Status of street children Acronyms ARISE
Appropriate Resources for Improving Street Children's Environment
Bangladesh Bureau of Statistics
Body Mass Index
Chronic energy deficiency
Demographic and Health Survey
Expanded Programme on Immunisation
Food and Agricultural Organization
International Centre for Diarrhoeal Disease Research, Bangladesh
Iodine deficiency disorder
Institute of Nutrition and Food Science
Non Government Organisation
National Institute of Population Research and Training
National Institute of Prevention and Social Medicine
Oral Rehydration Therapy
Protein Energy Malnutrition
United Nations Childrenâ€™s Fund
World Health Organization
Introduction 1.1General introduction Street children are the children of the poorest people in Bangladesh. Street children live, grow up and work on the margins of the society in a state of neglect and deprivation. They lack protection, education, affection, care and proper guidance from adults. In 1990, the government estimated that there were about 1.8 million children on the streets of Bangladesh. About 215,000 children (including 100,000 girls) were thought to be in Dhaka City
alone. Twelve years later, there are probably several million children on the streets in Bangladesh. Most of them work as vendors, car-cleaners, newspaper-sellers, beggars, helpers in garages/ rickshaw repair shops, rag pickers, and in other informal areas. They are often involved in dangerous and hazardous jobs.2 There are many reasons why the numbers of street children are growing. These include the spiraling growth of urban population at 7 - 9 % per year, rural poverty and migration to uus rban centers, unemployment, landlessness, river erosion, family conflict, law and order situations, and the disintegration of traditional family and community structures. The Ministry of Soda! Welfare of the Government of Bangladesh, with UNDP financial and technical assistance, Is implementing a pilot project (Appropriate Resources for Improving Street Children's Environment, or "ARISE") targeting children who work and live on the street without families -the- most vulnerable category of children.1 Government statistics, based on a survey by the Bangladesh Institute of Development Studies, estimate the number of street children in Bangladesh to be around 380,000 -- of whom 55% are in Dhaka city. A little less than half of them (49.2%) are of the age group < 10 years, while the remaining falls in the age group of 11-19 years. Their gender composition is as follows: boys 74.3%, while girls account for 25.7%. The above report estimates that by 2014 the number of such children would exceed 930,000.23 The major problems of street children are: Insecure life; physical and sexual abuse by adults of the immediate community; harassment by law enforcing agencies; no, or inadequate, access to educational institutions and healthcare facilities; and lack of decent employment opportunity. The role of appropriate education for empowerment of children - especially the disadvantaged groups like the street or working children -- has been unequivocally established. Article 17 of the Constitution of Bangladesh recognizes the right to education for all - including the disadvantaged children. The National Plan of Action for Children (2005-2010) also clearly emphasizes the urgent need for "education and empowerment." Along the same vein, the National Poverty Reduction Strategy of the country provides for education as a means of "empowerment of disadvantaged groups" - including children.13 The schools are strategically located, covering the city-entry points and/or working places for street children, such as railway, launch and bus terminals, market places on riverbanks, busy city markets, parks, etc. The street school spots are typically acquired (often free of cost) from the community or relevant public authorities.14 A typical school functions for two to three hours every day for up to six days a week. School operating hours are decided so that they do not interfere with the working hours of the children. Prior to commencement of classes, the concerned staff (development workers, teachers) walks around the neighboring area to identify newly arrived children and to invite regular children to classes. The learning materials predominantly focus on various life skills related topics. To cite a typical example, the schools run by the NGO Aparajeyo Bangladesh use an open learning package that includes the following topics: Life skills, child rights, child labor, protection from sexual abuse and exploitation (including trafficking), creating dreams, keeping safe on the streets, dealing with the police, and HIV/AIDS/STI prevention. The idea is to create an educational foundation amongst the targeted children by blending pedagogical and practical life skills.18
The time of the training (2 to 3 hours including the time for rapport building) is considered insufficient by most educators. Some terminologies and technical jargons used in the training sessions are not easily amenable to children's understanding.11 In the OAS, ensuring and maintaining regular presence of the children, who often tend to be highly mobile and restless, is a huge challenge. Although most educators/trainers have basic relevant training (to a varying degree), advanced training on teaching techniques and tools is clearly inadequate. It may be relevant at this point to think about and furnish some clues on improving the effectiveness of the OAS campaign. Some such ideas include the following: The training topics, session time and contents need to be reviewed and analyzed by appropriately qualified experts and practitioners in order to make them more consistent, comprehensible and adaptive to the specific age and intellectual development of the targeted children and the local context.20 To ensure "age-content compatibility," some educators and trainers opined that the children may be divided into two groups - up to 11 years of age and 12 years and above. The logistical requirements of the OAS should be reviewed. The contents and mode of delivery of various training and capacity development initiatives should more clearly focus on (and lean towards) a "right-based approach" as distinct from mere philanthropic orientations.3 Along the same vein, the training methodologies used in these schools need to be reviewed by appropriately qualified experts. Emphasis may be given to use of learning by doing, mock