Morbidity Pattern, Nutritional Status and Life Style Behavior of Selected Street Children (6-17 Years) In Dhaka City
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.
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:
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:
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 can’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 cities5. 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, car-cleaners, 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:
· To obtain information on the socio-economic status of the street children.
· To assess the nutritional status of the selected street children.
· To identify their nutritional deficiency diseases.
· To evaluate their food intake by food frequency.
· To study of hygienic and living status of the selected street children.
· To observe the hygienic aspect of consumed foods, drinking water, environmental and living areas.
· To know about the living place and working condition of the street children.
· To find out smoking, drug addiction and other anti-social activities of the street children.
· To recommend appropriate intervention to improve the nutritional status of the street children.
Methodology
Type of study
The study was a cross sectional study.
Methodological approach:
· Study population
· Study period
· Study area
· Sampling and sample size
· Study design
· Development of tools
· Data verification
· 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 January 2012 to 20th May 2012. 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 –
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 (±10%) = 0.1
Now,
The sample size was 100. Where, the level of precision (±10%) 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 collected-
Body 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 child’s arms were relaxed at the sides, legs straight and knees together and head in the Frankfort’s plane52. Each child’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
Table-1: Age distribution of the all respondents (n=100)
| Age range (years) | Number of respondents | Percentage |
| 6-9 | 51 | 51.0 |
| 10-13 | 33 | 33.0 |
| 14-17 | 16 | 16.0 |
| Total | 100 | 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 | Number of respondents | Percentage |
| Male | 50 | 50.0 |
| Female | 50 | 50.0 |
| Total | 100 | 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 | Frequency | Percent (%) |
| 1-2 years | 21 | 21.0 |
| 3-5 years | 43 | 43.0 |
| 6-8 years | 27 | 27.0 |
| 9- higher | 7 | 7.0 |
| Total | 100 | 100.0 |
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 | Number of respondents | Percentage |
| Divorce of parents | 13 | 26.0 |
| Second marriage of Father | 8 | 16.0 |
| Second marriage of Mother | 6 | 12.0 |
| Financial problem | 7 | 14.0 |
| Orphan | 11 | 22.0 |
| Parents live in village | 5 | 10.0 |
| Total | 50 | 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 | Number of respondents | Percentage |
| Yes | 79 | 79.0 |
| No | 15 | 15.0 |
| Part time | 5 | 5.0 |
| Total | 100 | 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 | Frequency | Percent (%) |
| Underweight | 29 | 29.0 |
| Healthy weight | 67 | 67.0 |
| Overweight | 2 | 2.0 |
| Obese | 2 | 2.0 |
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 | Yes (%) | No (%) |
| Are you satisfy with the meal | 64.0 | 36.0 |
| Do you get sufficient amount of food that you want to eat | 79.0 | 21.0 |
| Is the food satisfied your satiety | 79.0 | 21.0 |
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 | Food Eaten | Frequency of consumption (%) | ||||
| Daily | Weekly | Once per fortnight | Once per month | Never | ||
| Cereal and cereal products | Rice | 100.0 | – | – | – | – |
| Bread/Ruti | 65.0 | 26.0 | 9.0 | – | – | |
| Potato | 97.0 | 3.0 | – | – | – | |
| Meat, fish, egg and beans | Meat | – | 61.0 | 16.0 | 13.0 | – |
| Fish | 5.0 | 94.0 | 1.0 | – | – | |
| Egg | – | 74.0 | 11.0 | 15.0 | – | |
| Pulses | 99.0 | – | 1.0 | – | – | |
| Fruits | Fruits | 6.0 | 15.0 | 34.0 | 45.0 | – |
| Milk and milk product | Milk/milk based food | – | 6.0 | – | 94.0 | – |
| Vegetables | Vegetables | 100.0 | – | – | – | – |
| Fats, oils and sugars | Butter/ghee | – | – | – | 100.0 | – |
| Others oil | 89.0 | 9.0 | 2.0 | – | – | |
| Sweetmeat | 3.0 | 48.0 | 35.0 | 14.0 | – | |
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 | Frequency | Percentage |
| Sources of drinking water | ||
| Tube-well | 17 | 17.0 |
| Pond | 2 | 2.0 |
| Tap | 73 | 73.0 |
| Tube-well and tap | 8 | 8.0 |
| Boiling of water | ||
| Yes | 0 | 0.0 |
| No | 100 | 100.0 |
| Bath regularly | ||
| Yes | 37 | 37.0 |
| No | 63 | 63.0 |
| Brush teeth regularly | ||
| Yes | 67 | 67.0 |
| No | 33 | 33.0 |
| Hand washing practice | ||
| Yes | 69 | 69.0 |
| No | 31 | 31.0 |
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 | Frequency | Percentage |
| Anemia | 28 | 28.0 |
| Angular stomatitis | 11 | 11.0 |
| Cheliosis | 8 | 8.0 |
| Glossitis | 5 | 5.0 |
| Others | 6 | 6.0 |
| Not present | 42 | 42.0 |
| Total | 100 | 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 | Frequency | Percent (%) |
| Playing | 65 | 65.0 |
| Watching TV | 13 | 13.0 |
| Playing & Watching TV | 12 | 12.0 |
| Sleeping | 6 | 6.0 |
| Others | 4 | 4.0 |
| Total | 100 | 100.0 |
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 | Frequency | percentage |
| Yes | 28 | 28.0 |
| No | 72 | 72.0 |
| Total | 100 | 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 (n=37) | Brush teeth regularly (n=67) | Hand washing practice (n=69) | Smoking regularly (n=36) | |
| Living with both parents (n=21) | 56.0 | 92.0 | 84.0 | 10.0 |
| With single parents (n=22) | 12.0 | 31.0 | 24.0 | 8.0 |
| Relatives (n=7) | 32.0 | 25.0 | 78.0 | 26.0 |
| Without parents (n=50) | 8.0 | 48.0 | 30.0 | 28.0 |
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 10-13 & 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 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.
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;
To find out the social reasons why do they become a street child and if possible to reduce the causal factors.
They should be rehabilitation and for that a special fund is to be developed by the state and donor agencies.
Their basic needs should be ensured so that they should not run after earning at this age.
They should to be provided with education and vocational education.
Amenities for recreational and health care should be made available for them which will help mental and physical growth.
Their liabilities such as other family members or disabled parents should also be considered and necessary help should be extended.
For all the above suggestions, a total plan of action is to be made by a definite organization which may be a government or volunteer organization and as a matter of fact, that it is the moral obligation for the rich people to extend their hand for such generous act of humanity.