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Year : 2014 | Volume : 2 | Issue : 1 | Page : 28 - 30  


Short Communications
A Study on Health Status of street children of Lucknow

Prattyush Singh 1, Megha Khobragade2, Anil Kumar3

1MPH scholar, 2Deputy Director, 3HOD Epidemiology, National Center for Disease Control (NCDC), New Delhi, India

Abstract:

The number of street children worldwide is estimated to be between 100 million and one billion. Street children are exposed to a number of health problems. Present study is a cross sectional study carried out among street children enrolled with NGO Suvidha, Lucknow from July 2012 – November 2012 to study the common physical health problems among the street children. All the 64 children of age 10-15 years meeting the operational definition and enrolled with NGO- within 7 days were included in the study. Majority (46.87%) had common cold followed by hearing difficulties in 28.12%. On clinical examination, it was found that 22(34.3%) had pallor, 10(15.6%) had lymphadenopathy. Out of 64 only 9 street children had taken any medication in the last 3 month & 58 did not visit to any for health checkup. Thus we can say that majority of street children are not healthy. There is a need for community mobilization, advocacy & sensitizing about issues pertaining street children.

Key words: Health status, NGO, Street children

Corresponding Author: Dr Megha P. Khobragade, Department of Epidemiology )   National Center for Disease Control (NCDC), New Delhi, India. Email: drmegha1603@gmal.com,

Introduction:

According to WHO Street children consists of children who are of the streets, live on the street & abandoned & neglected children. [1]

  • On the street are those who work on the street throughout the day & return to home at night.
  • Of the streets are those who mostly work & stay on the street but family ties exist.
  • Abandoned children have no family ties.

The number of street children worldwide is estimated to be between 100 million and one billion (UNCHS 1996). [2] The gap between the low and high estimates is very large; however, the true number depends on the definition used. While there are several authentic parameters on which the homeless population numbers can be estimated, there is practically no authentic estimate of the homeless people in India. Enumeration of street children population is difficult in the absence of any fixed abode, identity or address. In 1991, the Census of India, [3] in its enumeration could find only 2,007,489 such people in the country. However, the 2001 census gives a total of 1,943,476 such people in the country. [4]  

Lucknow, like many other cities in India is also home to a large number of ‘street children’. Most of these children who live and work on the streets and find subsistence work ranging from polishing shoes at railway platforms to selling newspapers; from working in small hotels and shops to cleaning cars.

Street children are exposed to a number of health problems. The reported prevalence of scabies varies from 3.8% in shelter-based investigations [5] to 56.5% among hospitalized homeless persons. [6] In homeless populations, prevalence rates of body lice vary from 7% to 22%. [7, 8, and 9] In very poor hygienic conditions, an infection prevalence of 80% has been reported. [10]

Minor upper respiratory infections have been found to be twice as common in homeless children and represent 40% of the acute medical complaints of the homeless. [11] As they live in highly unhygienic conditions, drink contaminated water, making them highly susceptible for gastrointestinal infections like diarrhea, dysentery, abdominal pain etc. [12] Mosquito born infections like Malaria and Chickengunya were also observed in homeless adolescents. [13] The arbovirus Chikungunya is transmitted to humans primarily by the mosquito species Aedes aegypti and Aedes albopictus. [14]

Hence present study was undertaken to study the common physical health problems among the street children.

Material and methods:

Present study is a cross sectional study carried out among street children enrolled with NGO Suvidha, Lucknow from July 2012 – November 2012.

For the sake of the present study we will be modifying the WHO definition of street children. The Operational definition was taken as

“A street children would be considered as one who actually survives entirely on the street or outside of a normal family environment”

All the 64 children of age 10-15 years meeting the operational definition and enrolled with NGO- within 7 days were included in the study. Universal sampling of all children enrolled with NGO Suvidha, Lucknow. The data was collected in a pre tested semi-structured questionnaire in Hindi.

Consent was taken from the NGO for the collection of data from street children enrolled. All street children who are enrolled with the NGO at the start of the study were enlisted and a schedule was made for their examination & interview on a weekly basis. Availability of children from their informal education classes & training sessions of handcrafts was especially seen while making of weekly plan for the study. Interview & physical examination was done in the presence of any employee of the NGO available at the time of the study. Interview was done in the very familiar atmosphere & simple Hindi language was used for narrating the questionnaire to them. Adequate time was given for answering the question, if the question was not clear to any of the respondents it was again repeated to them loud and clear. They were made free to not to answer any of the questions if they did not like to answer. Physical examination was done with utmost care. They were also told about the healthy habits to be followed in day to day life.