sessions, and various illustrative tools.7 The concerned staff should have systematic and regular consultations with the targeted children and community people before designing and/or implementing any training scheme, especially about its contents, time and location. Female children should be given preference, or at least equal opportunity, in availing various skills development training. About 73 per cent street children in Dhaka city suffer from chronic malnutrition while mortality and morbidity status among the street dwellers has reached an alarming level due to lack of basic healthcare services, reports BSS. This was revealed in an ICDDR,B study on "Health Needs and Health Seeking Behaviors of Street Dwellers in Dhaka City". Its findings were released at a seminar in the city Wednesday.24 According to the study, the disadvantaged street children are most vulnerable to various complicated diseases due to overcrowding, poor environmental status and unhygienic foodstuffs.9 The study said massive urbanization process is solely responsible for the large segment of street people in Dhaka city and they remain beyond healthcare facilities. It found that the street children mostly came to Dhaka from Jamalpur, Sherpur, Mymensingh and Rajshahi districts.10 ICDDRB in cooperation with Marie Stopes Clinic Society (MSCS) and Oparajeyo-Bangladesh carried out the study among day- laborers, rickshaw pullers, sex workers, butchers, beggars, aged between 15 and 49 at 11 major points in Dhaka city. 24 . 1.2. Body Mass Index (BMI)
Body Mass Index (BMI) is a number calculated from a child's weight and height. BMI is a reliable indicator of body fatness for most children and teens. BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA)55. For children and teens, BMI is age- and sex- specific and is often referred to as BMI-for-age. 1.2.1 BMI percentile After BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-forage growth charts (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child's BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, overweight, and obese). BMI-for-age weight status categories and the corresponding percentiles are shown in the following table. Weight Status Category Underweight Healthy weight Overweight Obese
Percentile Range Less than the 5th percentile 5th percentile to less than the 85th percentile 85th to less than the 95th percentile Equal to or greater than the 95th percentile
1.2.2 Use of BMI with children and teens BMI is used as a screening tool to identify possible weight problems for children. CDC and the American Academy of Pediatrics (AAP) recommend the use of BMI to screen for overweight and obesity in children beginning at 2 years old. For children, BMI is used to screen for obesity, overweight, healthy weight, or underweight. However, BMI is not a diagnostic tool. For example, a child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments. These assessments might include skin fold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings. 1.2.3. BMI interpretation for children and teens Although the BMI number is calculated the same way for children and adults, the criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. For children and teens, BMI age- and sex-specific percentiles are used for two reasons: â€˘ â€˘
The amount of body fat changes with age. The amount of body fat differs between girls and boys.
The CDC BMI-for-age growth charts take into account these differences and allow translation of a BMI number into a percentile for a child's sex and age. For adults, on the other hand, BMI is interpreted through categories that do not take into account sex or age. 1.2.4 Healthy weight ranges can't be provided for children and teens Healthy weight ranges cannot be provided for children and teens for the following reasons: â€˘ â€˘
Healthy weight ranges change with each month of age for each sex. Healthy weight ranges change as height increases.
1.2.5. Adult BMI calculator canâ€™t be used for children The adult calculator provides only the BMI number and not the BMI age- and sex-specific percentile that is used to interpret BMI and determine the weight category for children and teens. It is not appropriate to use the BMI categories for adults to interpret BMI numbers for children and teens. Rationale of the study In Bangladesh, street children can be defined as those who earn their living on the city streets and stay there for most, or all, of the day. They may or may not have parents or legal guardians. The present urban population growth rate is in Bangladesh about 7% and 9% per year in the smaller & bigger cities respectively6. Street children are almost always the children of the poorest people in any urban area. There is no single reason why some children are forced, or choose, to work and/or live on the streets. There are, however, interrelated elements and influences that lead children to this unwanted, and often dangerous, way of life. The phenomenon of street children is a symptom of extreme social and economic stress. A lot of children are found floating in the cities 5. They travel from one city to other and get involved in some economic activates either for survival or to support their families. Several factors are contributing to increase the number of street children and in Bangladesh every on street child out of 10 urban street children live under difficult circumstances and are involved in dangerous and hazardous job. Poverty, inadequate housing, poor healthcare, malnutrition, unemployment and lack of education have collectively contributed to the incidents of child annihilation, abuse and neglect. There is violation of rights at every stage of their lives, having no means and access to protection or a support structure to prevent exploitation or negligence. The street children health and nutritional status as well as their life style is bully due to absence or lack safety, shelter, food security and any mechanism to prevent their abuse. Most of the street children are found to be involved in unorganized labor sector as vendors, carcleaners, news paper-sellers, beggars, flower sellers, helper in garages/rickshaw repair shops/tempo rag pickers etc6'10. The age group of the street children is between 6 to 8 years and works 4-12 hours a day. This study will explore the situation of the street children and their requirements, which will be helpful for developing relevant programmers on their issue.
