils), drowsy
appearance (‘goofing’ or ‘goofing off’), unconsciousness,
slurred speech, shallow breathing, use has problems
maintaining focus, visible ‘track-marks’ on arms from injecting
(sometimes on legs/neck) with bruising and discolouration
 Acute and chronic opioid use is associated with a lack of
secretions, i.e. dry mouth and nose, and a slowing down of
gastrointestinal activity resulting in constipation
EFFECTS
 Personal safety may be an issue depending on how much
opiate/heroin has been taken.
 Injecting in veins at high-risk sites such as the neck (close to
the jugular vein) and groin (close to the femoral vein)
 Serious illness and premature death
 Break down in family and community relationships
 Involvement in crime
232
 COMMON ABUSED DRUGS – CONTINUED
 SOLVENTS, LSD, MAGIC MUSHROOMS AND MIRAA
 AMPHETAMINES, ECSTASY, OTC AND PRESCRIPTION DRUGS

SOLVENTS DESIRED EFFECTS

 Euphoria
 Visual and auditory hallucinations, ranging from

pleasant to unpleasant
 Delusions, such as believing one can fly

SOLVENT HEALTH EFFECTS

i) Heart failure
ii) Fatal injury arising from accidents while intoxicated
iii) Risk of choking associated with the inhalation of vomit
after use
iv) Asphyxiation from repeated inhalations 233
LSD (LYSERGIC ACID DIETHYLAMIDE)
 Lysergic acid diethylamide (LSD), also known as “acid” is

a hallucinogenic drug, which can generate profound

distortions in the user’s perceptions of reality
DESIRED EFFECTS
The desired effects of LSD are a ‘good’ trip; that is a
positive hallucinogenic experience which may involve:
 Colours taking on brighter, more vivid appearance
 Body images and shapes may appear distorted
 Sight and sound may become confused in that the
individual may “listen” to colour and “see” music
due to sensory crossover.
 A sense of time and place may become distorted
 Emotional/mood changes including heightened
self-awareness and mystical experiences 234
EFFECTS OF LSD (LYSERGIC ACID DIETHYLAMIDE)
Short Terms Risks
 Impair cognitive skills such as learning, memory and

concentration
 Mentally unstable, anxious or depressed
 A bad trip may include frightening mood changes and severe

terrifying thoughts; anxiety and feelings of loss control;

depersonalisation (a feeling of floating outside one’s own
body); disorientation and panic and fear of going mad or dying
Long Term Risks
 Trip re-experience without taking LSD again
 Sensory distortions
 Disorientation, anxiety and distress
 Flashbacks can be particularly dangerous if experienced when

one is driving, working at heights or operating machinery

 Tolerance

235
 MAGIC MUSHROOMS
 This mushroom is small, with a thin stem and a head

which is said to resemble head gear worn during the

French Revolution, hence its name
DESIRED EFFECTS
 The desired effects of magic mushrooms are similar to a

mild LSD trip, including:

o Euphoria and hilarity
o Dilated pupils, increased pulse rate, high blood pressure
 Hallucinations tend to be visual but some users will

experience auditory ones (heightened awareness of

sound and colour and the sensation of objects changing
shape)
EFFECTS
Short Term Risks
 Nausea, vomiting and abdominal pain 236
 Experience of bad trips (lasts 12 hours) which may
include feelings of depersonalisation, panic and anxiety,
psychotic reactions, aggression and hyperactivity,
tingling limbs and flushing
Long Term
 Tolerance develops rapidly
 Psychological dependence

MIRAA
 Miraa is a plant whose fresh leaves and soft twigs

are chewed to release a juice containing

cathinone and cathine, the active chemicals that
alter the mood of the abuser
 Botanically, Miraa (Khat) plant is known as catha

edulis. Other names - khat, veve, muguka, goks,

gomba, mbachu, mairungi, alele, giza or halwa 237
HEALTH EFFECTS OF MIRAA
1) Has similar but less intense effects than the stimulating
effects of cocaine
2) Unusual feeling of excitement and alertness (talk too much,
lose concentration on simple tasks or even forget simple facts)
3) Rapid heart rate and increased blood pressure, symptoms
that are sometimes confused with increased sexual libido or
stamina
4) Chronic constipation since it causes dehydration
5) Lack of adequate sleep - danger of causing harm through
accidents
6) Reproduction
 Evidence suggests that miraa inhibits blood flow to
the reproductive system
 Chewing miraa during pregnancy decreases blood
flow to uterus, disrupting flow of nutrients from your
bloodstream to the unborn baby. 238
 AMPHETAMINES
 A synthetic stimulant, which has been in
production since 1887
 Has featured in a range of applications (medical

