MORBIDITY PATTERN, NUTRITIONAL STATUS AND LIFE STYLE BEHAVIOR OF SELECTED STREET
CHILDREN (6-17 YEARS) IN DHAKA CITY (2)
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 urban 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.
After BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-for-age 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 | Percentile Range |
| Underweight | Less than the 5th percentile |
| Healthy weight | 5th percentile to less than the 85th percentile |
| Overweight | 85th to less than the 95th percentile |
| Obese | 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.