Objectives General Objective: To observe morbidity pattern, assess nutritional status and socio-demographic condition of the selected street children in Dhaka City. Specific objectives: 1. To obtain information on the socio-economic status of the street children. 2. To assess the nutritional status of the selected street children. 3. To identify their nutritional deficiency diseases. 4. To evaluate their food intake by food frequency. 5. To study of hygienic and living status of the selected street children. 6. To observe the hygienic aspect of consumed foods, drinking water, environmental and living areas. 7. To know about the living place and working condition of the street children. 8. To find out smoking, drug addiction and other anti-social activities of the street children. 9. To recommend appropriate intervention to improve the nutritional status of the street children. Literature Review Bangladesh is located in southern Asia, bordering the Bay of Bengal, between Burma and India. The capital is Dhaka. Population was estimated at 138.4million in 2003, and is growing at a rate of 2.06 percent11. Increased poverty in urban areas (out of Dhaka's population of 9.3 million, an estimated 5 million are below the poverty line) 90% of the urban or live in single room, very poor quality accommodation. Estimated number of street children in Bangladesh: 445, 226 (of which 75% are in Dhaka city.53% boys, 47% girls-Sept 2001 survey. All categories of street children are called rag pickers by the general public, although they may be engaged in a range of petty trading/ employment / criminal activities. Children living in street situations are an increasing phenomenon in developing countries and economically advanced countries. Amongst the world's one billion children suffering from deprivation of basic needs, these children are highly likely to experience 'absolute poverty' 25. Once on the street their living experience can be viewed as a condition of both severe and chronic poverty2. The plight of girls in street situations is a special concern. Many types of program attempt to assist children in street situations - 'street children', 'hard to reach children', 'working children', 'children in need of special protection' or 'specially disadvantaged children'. However, their high spatial mobility, independence and suspicion of adultâ€™s means that attempts to provide support and reintegration are problematic and often unsuccessful. Commonly, policymakers and social activists have prioritized preventing or reducing child migration to the streets and this has led to a research focus on the causes of children leaving their families and moving to the streets1. According to a recent official study some 500,000 children are living on the streets in the country's main cities. It frames this analysis within broader discourses concerning the nature of poverty. In particular, it distinguishes between economic (income/consumption) and other dimensions of poverty and uses both objective and subjective assessments of poverty. Underpinning the paper is a belief that
development action is not simply about the provision of basic needs or minimum incomes but about raising people's (including children's) ability to access and convert livelihood assets (human, social, physical, natural and financial) into desired beings, doings and becomings.3 By adopting a more holistic and multidimensional view of poverty, and utilizing the findings of extended qualitative research methods, we argue that in Bangladesh children move to the street not simply because of economic (income, consumption or material) shortfalls as is commonly assumed. Rather, it is the abuse of human rights, especially in terms of physical violence, and the breakdown of trust within househoids4 that leads children to move to the street. The health of children often is viewed as a mirror on the health of their parents. In the ease ofmothers in developing countries, child health also is found to reflect their social standing and household power. In some places, health disadvantage for girls has been documented based Q gender preferences for sons and low maternal autonomy in the home 26. A recent study in India documents selective neglect of girls based on certain sex and birth- order combinations38. Howler, other recent studies report a diminishment or even reversal of this pattern, finding to be better nourished than boys in some African countries48. Some of the changes in child health in the developing world might be attributed to health interventions, increased education of women, and increasing empowerment of females in the home. These conflicting reports suggest that sexbiases observed though selective neglect of girls ' nutrition and health are shifting in many contexts, and we attempt to document such a shift using longitudinal data from Mat lab, Bangladesh. In our previous work, we find that the health status of Bangladeshi children under the age of 10 has improved markedly during the past decades, despite significant Ricks of both long and short- term malnutrition that still exist. However many Bangladeshi children still suffer from some degree of malnutrition, preventable disease, and high rates of child of child mortality, therefore continued study of at risk populations is a crucial step in development work. Indeed, the United nations (1998) reports that evidence from 52 countries supports the conclusion that while systematic neglect of girls in terms of diet and domestic care is uncommon, girls are most severely disadvantaged in Southcentral Asia34, 45. This report also points out also points out that female disadvantaged based on behavioral factors often is masked by biological factors that favors girls, particularly in adolescence, thus, there is definitive understanding of sex-bias in nutrition. The inadequate food, health and care which lead to malnutrition can be factors at the international, national local and family level 54. Child care may be influenced by international, national local and family level. Child care may be influence by international factors such as war, blockade or global determinants that keep nations in poverty; national factors such as equity issues and availability of good health services and educations; local factors such as land distribution, climate, water supplies and primary health care; and family factors such as the presence of other family members, type of housing, availability of water, household hygiene and mother's knowledge29, 44, 34. Although the country has recently achieved nearly self- sufficiency in food production that is, mainly rice and to a lesser extent wheat, the poor children have little access to the food because of lack of buying capacity on the part of their parents. Also, rice alone cannot provide the necessary nutrients for balanced growth; there is a need for certain amount of protein intake such as meat and fish, and of food items with high vitamin and mineral content such as fruits and vegetables. The typical manifestation of child malnutrition is a deficiency what is described as protein-containing food and energy- providing cereal. Prolonged protein-energy malnutrition in