and non-medical) including use by soldiers during

the Second World War and the Vietnam War to
promote performance and endurance; as a
slimming tablet; to treat mild depression; in youth
culture as a feature of parties in the 1960s and
more recently, as one of the drugs associated with
ecstasy and other dance drugs.
 Administered by mouth, sniffing/snorting,
smoking and by dissolving in water and
injecting 239
DESIRED EFFECTS
 Intensity of effects depend on the mode of
administration (small dose of around 30 mgs
taken orally will have a similar effect to the
natural release of adrenaline)
 Effects include stimulation of the nervous system

is stimulated, breathing and heart rate increase,

user feels more active, alert and energetic, mental
activity increases with better concentration and
clearer thinking.
 Higher doses see users become overactive,

boastful and they may indulge in repetitive

behaviour and experience hallucinations and
feelings of persecution and/or panic. 240
EFFECTS
Short Term Risks
 Irritability, confusion and dizziness
 Feelings of deep depression, exhaustion, sleepiness

and extreme hunger as the body addresses postponed

fatigue and the depletion of energy.
 ‘Amphetamine psychosis’ - similar to schizophrenia

and includes thought disorders, hallucinations and

feelings of being persecuted, which in turn may lead
to hostility, aggression and violence towards others,
as the user defends themselves against their
imagined persecutors
Long term risks
 Tolerance
 •Severe psychological dependence
241
 ECSTASY
 Ecstasy (‘designer drug’) is synonymous with young
people and the dance music scene since the mid-1980.
Has both stimulant (amphetamine) and hallucinogenic
properties, the active ingredient being
methylenedioxymethamphetamine (MDMA)
 Taken orally
DESIRED EFFECTS
 Feeling of content, relaxation and happiness with a

warm friendly feeling towards others; feel

energetic in that it allows them to dance for
sustained periods; increased self-awareness;
increased perception of visions and music;
however, no true hallucinations occur at “normal
dose” levels 242
EFFECTS
Short-term risks
 Heat stroke or hyperthermia
 Death (rare)
 A rise in blood pressure, pulse and temperature
 Convulsions, stroke and severe chest pains

Long-term risks
i) Chronic psychiatric symptoms including Psychotic
episodes, Panic disorder, Depersonalisation
ii) Other risks associated with prolonged use include:
Weight loss due to appetite suppression/frequent
dancing, Mood swings and depression, Memory loss
iii) Behaviours that increase harm include: Using other
drugs to bring on a “comedown”, Excessive intake of
alcohol (dehydrating) and/or water in order to cool down
243
 OTC AND PRESCRIPTION DRUGS
Three types of prescription drugs abused most include:
1) Opioids e.g. morphine and pethidine prescribed for
pain relief
2) CNS depressants—barbiturates and benzodiazepines
prescribed for anxiety or sleep problems (often referred
to as sedatives or tranquilizers)
3) Stimulants — prescribed for attention - deficit
hyperactivity disorder (ADHD), the sleep disorder
narcolepsy, or obesity.
 Commonly abused classes of prescription drugs
include opioids (for pain), central nervous system
(CNS) depressants (for anxiety and sleep
disorders), and stimulants (for ADHD and
narcolepsy). 244
DEPRESSANTS
 Depressants include barbiturates (e.g.
phenobarbitone), benzodiazepines (e.g. Valium) and
sleep Medications
Intoxication Effects
 Sedation/drowsiness, reduced anxiety, feelings of

well-being, lowered inhibitions, slurred speech, poor

concentration, confusion, dizziness, impaired
coordination and memory
Potential Health Consequences
 Lowered blood pressure, slowed breathing, tolerance,

withdrawal, addiction; increased risk of respiratory

distress and death when combined with alcohol
 Euphoria, unusual excitement, fever, irritability/life-

threatening withdrawal in chronic users 245

 OPIATES AND MORPHINE DERIVATIVES
 These include codeine, morphine, methadone and pethidine

