Study on the NutritionalStatus of the Street Children at Shabagh Area of Dhaka City
Mesbah Uddin Talukder1,Md. Mahbubul Alam1, Md. Ariful Islam1, *, Gowranga KumarPaul2,Md. Torikul Islam3, Farhana Akther1
1 Department of Food Technology andNutritional Science, Mawlana Bhashani Science and Technology University,Tangail, Bangladesh
2 Department of Statistics, Mawlana BhashaniScience and Technology University, Tangail, Bangladesh
3 Institute of Nutrition and FoodScience, University of Dhaka, Dhaka, Bangladesh
(Md. A. Islam)
To cite this article:
Mesbah UddinTalukder, Md. Mahbubul Alam, Md. Ariful Islam, Gowranga Kumar Paul, Md. TorikulIslam, Farhana Akther. Study on the Nutritional Status of the Street Childrenat Shabagh Area of Dhaka City. InternationalJournal of Nutrition and Food Sciences. Vol. 4, No. 3, 2015, pp. 240 - 245 . doi: 10.11648/j.ijnfs.20150403.11
Abstract: Malnutritionis a major health problem; especially in developing countries and it is thegravest single threat to global public health. Malnutrition is by far the majorcontributor of child mortality across the globe. A non experimental,descriptive action research with a multi-methodological approach study was carriedout to assess nutritional status, socio-demographic condition and associatedfactors of the selected street children of Dhaka City. This study was conductedamong 120 street children at Shabagh area in Dhaka city. All of the respondentswere boys, and aged between 6-18 years. Methods included on site observation,completion of a standard demographic questionnaire, a validated quantitativefood frequency questionnaire and anthropometric measurements. The nutritionalstatus indicated that, 61.7% of the children were underweight and 38.3% of thechildren were healthy. According to this study about 31.7% were involved withdifferent types of work and also 68.7% were not involved with any kind of work.Majority (87.5%) of the street children ate three times a day followed byanother 12.5% having two meals a day.Withrespect to sources of drinking water, most (63.3%) of the respondents took drinkingwater from tube wells, while 36.7% of the respondents took drinking water from the WASA/Supply. Most ( 86.7% ) of the respondents washed their hands before eating and 60.8% of them suffered from a disease in the 3 monthsprior to the study . It is necessary to designinterventions that will prevent children from coming to the streets.
Keywords: Nutritional Status, Street Children,BMI, Dhaka
The term‘street child’ describesany girl or boy for whom the street (in the broadest sense of the word,including unoccupied dwellings, wasteland etc) has become his or her habitualabode and or source of livelihood, and who is inadequately protected,supervised or directed by responsible adults . UNICEF however , gives the following definition: Street children are those who haveabandoned their homes, school and immediate communities before they are sixteenyears of age, and have drifted into a nomadic street life [ 1]. Street childrenlive, grow up and work on the margins of the society in a state of neglect anddeprivation. They lack protection, education, affection, care and properguidance from adults. Every street child has a reason for being on the streets.Children leave their homes and come on to the streets because of theinter-connection and relationship of three reasons; poverty, family violenceand allure of modernity, which have destabilized the traditional familystructures, whose consequence is broken families and child abuse [ 2, 3]. TheBengali term of street children is ‘Pathshishu’ and informally people used‘Tokai’ to address them .‘Tokai’ means rag pickers who use to collect waste paper, bottle, shoes andother item from road and dustbin. These floating children are also named asdisadvantaged children, hard to reach children, urban working children andchildren at risk or in need of special protection to associate them withsupport and reintegration .
It isestimated that the number of world’s street children has reached any numberbetween 30-170 million. Every year, the number of street children increases.The number of street children may reach 800 million by 2020 if there is noserious effort to overcome the problems faced by street children . There hasbeen an alarming rise in the number of street children in the major cities ofBangladesh. A report in Bangladesh has warned that the number of Streetchildren in the country is set to rise as the urban population grows by 9% ayear. The report has been released by Appropriate Resources for ImprovingStreet children Environment (ARISE) which is a joint between the governmentreports into the plight of street children in Bangladesh . In 1990, the government estimated that there were about 1.8 millionchildren on the streets of Bangladesh. About 215,000 children (including100,000 girls) were thought to be in Dhaka City alone. Twelve years later,there are probably several million children on the streets in Bangladesh. Mostof them work as vendors, car-cleaners, newspaper-sellers, beggars, helpers ingarages/rickshaw repair shops, rag pickers, and in other informal areas. Theyare often involved in dangerous and hazardous jobs [ 7]. The number of streetchildren in Dhaka was 249200 at 2005 [ 8].