children results in growth stunting and wasting; weight gained at a certain age (weight for age) is much less than what is accepted as normal in such children55. In the mid -1990s, it was estimated by the FAO that about 56% of Bangladesh's children were underweight for their age suggesting chronic malnutrition. The situation has not improved. Around two-thirds of children under the age of five years suffer from some degree of malnutrition of Bangladesh 21, 30, 38. Malnourished children are more vulnerable to infectious diseases, have stunted growth and suffer from slower mental development. Data show that per capita axuiual income of less than 2,000 nearly 85% of the children in the income â€”groups are malnourished. With per capita animual income in the range TK 2,000 to 10,000 about 60% children are malnourished, and with over 1K 12,000 the percentage of malnourished children is still quite high, about 30%.The last finding suggests that only income is not sufficient for achieving proper nutritional status, there are other factors such as food habit, disease susceptibility etc that are also to be taken into account 22. An NGO called Hunger project recently (end of year 2000)23 estimated that in Bangladesh as many as 700 deaths occur in a day, of which 655 are children, due to causes related to 'persistent hunger'. This is an astounding figure, but given the level of acute poverty and its painful manifestations that are too seen in various settings, the figures may not to be far -removed from the truth. This nutritional deprivation occurred despite of many nutritional intervention programmers that were instituted, by the government under the aegis of the World Bank to cushion the adverse effects of free market transition on health of the poor. Among these, a major project was the National Integrated Nutrition project, funded by the World Bank, and Vulnerable Group Feeding Programmer. These were targeted at the poor below poverty line, since it is well established that this suffers most for a few years during the transition from a regulated economy to free market economy; these people become poorer during this time with grave consequences on their nutritional status. Child malnutrition due to vitamin A deficiency that causes night-blindness in children is high in Bangladesh. Most rural Children run a high risk of vitamin A deficiency because of inadequate dietary intake of the vitamin, due largely to poverty, and partly due to poor eating habits resulting from ignorance. Surveys that have been carried out in recent years suggest prevalence of vitamin A- associated night blindness in children of 1-6 years of age, of about 2%. Each day, nearly 82 children become blind in Bangladesh due to vitamin A deficiency, again an unbelievable number, but it tells the painful truth. For infants, it has been found that Bangladeshi lactating mother can provide nearly 70% of the infant's vitamin A requirement. Vegetable and fruits are very rich in vitamin A. Homesteads in rural areas can serve well in reducing green vegetables for the family with little cost and effort in our country since the weather is congenial for cultivation of some vegetables and fruits throughout the year. In recent years the government has instituted the EPI programmed where children under the age of 5 years are given high potency vitamin A capsule. However, the coverage achieved so far varies considerably from region to region; the range is 16% to 85%. Another nutritional deficiency in children of Bangladesh is iodine deficiency disorder (IDD). But lie problem is more pronounced among the adults. To ameliorate this, the government has promoted production and marketing of iodized salt which, it is hoped, will largely eliminate this deficiency from the population. Child labor in Bangladesh has increased alarmingly in recent years. Traditionally, many children always worked in village agriculture, but the numbers employed in urban industrial and
commercial sectors has risen sharply. Working children are a neglected group in Bangladesh '. Laws in Bangladesh do not restrict the employment of children in all kinds of industry where the nature of work is very strenuous. There has been an alarming rise in the number of street children in the major cities of Bangladesh. A report in Bangladesh has warned that the number of Street children in the country is set to rise as the urban population grows by 9% a year. The report has been released Appropriate Resources for Improving Street children Environment (ARISE) which is a joint between the government reports into the plight of street children in Bangladesh. The rt concentrates on six of the country's largest cities and recommends a series of measures at should be taken to combat the problem. The social unit of Asiatic Extended Family System, which used to provide a way for most children to remain within an attached framework at least at some minimum level, is breaking down. Children are increasingly finding themselves outside the traditional support system. Disintegration is increasingly finding themselves outside the traditional support system disintegration begins. Mothers with children migrate to the city. Here they face profound depravation. They take shelter in the squatters' slum29. Progressively ethos I values alter and the mother grows dependent on serial male partnerships leading to her total exploitation and the gradual rejection of her children. Violence within such 'families' is common particularly against children 57. This is one of the principal reasons for children fleeing their 'homes '. In other cases the family bond remains strong but the parents simply cannot feed their large families and children are sent to fend for themselves. In such circumstances the children of the urban poor regularly find themselves active participants in the struggle for survival of the whole family36, 38, 41. High incidents of maltreatment correlate with factors such as socioeconomic status, unemployment, indebtedness, family size, corporal punishment, age of the mother at bight etc. Where deprivation is greater, child abuse is higher. Striking or beating children or inflicting pain in order to reform them is an acceptable and normal phenomenon in Bangladesh society58. Terror, violence and cruelty against and kidnapping and abduction of women and children are becoming a feature in Bangladesh society, so the cases of suicide amongst teenage girls and young women 57. Children are arrested, beaten and molested on any pretext. Once arrested there generally is no end of the detention. It can continue for years without trial, in rat infested prisons. There are reported incidents of pregnant girl prostitutes kicked in the stomach by adults in authority to induce abortions. There are reported incidents of continuous rape of children in custody. Imagine a 12- year- old child in the same cell as a hardened criminal. Sometimes a van comes to pick them up, under the Vagrants Act. Their grapevine is very effective and usually they come to know long before the van arrives. They are very scared of these vans; they hate being picked up and then confined. Their word of mouth info-system is apt and effective. On occasions, when they are asleep or weak, they get caught by these van peddlers. Sometimes they avoid being picked up by offering a cash bribe or an act in kind including sexual favors. The exploitation of child labors is rampant. Millions of working children, unable to assert themselves, have no