Intoxication Effects
 Pain relief, euphoria, drowsiness, sedation, weakness,

dizziness, nausea, impaired coordination, confusion, dry

mouth, itching, sweating, clammy skin, constipation
Potential Health Consequences
 Slowed or arrested breathing, lowered pulse and

blood pressure, tolerance, addiction,

unconsciousness, coma, death; risk of death
increased when combined with alcohol or other CNS
depressants
Other prescribed drugs abused:
 ANABOLIC STEROIDS
 TRANQUILLIZERS
246
 PREVENTION AND CONTROL OF DRUG AND
SUBSTANCE ABUSE
Primordial
1) Policy Formulation
 Policies and procedures ensure that a point of view

held by the governing body of an organization is

translated into steps that result in an outcome
compatible with that view.
Examples of Polices
I. Various government policies
II. Various organization policies
III. Sub-sector workplace policy on HIV and AIDS, 2006
IV. Workplace Counselling Policy 2008
V. Gender Policy in Education, 2007
VI. Vision 2030 (social pillar) 247
2) Legislation – Examples of Laws Regulating Drug and Substance Abuse
I. Narcotic Drugs and Psychotropic Substances (Control) Act, 1994
II. Tobacco Control Act, 2007
III. The Compounding of Potable Spirits Act (Cap 123)
IV. The Chang’aa Prohibition Act (Cap 70)
V. The Industrial Alcohol (Possession) Act (Cap 119)
VI. Methylated Spirits Act (Cap 129)
VII. Liquor Licensing Act (Cap 121)
VIII. The Use of Poisonous Substances Act (Cap 245)
IX. Customs & Excise Tax Act
X. The Pharmacy and Poisons Act (Cap 244)
XI. The Food Drugs and Chemical Substances Act (Cap 254)
XII. The Standards Act (Cap 496)
XIII. The Public Health Act (Cap 242)
XIV. The Trade Descriptions Act (Cap 505)
XV. Weights and Measures Act (Cap 513)
XVI. Foods, Drugs and Chemical Substances Act Cap 254
XVII. Environmental Management & Coordination Act, 1999 (S78)
XVIII. The Service Commissions Act Cap 185
XIX. The Sexual Offences Act 3 of 2006
XX. The HIV and AIDS Prevention and Control Act 14 of 2006
XXI. The Mental Health Act Cap 248
XXII. Public Officers Ethics Act
XXIII. Vocational, rehabilitation and employment (disabled persons 248
 Primary Prevention
 A way of preventing initiation of psychoactive substance use or

delaying the age at which use begins

 Factors that increase individual risk for substance use are known

as risk factors and those that decrease the risk are called
protective factors.
 Risk factors have a tendency to push an individual toward using

substances while protective factors do the opposite. Identifying

the risk and protective factors for substance use in a community
is an important step in determining how one can respond to this
problem.
Approaches (Strategies)
1) Dissemination of Information
2) Skills Development
3) The family
4) Alternative activities and Attachment
5) Community Based Processes
6) Environmental Approaches
7) Problem Identification and Referral 249
 Secondary Prevention
 Intervention aimed at individuals in the early stages of
psychoactive substance use, in order to prevent substance
use becoming a problem and thereby limit the degree of
damage to the individual
 Secondary prevention focuses on youth who have begun
experimentation, use and abuse of drugs (experimentation,
occasional and regular use and drug dependency)
 Includes activities related to activities used to change
behaviour of individuals who are involved with or suffer from
problems related to alcohol and other drug use
 Services and activities include crisis intervention, targeted
education, peer group intervention, detoxification services,
and inpatient and outpatient treatment; behaviour change
(using the Transtheoritical model of five stages namely
precontemplation, contemplation, preparation, action and
maintenance) 250
 Tertiary Prevention
 This aims at ending dependence and minimising
problems resulting from use/abuse.
 This type of prevention strives to enable the
individual to achieve and maintain improved levels
of functioning and health
 Sometimes tertiary prevention is called
rehabilitation and relapse prevention

251
 KENYA GOVERNMENT AGENCIES INVOLVED IN
PREVENTION AND CONTROL
1) Ministry of Interior and National Coordination
2) Kenya Police Service (Anti-Narcotic Police Unit)
3) State Law Office
4) Judiciary
5) Customs Department
6) Office of the DPP
7) NACADA
8) KEBS
9) Ministry of Education
10) Ministry of Health
11) The Parliament (National and Senate)
12) Faith Based Organizations