Governmentstatistics, based on a survey by the Bangladesh Institute of DevelopmentStudies, estimate the number of street children in Bangladesh to be around380,000 — 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 theage group of 11-19 years. Their gender composition is as follows: boys 74.3%,while girls account for 25.7%.
It foundthat the street children mostly came to Dhaka from Jamalpur, Sherpur,Mymensingh and Rajshahi districts . They generally sleep at footpaths,railway stations, bus stations and in other public places at night and are found in district and thana (Subdistrict) headquarters . Even though many streetchildren can usually get some amount of food to eat, they do not havenutritious or balanced diets. Malnutrition results from a combination of causesor factors and conditions. Low birth weight arises from poor maternalnutrition, early marriages, repeated pregnancies, short birth intervals apartfrom other factors. Globally, street children experience poor health because oftheir life style and often fall sick due to such ailments as malaria-likefebrile illnesses, respiratory tract illnesses diarhoeal diseases, headaches,chest pain, abdominal colic, renal colic, back pain, blood in the urine,coughing, wounds, bruises, diarhoea, dental problems, fever, intestinalparasites, anaemia, tonsilitis, otitis media, hair lice, skin abscesses, skin diseases,HIV/ AIDS andmalnutrition [11, 12].
Nutrition,which they should have gotten as the priority to support development andgrowth, is often not present. Eating for fullness is merely their own majorneed. The eating of healthy and balanced meals is not their main concern.
So farthere has been no accurate data about the nutritional status of streetchildren. Irregular eating habits and food quality below the standard ofnutritional requirement have made street children susceptible to healthproblems. Nutritional deficiency is one of the factorsthat increases the risk of developing infectious diseases to an individual because the body’s natural system of immunity hasweakened. This condition is worsened by the exposure to heavy-metal pollutedair they breathe in everyday, making them easily develop various infectiousdiseases which are closely related to the decreased level of immunity againstgerm infliction [5, 13]. The major problems of street children are: insecurelife; physical and sexual abuse by adults from the immediate community; harassment by law enforcement agencies; non-existent / inadequate access to educationalinstitutions and healthcare facilities; and lack of decent employment opportunities .
About 73percent of street children in Dhaka city suffer from chronic malnutrition whilemortality and morbidity status among the street dwellers has reached analarming level due to lack of basic healthcare services .
Thisstudy will explore the situation of the street children and their requirements,which will be helpful for developing relevant programmers on their issue. Academicunderstanding of street children is fragmented and research is not systematic.Thus, there is a need to conduct more studies to generate new knowledge onstreet children, therebyenriching the information used by policymakers and governments in country specific contexts as they address theproblem. This study explored the situation of the selected street children atShabagh area in Dhaka City with respect to morbidity pattern, nutritional status, hygienic condition andsocio-economic condition. It is hoped that this study will be helpful for the development of relevant programmes that will adequatelyaddress their issues.
2. Materials andMethods
Studypopulation: Street children are the most vulnerablechildren in any context and therefore selected population for this study. Theage group of the street children is between 6 to 18 years and o nly males were purposively selected for our study a s they were willing to take part inthe study .
Studyarea: The study was conducted in 6 purposively selectedarea of Dhaka city including Shahbag, Ramnapark, Suharwardy Uddan, High CourtMazar gate, Dhaka University campus Area and Karwan Bazar.
Sample sizeand Study design: It was a cross sectional study. Atotal of 120 subjects were selected based on theselection criteria and on their availability.
Development of tools: A semi-structured questionnaire was developed tocollect data through face-to-face interview with the respondents. Thequestionnaires were pretested in areas outside our sample area and revised onthe basis of feedback received from field-testing. This questionnaire wasdeveloped to obtain the relevant informationregarding personal information, household information, socio-economicinformation, dietary intake pattern, morbidity treatment seeking behavior,leisure time activities, drug addiction & abuse, anthropometric measurementsof target children & the interrelationship between different variables.After pre-test, the questions which were related for quantitative datacollection were improved & reformatted to ensure content coverage, thereliability & validity of the study. The anthropometric data were collectedbased on standard methods.
2.1. Data Verification
Questionnaireswere checked each day after interviewing and again these were carefully checkedafter completion of all data collection and coded before entering into thecomputer. The data was edited if there was any discrepancy (doubt entry, wrongentry etc).
All ofthe statistical analysis and all other data processing were done by using SPSS16.0 windows program. For tabular, charts and graphical representationMicrosoft Word and Microsoft Excel were used.