collective bargaining power and are usually unaware of their rights. They are made to work long hours and frequently under inhuman conditions. An employer in a motor repairing shop said, "They are nimble and have keen eye sight, eat less food and their size enables them to crawl in small spaces, which costs less". Commercial exploitation of children for pornographic or sexual purposes (though not yet of the magnitude of some other countries) is increasing at a rapid rate. Homosexual Abuse of male children is more prevalent than people are prepared to accept. Trafficking of women, children and babies is increasing at an alarming rate 27, 36. Child trafficking is one of the most distressing and inhuman acts against children. It is even more heart-rending when the trafficker's torture kidnapped children. In many cases they are blinded, their limbs are broken and they are crippled for begging. UNICEF confirms that street children are among the most physically visible of all children, living and working on streets and public squares. Yet, paradoxically, they also are among the most invisible and therefore, the most difficult to protect, the hardest to reach with vital services like education and health care as well. The health effects of homelessness include higher rates of infectious diseases, mental health problems and physical disorders. A United Kingdom report noted that those sleeping on the street on average lived only to their mid-to-late forties. Higher rates of infectious disease result from overcrowding, damp and cold living conditions, poor nutrition, lack of immunization, and inadequate access to health care services42, 43. The increase in homelessness among families in recent years focused attention on the serious health problems faced by children living in hostels and temporary accommodation. These problems include disturbed and developmental delays, as infections, injuries, and other health problems46, 49, 50. Even though many street children can usually get some amount of food to eat, they do not have nutritious or balanced diets. Hixon (1993) in her study on social correlation of malnutrition among street children in Metro Manila, identified two factors that are strongly correlated with malnutrition, these are drug use and non-attendance at school. About 30% of Manila's 50,00075,000 street children are estimated to be moderately or severely malnourished. A sample of 150 street children ages six through 18 were weighed, measured, and interviewed to establish nutritional parameters and to explore the interrelationships of nutritional status with social conditions. According to international standards, both male and female respondents were seriously underweight and under height. Children who were in school and did not use drugs showed the highest mean weight, while those who were out of school and using drugs had the lowest mean weight; children with one of these risks factors occupied an intermediate position. Drug use by children on the street is common as they look for means to numb the pain and deal with hardship associated with street life. Studies have found that up to 90 percent of the street children use psychoactive substances, including medicines, alcohol, cigarettes, heroin, cannabis, and readily available industrial products such as shoe glue36, 40. Jasmine, Akter, 2004 (Health and Living Condition In Dhaka Street) revealed that street children are generally exposed to dangerous and unhealthy conditions and were reported to suffer from a variety of illnesses52. Fever is the most common illness among the street children. The other prevalent illnesses included accident injury, jaundice, chicken pox, allergy, measles, asthma, and diarrhea. About 99% of the respondents reported that they did fall ill seriously on one or more
occasions. Among them three quarters sought health care services and a third did not. They were asked whether a medical professional was contacted for the illness and about half of them reported that they sought services from medical professionals. In the west Asian and neighboring countries there is a large number of Bengali women and children living either illegally who become victims of blackmail, or who are in prisons as victims of unlawful trafficking of human begins 41, 44. A lot of these women and children end up in the brothels of various cities. Some social street children are not still in good condition, so some NGO s is taking some project for them. The project initiated for ensuring the street children's security with regard to shelter, education, skill development, physical and mental health through institutional capacity building of all stake holders in general and of the partner NGO s in particular. This project will undertake sustainable interventions ensuring mobilization and utilization local and external resources through the participation of all stake holders including the local community. The particular health problems, which have been identified among street children, include malnutrition as disorders of diet. Specific nutritional deficiencies resulting from such disorders like as anemia, infectious diseases, including hepatitis, parasitic, tuberculosis and rheumatic fever. Hazardous, harmful and dysfunctional drugs use, including drug dependency. Forced /survival sex, often at a young age and with no precautionary care, against STD /HIV-AIDS, risks associated with having sex without STD/HIV-AIDS. Methodology Type of study The study was a cross sectional study. Methodological approach: i. Study population ii. Study period iii. Study area iv. Sampling and sample size v. Study design vi. Development of tools vii. Data verification viii. Statistical analysis i. Study population: The study was conducted among 100 street children of 6-17years old in different selected areas in the Dhaka city. ii. Study period: The study was started from 20th May 2011 to 20th August 2011. During this period a standard questionnaire was developed, data entry, data analysis and final presentation of data was also prepared. iii. Study area: This cross-sectional study information from street children in 10 purposively selected areas of Dhaka city having high concentration of the target population. The study areas included â€“
Shahbag Ramna park Suharwardy Uddan High Court Mazar gate Dhaka University campus Area Gulistan stadtum, Bahadur Shah Park, Victoria park Karwan Bazar Kamalapur Rail station Both quantitative and qualitative methods were used. iv. Sampling and sample size: Before the main survey, a quick field visit to the selected study areas gave an idea about the concentration of street children and their characteristics. This also helped to determine the way for approaching the ultimate study samples. In selecting the individual children, simple random sampling techniques were employed. A total 50 street children were randomly selected from each of the locations selected in the first stage. Thus a total of 100 children were included which comprised the sample size. Sample size: Sample size of the selected street children = n Here, Z = the value associated with 95% confidence interval = 1.96 p = 50% proportion when p unknown. q = (1-p) = 50% = 0.5 d = level of precision (Âą10%) = 0.1 Now, 2
(1.96) * (0.5) * (0.5)
The sample size was 100. Where, the level of precision (Âą10%) and the value associated with 95% confidence interval. v. Study design: It was a cross sectional study. The subjects were selected on the availability. vi. Development of tools: A semi-structured questionnaire was developed to collect data through face-to-face interview with the respondents. The questionnaires were pretested in areas outside our sample area and revised on the basis of feedback received from field-testing. This questionnaire was developed to obtain the relent information regarding the personal information,