252
ROLES OF SOCIAL INSTITUTIONS
Institution Role
Health Health Education; Treatment; Detoxification;
Rehabilitation
Family Parenting; Social responsibility; Reduce exposure;
Physico-social support; Attachment
Education Peer Education and counselling; Attachment
Knowledge and acquisition of knowledge and skills
Religion Moral guidance; Behaviour change; Advocacy;
attachment
Political/ Policy formulation; Legislation; Standardization; Civic
Government education; Social support; Execution of policies
Resource mobilization; Training and capacity building
Leadership
Community Advocacy; Information; attachment
organization
s
Community Attachment
Economy 253
 ALCOHOL CONTROL AND NACADA ACT.
Alcoholic Drinks Control Act (2010)
 The Alcoholic Drinks Control Act is an act of

Parliament to regulate the production, sale, and

consumption of alcoholic drinks, to repeal the
Chang'aa Prohibition Act, the Liquor Licensing Act
and for connected purposes. The Act seeks to: To
educate the public on the dangers of alcohol use
(economic, social & health)
 Date of commencement: 22nd November, 2010
Key mandate of the act
 To protect the health of individuals by providing

a legal framework to control sale, production &

consumption of alcoholic drinks 254
 To protect consumers of alcohol products from
misleading inducements to use alcohol
 To protect young people (those below 18 years) by
restricting their access to alcoholic products
 To educate the public on the dangers of alcohol use
(economic, social & health)
 To protect the government by dealing with illicit
trade
 To promote and provide for treatment & rehab
programmes for the addicted
 To promote research and dissemination of
information esp of health risks
 It also seeks to legalise production & consumption
of chang’aa
255
 NACADA Act
 The National Authority for the Campaign Against Alcohol and
Drug Abuse (NACADA) is a Semi-Autonomous State Corporation
under the Ministry of Interior and Coordination of National
Government as per the Executive Order No. 1 of June 2018
(Revised).
 The National Authority for Campaign against Alcohol and Drug
Abuse (NACADA) was established by an Act of Parliament in
July 2012. The Authority's core function is to coordinate a
mulch-sectoral public education and awareness campaign
against alcohol and drug abuse in Kenya; to undertake public
education and awareness campaign against drug abuse,
especially among youth in schools and other institutions of
higher learning.
 Previously, the Authority was known as the National Campaign
Against Drug Abuse Authority established via Legal Notice No.
140 of 2007.
 Its vision is A nation free from alcohol and drug abuse. 256
 FUNCTION OF NACADA
1. Carrying out public education on alcohol and drug abuse
directly and in collaboration with other public or private bodies
and institutions;
2. Coordinating and facilitating public participation in the
control of alcohol and drug abuse;
3. Coordinating and facilitating inter-agency collaboration and
liaison among lead agencies responsible for alcohol and drug
demand reduction;
4. In collaboration with other lead agencies, facilitating and
promoting the monitoring and surveillance of national and
international emerging trends and patterns in the production,
manufacture, sale, consumption, trafficking, promotion of
alcohol and drugs of abuse;
5. In collaboration with other lead agencies, providing and
facilitating the development and operation of rehabilitation
facilities, programs and standards for persons with substance
use disorders; 257
6. Subject to any other written law, licensing and regulating the
operation of rehabilitation facilities for persons with substance use
disorders;
7. Coordinating and facilitating in collaboration with other lead agencies
and non-state actors the formulation of national policies, laws, and plans
of action on control of alcohol and drug abuse and facilitating their
implementation, enforcement, continuous review, monitoring and
evaluation;
8. In collaboration with other public and private agencies, facilitating,
conducting, promoting and coordinating research and dissemination of
findings on data on alcohol and drug abuse and serve as the repository
of such data;
9. In collaboration with other lead agencies, preparing, publishing and
submiting an alcohol and drug abuse control status report bi-annually to
both Houses of Parliament through the Cabinet Secretary;
10. To assist and support county governments in developing and
implementing policies, laws, plans of action on control of drug abuse.
11. Carrying out such other roles necessary for the implementation of
the objects and purpose of this Act and perform such other functions as
may from time to time, be assigned by the Cabinet Secretary.
258
END

259
THANKS

260