Results:

Out of 64 street children studied, 31 (48.44) were in the age group of 10 -12 years and 33 (51.56%) in the age group of 13-15 years. Religion wise 55 were Hindu, 6 were Muslim, 1 was Sikh and 2 were Buddhist. As per literacy status, 21 were illiterate, 38 had informal education while 5 were primary educated. 25(39.6%) were daily wage worker, 14(22.2%) were rag pickers, 12(19%) were roadside seller, 6(9.3%) were rickshaw puller (helper), 6 were labor and baggers. (Table 1)

When the duration on streets was studied, it was found that 21 were there between 0-1 years, 13 were on streets between for 1-2 year duration. 30 children were on streets for more than 2 years. Reason to be on the street was running away from the family for the majority i.e. 33(51.56%). (Table 2)

Table 3 shows the common health problems of street children. Majority (46.87%) had common cold followed by hearing difficulties in 28.12%. On clinical examination, it was found that 22(34.3%) had pallor, 10(15.6%) had lymphadenopathy. Out of 64 only 9 street children had taken any medication in the last 3 month & 58 did not visit to any for health checkup.

Discussion:

The present study is a NGO based study among street children to study the common physical health problem among them. The objective of the study was to find out the prevalence of diseases in them and also to find out socio-demographic profile of the street children.

Most of the children were on the streets for the period more than 2 years and majority 47% have run away from their families. This was similar to the finding in a study by Singh A et al. [5] It was found that only six (9.3%) out of 64 visited medical practitioner in last three months. Only nine (14%) had taken medication in last three months. In 48.43% of children itching was found. Singh A et al [5] also reported that scabies is more prevalent in the homeless than in the general population. The reported prevalence of scabies varies from 3.8% in shelter-based investigations [5] to 56.5% among hospitalized homeless persons. [6] In the present study, 67.18% of children were found to have head lice. Other authors in their study also reported that in homeless populations, prevalence rates of body lice vary from 7% to 22%. [7, 8, and 9] We noted that 59.37% of children had complaint of cough. Badiaga S et al [11] stated that minor upper respiratory infections have been found to be twice as common in homeless children and represent 40% of the acute medical complaints of the homeless.

We recommend that Special policy framework need to be designed for the upliftment of the street children. There is a need for community mobilization, advocacy & sensitizing about issues pertaining street children.

Limitations:

  1. Data of street children have been taken from those attached to an NGO.
  2. Drug abuse, physical violence & sexual abuse are not studied.
  3. Study of only male street children have been done, as only Male Street children were enrolled in the NGO.
  4. Due to time constraints & legalities of enrolling street children in the NGO the sample size is less.

References:

  1. World Health Organization. A profile of street children. Module 1. Available at: hawaii.edu/hivandaids/A profile of street children.pdf.
  2. Nigam S, Street children of India -- a glimpse. J Health Manag. 1994;7(1):63-7.
  3. Remington F, The forgotten ones. A story of street children and schooling in South Asia. 1993 Sep;(37):40-2.
  4. Aptekar L. Street children in the developing world: a review of their condition. Cross-Cultural Research 1994;28:195–244.
  5. Singh A, Purohit B. Street Children as a Public Health Fiasco. Peace Review 2011; 23(1): 102–9.
  6. Panter-Brick, Catherine. Street Children, Human Rights, and Public Health: A Critique and Further Directions. Annual Review of Anthropology 2002;21:147–171.
  7. Arfi C, Dehen L, Benassaia E, Faure P, Farge D, Morel P et al. Dermatologic consultation in a precarious situation: a prospective medical and social study at the Hôpital Saint-Louis in Paris [in French]. Ann Dermatol Venereol. 1999;126:682–6.
  8. Brouqui P, Stein A, Tissot Dupont H, Gallian P, Badiaga S, Rolain JM et al. Ectoparasitism and vector-borne diseases in 930 homeless people from Marseilles. Medicine (Baltimore). 2005;84:61–8.
  9. Seki N, Sasaki T, Sawabe K, Sasaki T, Matsuoka M, Arakawa Y et al. Epidemiological studies on Bartonella quintana infections among homeless people in Tokyo, Japan. Jpn J Infect Dis. 2006;59:31–5.
  10. La Scola B, Raoult D. Acinetobacter baumanii in human body louse. Emerg Infect Dis.2004;10:1671–3.
  11. Badiaga S, Richet H, Azas P, Rey F, Tissot Dupont H, Foucault C et al. Prevalence of respiratory diseases in sheltered homeless people in Marseille, France. In: Abstracts of the 16th European Congress of Clinical Microbiology and Infectious Diseases; Nice, France, 2006 Apr 1–4. Abstract O420. Nice (France): The Congress; 2006.
  12. Foucault C, Raoult D, Brouqui P. Randomized open trial of gentamycin and doxycycline for of Bartonella quintana from blood in patients with chronic bacteremia. Antimicrob Agents Chemother. 2003;47:2204–7.
  13. Hay S, Guerra C, Tatem A, Noor A, Snow R. The global distribution and population at risk of malaria: past, present and future.The Lancet Infectious Diseases. 2004;4:327–336.
  14. Dev V, Sangma BM, Dash AP. Persistent transmission of malaria in Garo hills of Meghalaya bordering Bangladesh, north-east India.Malar J. 2010;9:263.