household information, socio-economic information, dietary intake pattern, morbidity treatment seeking behavior, leisure time activities, drug addiction & abuse, anthropometrical measurements of target children & Inter relationship between different variables. After pre-test, the questions which were related for quantitative data collection were improved & reformatted to ensure content coverage, the reliability & validity of the study. a. Personal information: Personal information such as name, age, address, religion, educational qualifications etc of the street children were collected, b. House hold information: house hold information such as whether they were alone or living with family, came from single or extended families etc were also collected, c. Socio-economic information: Socio-economic information such as daily income was also collected, d. Dietary intake pattern: Dietary intake pattern such as how many times they took meal, menus of meal, regular bath habit, drinking of pure water, every day brushing their teeth etc were included in the study. e. Morbidity treatment seeking behavior: we collected data about their treatment such as whether they took proper treatment during their illness. f. Leisure time activities: we collected the data about their leisure time activities, i. Drug addiction & abuse: Smoking and drug addiction habit were collected, j. Collection of anthropometric data The anthropometric data were collected based on standard methods. The following anthropometric data were collectedBody weight A bathroom scale was used to measure body weight of the study respondents. The weight measurements were taken before breakfast to avoid diurnal variations.50 The scale was placed on an even floor. Children were weighed with light underclothes without shoes. Children stood upright in the middle of the scale, facing the field worker and looking straight ahead. They stood with feet flat and slightly apart until the measurement was recorded on the Personal Information questionnaire (Demographic questionnaire). The scale was calibrated to zero reading before each weighing session by the researcher. Body weight was recorded to the nearest 100 g (0.1kg), 51 repeated and the average of the two measurements recorded. Height A modified tape measure was used to measure the height of the study children. Height was measured, with the child facing the field worker, shoulders relaxed, buttocks and heels touching the wall. The childâ€™s arms were relaxed at the sides, legs straight and knees together and head in the Frankfortâ€™s plane52. Each childâ€™s height was taken barefooted. A direct reading of height was
recorded to the nearest five millimeters (0.5 cm) and then repeated and the average of the two measurements recorded53. After measuring weight and height BMI was calculated by using the following formula: Wt (in kg) / Ht (in m2) = BMI (in Kg / m2).The Body Mass Index of the respondents was calculated and plotted into CDC(Centers for Disease Control and Prevention) growth chart.55 vii. Data verification: Questionnaires were checked each day after interviewing and again these were carefully checked after completion of all data collection and coded before entering into the computer. The data was edited if there was any discrepancy (doubt entry, wrong entry etc). viii. Statistical analysis All of the statistical analysis and all other data processing were done by using SPSS 16.0 windows program. For tabular, charts and graphical representation Microsoft Word and Microsoft Excel were used. RESULTS Results Table-1: Age distribution of the all respondents (n=100) Age range (years) 6-9 10-13 14-17 Total
Number of respondents 51 33 16 100
Percentage 51.0 33.0 16.0 100.0
Table-1 shows age distribution of the respondent girls where more than half (51%) of the respondents was within the age of 6 to 9 years. From the table it is also observed that 33% and 16% of the respondents were within the age range 10-13 & 14-17 years respectively. Table-2: percent distribution of the respondents according to gender (n=100) Gender Male Female Total
Number of respondents 50 50 100
Percentage 50.0 50.0 100.0
Table-2 shows the distribution of all respondents by their gender and indicated that boys-girls ratio is 1.0 as data were collected purposively.
Figure -1: Percent distribution of religious status of all respondents The above figure -1 represents the religious status of selected street children. Among them about 95% were Muslim and about 5% were Hindu.
Figure-2: percent distribution education level of selected street children The figure-2 evolve that about 34% of the selected street children were illiterate and about 41% of them were just studied class one or two. So it can be said that most of the street children were drop out from the primary level.
Table- 3: Percent distribution of the respondents according to their years of staying in the street. Years of staying
Data presented in table-3 shows the number of years that the individual respondents were staying in the street. From the study it is seen that 21% of the respondents were staying in the street for last 1 to 2 years while majority of them about 43% were staying for 3 to 5 years. The study also depicts that 27% of the respondents were passing 6 to 8 years and about 7% of the respondents were staying 9 years or more in the street of Dhaka city.
Figure-3: percent distribution with whom respondents live. This figure represents that about 8% street children live with their father, 14% with their mother, 21% with both father and mother, 7% with relatives and about 50% live alone. So most of the street children in the city live alone.
Table-4: Distribution of all respondents by reasons of their living alone (n=50) Reasons Divorce of parents Second marriage of Father Second marriage of Mother Financial problem Orphan Parents live in village Total
Number of respondents 13 8 6 7 11 5 50
Percentage 26.0 16.0 12.0 14.0 22.0 10.0 100.0
Table-4 shows the distribution of the respondents why living alone. Divorced or separated, second marriage of their parents was the major causes for living alone. Financial problem and orphan life was also a big problem so these problems forced them to live in street.
Figure-4: Distribution of sleeping places for the respondents. This figure shows that most of the street children have no permanent house to sleep at night and about 53% of them sleep at night in the street corner. Table-5: Distribution of all respondents by having any type of jobs (n=100) Response Yes No Part time Total
Number of respondents 79 15 5 100
Percentage 79.0 15.0 5.0 100.0
Table-5 indicated that among the selected street children about 79% were involved with different types of work. About 15% said that they had nothing to do and 5% said that they were involved with part time work.
Figure-5: Distribution of the respondents by different works done by them. This figure shows that about 48% of them were selling different types of things in the street. On the other hand, about 27% of them worked as a garbage picker which is a very unhygienic work.
Figure-6: Distribution of the respondents by their daily income.
Figure-6 shows that 11% of the street children earn 76 to 100 Tk. Daily and 48% of the respondents earn 51 to 75 Tk. per day and a smaller number of respondents earn more than 100Tk. daily. Table-6 : Nutritional Status of the respondent street children by Body Mass Index (BMI) Weight Status Category
Table-6 represents the nutritional status of the respondent Street children where nutritional status was measured by using BMI for age. From the data it was observed that majority (67%) of the respondents were in healthy weight category. The study also showed that 29% of the respondents were underweight and only 2% of the respondents were overweight. Among the respondents 2% were obese.
Figure-7: Distribution of number of meal taken by respondents daily.