Table 1. Distribution of the respondents according to some background characteristics.
|Age of the Respondent ||Percentage of the respondents (%) ||Number of Family Members ||Percentage of the respondents (%) |
|6-10 ||21.7 ||<4 ||36.7 |
|11-15 ||56.7 ||4-6 ||58.3 |
|>15 ||21.7 ||7-9 ||5.0 |
Table 1 showsage distribution of the respondent where 21.7% of the respondents were withinthe age of 6 to 10 and >15 years and 56.7% of the respondents were withinthe age range 11-15 years respectively. From the table it is also observed that36.7% of the respondents had <4 family members and 58.3 % of the respondentswere within the range of 4-6 & 7-9 members respectively.
Table 2. Monthly income and Number of meals eaten per day by the respondents.
|Monthly Income ||Percentage of the respondents (%) ||Number of meals eaten per day by the respondents ||Percentage of the respondents (%) |
|<1000 ||0 ||1 ||0 |
|1000-1500 ||30.5 ||2 ||12.5 |
|1501-2000 ||31.7 ||3 ||87.5 |
|>2000 ||37.8 ||4 ||0 |
Table-2shows that 31.7% of the respondents earned 1501 to 2000 Tk. per month whereas37.8% of the respondents said they earned more than 2000 TK per month and noone earned less than 10000 TK per month. The majority (87.5%) of the streetchildren ate three times a day followed by another 12.5% having two meals aday. It was also observed that none of the respondents had only one meal a day.
Figure 1. BMI-for-age weight status categories.
Figure 1represents the nutritional status of the respondent where nutritional statuswas measured by using BMI for age. From the data it was observed that the majority(61.7%) of the respondents were in the underweight category and 38.3% of therespondents were in the healthy weight category.
Table 3. Hygiene habits and disease experience in the in the last 3months.
|Respondent washed hand before eating ||Percentage (%) ||Took Bath Everyday ||Percentage (%) ||Suffered from a disease in last 3 months ||Percentage (%) |
|Yes ||86.7% ||Yes ||52.5 ||Yes ||60.8 || |
|No ||13.3% ||No ||47.5 ||No ||39.2 || |
Most (86.7%) of the respondents washed their hands before eating and only 13.3% respondent did not . Alittle more than half (52.5%) of them took a bath everyday while 47.5% did not. In addition , 60.8% of the respondents suffered from adisease in the last 3months, while 39.2% of the respondents did not (Table 3).
Table 4.Crosstab between Respondent Nutritional Status andAge of the Respondent.
|Age of the Respondent ||Nutritional Status |
|Underweight ||Healthy |
|N (%) ||N (%) |
|6-10 ||12 (16.2) ||14 (30.5) |
|11-15 ||46 (62.2) ||22 (47.8) |
|>15 ||16 (21.6) ||10 (21.7) |
|Chi-square =3.67 ||P-Value =0.159 || |
Table 4 represents, maximum 62.2% underweight respondent’s age andmaximum 47.8% healthy respondent’s age belong to 11-15. Chi-square test resultindicates that null hypothesis is accepted. In other word, age of therespondent makes no difference in nutritional status. And the result of P- Valueindicates that result is not significant.
Figure 2. Crosstab between Respondent Nutrition Status and Educational Status.
Most(78.4%) of the underweight respondents were illiteratewhile 50% of the healthy respondents were illiterate ( figure 2). TheChi-square test result indicates that the educational status makes differencein nutritional status and the P- Value indicates that result is highlysignificant.
Table 5.Crosstab between Respondent Nutrition Status andSources of Drinking Water.
|Sources of Drinking Water ||Nutritional Status |
|Underweight ||Healthy |
|N (%) ||N (%) |
|Tube Well ||39 (52.7) ||37 (80.4) |
|WASA/Supply ||35 (47.3) ||9 (19.6) |
|Chi-square =9.39 ||P-Value =0.004 || |
Table 5 shows that maximum 52.7% underweight respondent tookdrinking water from Tube Well whereas minimum 19.6% healthy respondent tookdrinking water from WASA/Supply. Chi-square test result indicates that thesources of drinking water make difference in nutritional status and the P-Value indicates that result is highly significant.