 

Table 1: Socio - Demographic Profile of street children (N = 64)

Socio demographic characteristic                               number (%)

  1. Age

                10 – 12 years                                       31 (48.44)

                13 – 15 years                                       33 (51.56)

  1. Religion

                 Hindu                                                  55 (85.94)       

                 Muslim                                                06 (09.37)

                 Buddhist                                             02 (03.12)

                 Sikh                                                   01 (01.57)

  1. Literacy status

                  Illiterate                                             21 (32.81)

                  Informal education                              38 (59.37)

                  Primay                                               05 (07.82)

  1. Work profile

                  Daily wages                                        26 (40.63)

                  Rag picking                                         14 (21.87)

                  Road side seller                                   12 (18.76)

                  Rickshaw puller                                    06 (09.37)

                  Begging                                               06 (09.37)

 

Table 2: distribution of street children as per duration of living on the street and reasons for leaving the family

Characteristic                                                         number (%)

  1. Duration on streets

                     0 – 1 year                                            21 (33)

                     1 – 2 years                                           13 (20)

                     More than 2 years                                 30 (47)

  1. Reason for leaving the family

                      Ran away from family                           33 (51.56)

                      Lost my way to family                           09 (14.06)

                      Abandoned                                           07 (10.93)

                      Other reason                                        15 (23.43)

 

Table 3: Common Health Problems among Street children

Health problem                                                                                   Number (%)

  1. Ear, nose, mouth & throat

                            Hearing difficulties                                                     18 (28.12)

                           Common cold                                                             30 (46.87)

                           Mouth sores                                                                08 (12.00)

                           Headache                                                                    07 (10.93)

                           Dizziness                                                                     02 (03.12)

                          Fever                                                                           12 (18.75)

  1. Chest, lungs & heart

                           Cough                                                                         38 (59.37)

  1. Gastro intestinal tract

                 Heart burn, indigestion &

                                    pain or discomfort in upper abdomen                     20 (31.24)       

                  Pain or cramps in lower abdomen                                            36 (56.25)

                            Diarrhea                                                                      18 (28.12)

                             Constipation                                                                27 (42.18)

  1. Musculoskeletal

                             Joint pains                                                                   12 (18.75)

                              Weakness of muscles                                                  36 (56.25)

  1. Skin

                            Itching                                                                         31 (48.43)

                            Rash                                                                            05 (07.81)

                             Head lice                                                                     43 (67.18)

  1. Oral cavity                                                

                              Dental caries                                                               41 (64.06)

                               Bad breathing                                                             25 (39.06)

                             Cavity                                                                         18 (28.12)

                   Bleeding gums                                                                        07 (10.93)

  1. Any medication in the past 3 months

                            Yes                                                                              09 (14.06)

                            No                                                                               55 (85.94)

  1. Visited doctor in past 3 months

                           Yes                                                                              06 (09.37)

                           No                                                                               58 (90.63)

  1. General physical examination

                           Icterus                                                                         03 (04.68)

                           Pallor                                                                           22 (34.37)

                              Lymphadenopathy                                                      10 (15.62)


               





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