The figure-7 depicted that the majority (57%) of the street children eat three times a day followed by another 39% having two meals a day , only 4% reported to have one meal a day Table-7: Information regarding meal pattern of the respondents Variable
Are you satisfy with the meal
Do you get sufficient amount of food that you 79 want to eat
Is the food satisfied your satiety
Data regarding meal pattern of the respondents shows that most of them about 64% were satisfy with their food and about 21% of them wanted to eat extra food to satisfy their satiety. Table-8: Percent distribution of the respondents by their food intake pattern Food groups
Cereal and cereal products Meat, fish, egg and beans
Rice Bread/Ruti Potato Meat Fish Egg Pulses Fruits Fruits Milk and Milk/milk milk based food product Vegetables Vegetables Fats, oils Butter/ghee and sugars Others oil Sweetmeat
Frequency of consumption (%) Daily Weekly Once per Once fortnight per month 100 65 26 9 97 3 61 16 13 5 94 1 74 11 15 99 1 6 15 34 45 6 94
100 89 3
Data in table-8 represents the diversity in the intake pattern of foods of respondent street children. The study shows that 100% of the respondent’s consumed rice and vegetable daily where 99% and 97% of the respondent’s consumed pulse and potato daily respectively. Any of them don’t consume meat, egg and milk daily. Whereas only 5%, 6% and 3% of the respondents
consume fish, fruits and sweetmeat daily respectively. And more than 50% respondents respectively consume egg, milk, butter/ghee fortnightly or monthly. Table-9: Hygiene practice among the selected street children. Hygienic practice Sources of drinking water Tube-well Pond Tap Tube-well and tap Boiling of water Yes No Bath regularly Yes No Brush teeth regularly Yes No Hand washing practice Yes No
17 2 73 8
17.0 2.0 73.0 8.0
The above table-9 indicated that the hygienic condition of the street children was not satisfactory. Most of them about 73% were using tap water as a source of drinking water but no one boiled the water before drinking. Only 37% of the take bath regularly. The rate of regular brushes their teeth was 67%. About 31% of the total selected street children were not following the proper hand washing practice.
Figure-8: Percent distribution of the respondents according to their consciousness about the use of sanitary latrine. The figure represents 48% of the street children used sanitary toilet, 37% of them used open toilet and 15% used both sanitary and open toilet.
Figure-9: Distribution of the respondents by having sickness during last 15 days Figure-9 indicated that majority (74%) of the respondents were suffering from some sort of illness during last 15 days while only 26% of the respondents were free from any kind of sickness during that period.
Figure-10: Percent distribution of the respondents by disease pattern.
The above figure depicts that everyone of the respondents were suffered from more or less some common types of illness. About 35% and 24% of the respondents were suffering from fever and cold respective and 17% of the respondents were suffering from both fever and cold. About 11% of them were suffered from abdominal pain. From the study it is also observed that only 6% of the respondents were suffering from diarrhea. Table-10: Clinical feature of the respondents. Clinical feature Anemia Angular stomatitis Cheliosis Glossitis Others Not present Total
Frequency 28 11 8 5 6 42 100
Percentage 28.0 11.0 8.0 5.0 6.0 42.0 100.0
The above table represents that 42% of the respondents showed no clinical sign-symptoms. But 28% of them had anemia, 11% had angular stomatitis, 8% had cheliosis, 5% had glossitis and 6% of them showed other different clinical sign-symptoms.
Figure-11: Percent distribution where the street children go for treatment This figure-11 represents the percent distribution where the street children go for treatment when they become sick. Most of them about 76% go to the pharmacy seller for the treatment. Only 3% of them go to MBBS doctor for treatment. About 12% of them go to traditional healer and 5%of them take homeopathy treatment.
Table-11: Percent distribution of the respondents by leisure time activities Activities
Playing & Watching TV
Table-11 shows that more than half (65%) of the respondents passed their leisure time by playing. About 13% of the respondents passed their leisure time by watching TV and 12% of the respondents passed their leisure time by both playing and watching TV. Another 6% of the respondents passed their leisure time by sleeping and about 4% of them passed their leisure time with other activities.
Figure-12: Percent distribution of the respondents according to their smoking habit. Figure-12 shows the percent distribution of the respondents according to their smoking habit. Here, 36% said that they had smoking habit and 64% said that they were non smoker.
Table-12: Percent distribution of the respondents according to their other drug addiction habit. Drug addiction Yes No Total
Frequency 28 72 100
percentage 28.0 72.0 100.0
Table shows that 28% of the selected street children had drug addiction habit and 72% had no drug addiction habit.
Figure-13: Distribution of the substances used by respondents for drug addiction. The above figure indicated that 70%, 11%, 10% of the drug addicted street children used cannabis, polythene and alcohol for drug addiction respectively. About 8% of them used other substances for addiction. Cannabis was the major source of addiction for most of the addicted street children. Table-13: Correlation between status of living with parents and personal hygiene and smoking behavior. Living status
Personal hygiene & smoking behaviour Bath regularly Brush teeth Hand washing Smoking (n=37) regularly (n=67) practice (n=69) regularly (n=36) with 56.0 92.0 84.0 10.0 parents
Living both (n=21) With single 12.0 parents (n=22) Relatives (n=7) 32.0 Without parents 8.0
(n=50) Table-13 indicated the correlation between status of living with parents and personal hygiene and smoking behavior of the street children. About 56% of the street children take bath regularly and more than ninety percent brush regularly whose were living with their both parents. But those who are living without parents among them only 8% take bath regularly and 48% brush regularly. About smoking habit those who were living without parents smoked more than other groups. Discussion This study was done to identify the life style behavior, nutritional status and nutritional deficiency diseases and prevalence among street children of Dhaka city through a quick but multi-faceted survey using a purposive but varied sample of the target population. The information is expected to fill in the knowledge gap regarding this marginalized population towards the development of a comprehensive and need-based intervention for them. Findings reveal that the street children, driven by poverty and natural disasters, had to adopt a very precarious and humiliating life on the streets of Dhaka which is devoid of all basic amenities and under constant threat of eviction and harassment by the law-enforcing agencies and the hoodlums. They failed to improve their lot even after five or more years of street-living. According to them housing, food, and lack of jobs were the three most common problems for which they sought assistance. Finally, some recommendations are made based upon the findings. The study showed that more than half (51%) of the respondents was within the age of 6 to 9 years. It was also observed that 33% and 16% of the respondents were within the age range 1013 & 14-17 years respectively. (Table-1) In the study, average educational qualifications of the studied street children is about 34% illiterate and about 41% of them were just studied class one or two. So most of the street children were drop out from the primary level (Figure-2). From the study it was seen that 21% of the respondents were staying in the street for last 1 to 2 years while majority of them about 43% were staying for 3 to 5 years. The study also depicts that 27% of the respondents were passing 6 to 8 years and about 7% of the respondents were staying 9 years or more in the street of Dhaka city. (Table-3) The study showed that 8% street children live with their father, 14% with their mother, 21% with both father and mother, 7% with relatives and about 50% live alone. So most of the street children in the city live alone. Divorced or separated, second marriage of their parents was the major causes for living alone. Financial problem and orphan life was also a big problem so these problems forced them to live in street. (Figure-3, Table-4) Among the selected street children about 79% were involved with different types of work. 48% of the respondents earn 51 to 75 Tk. daily. About 48% of them were selling different types of things in the street. On the other hand, about 27% of them worked as a garbage picker which was a very unhygienic work.