Table 6.Logistic regression analysis of RespondentNutrition Status by Occupation.
|Occupation of the Respondent ||Coefficient (β) ||S.E. of β ||P-Value ||Odds Ratio |
|Day lobour® ||---- ||---- ||---- ||1.000 |
|Street Hawker ||-0.660 ||1.002 ||0.510 ||0.517 |
|Bus Helper ||0.318 ||1.321 ||0.810 ||1.375 |
|Garbage picker ||0.303 ||1.062 ||0.775 ||1.354 |
|Others ||0.735 ||1.172 ||0.530 ||2.086 |
Tab le 6 shows the logistic regression analysisof respondent nutrition status by occupation, where the odds ratio 0.517indicates that the street hawker have 0.517 times less chance to become underweightthan the day labor, the odds ratio 1.375 indicates that the bus helper have1.375 times more chance to become underweight than day labor. From the oddsratio 2.046 it can be understood that the others have 2.086 times more chanceto become underweight than day labor and the Odds ratio 1.354 indicates thatthe garbage picker have 1.354 times more chance to underweight than day labor.
Streetchildren are equally deprived of their rights to survival, health, nutrition,education and safe drinking water. The study hascovered important areas and indicators relevant for street children health andnutritional care as well as dietary habits for improving conditions of theirnutritional status. A total of 120 street children between the ages of 6 -18 years wereselected from "Shabagh area" in Dhaka city. About 67.5%of the selected street children were illiterate and about 9.2% of them were only able to do their signature . In addition , only 23.3% of them studied to the primary level of education . So it can be saidthat most of the street children were drop out from the primary level or they may have never been given the opportunity of an education . The nutritional status of the children studied was generally poor. Nutritional Status was assessed by BMI-for-age weightstatus categories. Majority of the street children inthe study were found to be underweight. Out of onehundred and twenty respondents 61.7% were belonged to underweight. While 38.3%belonged to healthy and there was no overweight or obese street children. These results are comparable to findings in literature reviewed thatstreet children experience malnutrition [15, 16]. Malnutrition impedes growthand weakens the immunity and this makes the children more susceptible toinfections. The immediate causes of malnutrition can be linked to ingestingtainted food which has been scavenged, inadequate dietary intake of essentialnutrients, faulty dietary habits and repeated illnesses. It is also reportedthat 63% of them go to bed hungry and 53% suffer from chronic malnutrition, 27million are severely underweight and 33 million never attended the school [ 1].
Thestudy determined that the street children in Shahbag were experiencing healthproblems. They lacked access to safe drinking water, adequate and nutritiousfood and shelter. Most of them recorded a BMI of <18 (61.7%) indicating thatthey were underweight and were experiencing poor nutritional status. Nutritionalstatus reflects how far some-one’s physiological needs for nutrients have beenfulfilled. When the nutrients are consumed in adequate quantities to meet theneeds of the body and metabolism, it is said the nutritional status is said tobe optimal. This situation will support good growth and development, healthcare, and physical activity, and help prevent disease. On the contrary, when nutrientsare consumed in excessive or less amount, the body will adapt to achieve homeostaticstate that maintains physiological functions. When excess or deficiencyconditions exist for a long time , they result in interference with the functions of the body and an increase in the occurrence ofdiseases .
Street childrenare not a homogeneous group and studies conducted in one part of a country donot necessarily reflect the circumstances of street children in another part ofthat country. It is necessary to develop programmes that will target streetchildren and their parents/guardians. The programmes should focus onstrengthening the link between health facilities through community healthworkers (CHWs) who can monitor their health status, refer them to healthfacilities for treatment and follow up on their adherence to the treatmentplan. The government needs to speed up the strengthening of the national childprotection system which will monitor the violation of children’s rights. Thoughthe findings of this study offer a general picture of the health status ofstreet children and the factors affecting it still there remains an urgent needto conduct in-depth investigations into their sexuality and reproductivehealth, nutrition status and factors influencing their adherence to treatment.There are opportunities for future research that can build upon the findings ofthis study.
Thepresent study findings divulge that the problem of malnutrition is multifacetedand has various links to socio-economic and demographic factors. Life on thestreet continues to have an unfavorable effect on the health of children livingand working on the street, particularly young children below 10 years. Streetchildren who are younger than 10 years have a higher risk of experiencing healthproblems because their young age increases their vulnerability. Children livingin the street are mainly involved in occupationsthat are mentally, physically and developmentally harmful. They are only able to earn a very small amount of money which is notenough for their own living expenses . In addition ,they have to support their family’s income due tobeing from very poor and socio-economically deprivedfamilies. Street children are exposed to various types of violence, abuse and exploitationswith most of them having to either live in the street or any openplaces in the city. Some of the street children are even involved in differentillicit activities such and drug mugging, drug selling; sometimes theythemselves become addicted to drugs. Social awareness and campaign on childrights could help build critical awareness among people to support streetchildren. Along with government , national and international NGOs and child rights organizationsshould come up with education, health, protection and development programmes toimprove the conditions of street children.
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