Nutritional status refers to a person’s physical condition as a result of the ingestion, absorption, and utilization of nutrients. Nutritional status depends not only on food intake, but also on the body's ability to utilize these nutrients, which may be influenced by other, unrelated health factors. In this study the nutritional status of the respondent street children was measured by using BMI for-age. It was observed that majority (67%) of the respondents were in healthy weight category. The studies also showed that 29% of the respondents were underweight and only 2% of the respondents were overweight. Among the respondents 2% were obese.(Table-6) Street children are faced with many problems such as lack of basic needs such as food and clean water. They suffer malnutrition and poor health. Hunger is the order of the day for many of them. Adequate quantities of safe and good quality foods together make up a healthy diet. The dietary changes include both quantitative and qualitative changes in the diet. The study showed that the majority (57%) of the street children eat three times a day followed by another 39% having two meals a day , only 4% reported to have one meal a day. Meal pattern of the respondents shows that most of them about 64% were satisfy with their food and about 21% of them wanted to eat extra food to satisfy their satiety. The study shows that 100% of the respondent’s consumed rice and vegetable daily where 99% and 97% of the respondent’s consumed pulse and potato daily respectively. Any of them don’t consume meat, egg and milk daily. Whereas only 5%, 6% and 3% of the respondents consume fish, fruits and sweetmeat daily respectively. And more than 50% respondents respectively consume egg, milk, butter/ghee fortnightly or monthly. (Table-8) In this study majority (74%) of the respondents were sufferings from some sort of illness during last 15 days while only 26% of the respondents were free from any kind of sickness during that period. Most of them about 76% went to the pharmacy seller for the treatment. Only 3% of them had the capability to go to MBBS doctor for treatment. (Figure-9, 11) The hygienic condition of the street children was not satisfactory. Most of them about 73% were using tap water as a source of drinking water but no one boiled the water before drinking. Only 37% of the take bath regularly. The rate of regular brushes their teeth was 67%. 31% of the total selected street children were not following the proper hand washing practice.(Table-9) Only 37% of them took bath regularly and 31% of the total selected street children were not following the proper hand washing practice and also 37% of them used open toilet. The correlation between living status with parents and personal hygiene showed that those who lived with both parents had better health and hygienic condition than those who lived alone or with single parent. The study also showed that 36% of the street children had smoking habit and 28% of them were drug addicted. (Figure-12, Table-12)
Conclusion Children living in the street are mainly involved in works which are mentally, physically and developmental harmful. They are able to earn a very little amount of money which insufficient for the living, in addition of that they have to support their family's income as they are from very poor and socio-economically disadvantaged families. Bangladesh has a significant progress in poverty reduction as well as other social development sectors including health and education due to rigorous government initiatives and innovative NGO programmes for last couple of decades. But this is also the cruel truth a remarkable number of people are living under poverty line and significant number of children is out of school and involved in different types of works. Working children specially the children, who are working and living in the streets for their livelihood, are denied of their rights to education and protection. Majority of the street children are unaware about proper health and hygiene practice. They do not have a provision of appropriate water and sanitation facilities. Most of the street children drink water directly from public tap without treatment which is not safe and hygienic which caused them to be infected by different diseases. They do not have facilities for wising, bathing and cleaning them and are not always aware about health hygiene practices. Street children are exposed to the different types of violence, abuse and exploitations most of them have to live in the street or any open places in the city. Some of the street children are even involved in different illicit .Activities such and drug mugging, drug selling, sometimes they themselves become addicted to drugs. Street children are from very poor and socio-economically vulnerable families. They do not have level of income to have to have three proper meals; half of them are able to manage only two meals a day which are not nutritionally adequate, therefore majority of the street children are suffering from malnutrition (under weight, stunted, wasted) and related diseases. Bangladesh has committed to achieve millennium development goals by 2015, which include reduction poverty, malnutrition, and endure education for all children. Street children are the affect of poverty and existence of childhood poverty is the symptom intergenerational transmission of poverty. Government needs to give proper attention to address the issues of street children through designing and implementing street children focused development programmers like supporting street children's family, special education and vocational training for the street children etc. Social awareness and campaign on child rights could help build critical awareness among the people to support street children. Along with government national and international NGOs and child rights organization should come up with education, health, protection and development programmers to improve the conditions of street children. RECOMMENDATIONS Recommendation It is very clear that the life of street children is very painful and inhuman rather it is cause for human life. This prevailing situation of the street children must be changed and they should be brought into normal life. Otherwise the whole society might be facing great threat of normal life. The following recommendations will be more helpful to ensure proper development and welfare of street children; 1. To find out the social reasons why do they become a street child and if possible to reduce the causal factors.
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