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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 89-94

Health and nutritional conditions of street children of Accra City Centers: An experiential study in Ghana


Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana

Date of Submission21-May-2019
Date of Acceptance27-Jun-2019
Date of Web Publication27-Nov-2019

Correspondence Address:
Dr. Frederick Vuvor
Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, P. O. Box LG 134, Legon-Accra, Ghana, Tel:+233244608344.

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhrr.jhrr_34_19

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  Abstract 

Aim: Children’s nutritional status offers valuable insights into the future of society’s well-being. Street children are quite vulnerable to poor health and malnutrition. The purpose of this study was to assess the health and nutritional status of street children in Accra, Ghana. Materials and Methods: A total of 300 children (210 males and 90 females) aged 10–17 years were recruited for the study. Anthropometric measurements included height, weight, mid-upper arm circumference, and triceps and calf skinfolds. Quality of diet and nutritional habits (number of meals per day and frequency of consuming particular foods) were studied using a 24-h dietary recall and food frequency questionnaires. Results: The mean age of the children was 14.8 years. Approximately 74.7% of them had at most primary education. The majority (65%) of the children lived on their own and the major economic activity engaged by them was hawking, and the average earnings per day were approximately US$1.00. The mean caloric intake of respondents was 1395 ± 483.63 kcal. Mean intake of vitamin A and iron among the children was 1054.63 ± 1222.84 retinol equivalent and 18.16 ± 10.28mg/day, respectively. Mean calcium intake was 424.57 ± 200.29mg/day. Children who were stunted formed 17.7% of respondents, 92.7% of them had normal range of body mass index (BMI), and 5.3% were underweight. Generally, BMI was higher in females compared to that in males. Conclusion: On the basis of findings, it could be concluded that street children were not adequately nourished and were highly susceptible to micronutrient deficiencies, stunting, and underweight. This calls for immediate action to put measures in place to combat this public health concern.

Keywords: Anthropometry, Health and Ghana, Nutritional status, Street children


How to cite this article:
Vuvor F, Mensah P. Health and nutritional conditions of street children of Accra City Centers: An experiential study in Ghana. J Health Res Rev 2019;6:89-94

How to cite this URL:
Vuvor F, Mensah P. Health and nutritional conditions of street children of Accra City Centers: An experiential study in Ghana. J Health Res Rev [serial online] 2019 [cited 2019 Dec 10];6:89-94. Available from: http://www.jhrr.org/text.asp?2019/6/3/89/271839


  Introduction Top


Nutritional status of children serves as the building block of the well-being of the society. It gives important insight into the health of future generations. Most often, the image of a malnourished child, living in miserable conditions and lacking access to basic social services has a rural backdrop. The situation in cities, worldwide, is evidence of the reality that many urban children are far from being the privileged citizens we might imagine. But cities also represent the frontline for effective action to overcome some of the most serious obstacles to children’s development and the enjoyment of their rights.[1],[2] Children under nobody’s care could have varied nutritional challenges and chronic illnesses more than those being cared for. The street children are ignorant about their own health, hygiene, and nutrition.

The term “street children” was first used by Henry Mayhew in 1851 when writing London Labour and the London Poor, although it came into general use only after the United Nations Year of the Child in 1979.[3],[4] The definition of street children adapted from[5] classifies them into two groups:

  1. Children on the street: “Home-based” children who spend much of the day on the street but have some family support and usually return home at night.


  2. Children of the street: “Street-based” children who spend most days and nights on the street and/or functionally without family support.


Owing to their inadequate nutrient intake, they form a malnourished subpopulation.[6] The WHO[7] report indicated that undernutrition, especially micronutrient deficiencies are the leading risk factors for morbidity and mortality worldwide. Together they account for over half the disease burden in low-income countries. The burden has been enormous and there is still a tremendous amount of work to be carried out on this front.[8] Volpi[9] reported that the current situation of children in the street across the world is alarming and demands an intensive intervention study, in relation to the phenomenon.

Street children often seem younger relative to their chronological age because of acute and chronic malnutrition, which stunts their growth. However, their furtive, hunted expressions and the devil-may-care attitude toward the world reveal maturity beyond their years.[10] Males predominate among street children, but females are also well represented in the streets of Asian and African countries. In almost all reports, there is a clear gender imbalance in street children: 70%–90% of Latin American and African street children are males.[11]

Researchers seem to agree that there are a number of factors that account for the rise in the number of street children worldwide. The process of becoming a street child does not occur within a vacuum and it is therefore essential to identify the relevant interrelationships between street children and their social environment.[12],[13] Factors associated with modernization have led to changes in family structure and increased family discord. It is likely that modernization brings with it new values and forms of social control.[14] Family disruption in the form of death, desertion, separation, and divorce has shrunk family size still further, often resulting in poor, single-parent, mother-headed households. This leaves children vulnerable, and with the general absence of community and governmental support, they have few options in times of crisis other than live on the street.[15] There were more than 20 million street children in Brazil,[16],[17] United Nations International Children’s Emergency Fund estimated that there are approximately 80 million youths living on the streets worldwide. It is deduced from this figure that approximately 20 million street children are found in Asia, 10 million in Africa and the Middle East, and approximately 40 million are said to be found in Latin America.[18],[19] Accra, the capital of Ghana is home to over 20,000 street children according to the Catholic Action for Street Children findings [unpublished]. This aim of this study was to assess the nutritional status of street children in Accra, Ghana, and to establish the indicators of these conditions.


  Materials and Methods Top


Study design: This was a cross-sectional study involving administration of questionnaire and anthropometric measurement. The prevalence of undernutrition among adolescents was found to be 23%.[20],[21] Using Epi Info statistical software (The Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA), version 7.1., the sample size obtained was 286, which was rounded up to 300. The respondents comprised 210 males and 90 females aging between 10 and 17 years. This age group was sampled because our pretesting results showed that in Ghana, it is difficult to see children below 11 years to leave their parents and those of ≥18 years tend to live an adult life and cannot be described as street children. Study was started after obtaining the Institutional Ethics Committee approval (Ref No. ECBAS 024/17–18). Informed consent was obtained before the data collection from participants with explanation to the study.

Those excluded from the study were female street children who were pregnant, disabled, and those who declined to participate. There are centers in Accra where these children go for some forms of assistance. These outdoor locations are places where many street children carry out their daily work.[22]

Self-constructed questionnaires were used to gather all information such as demographic, socioeconomic, and health indicators. A 24-h dietary recall and food frequency questionnaires were used to assess dietary intakes of study participants. Anthropometric measurements taken were height, weight, mid-upper arm circumference (MUAC), triceps skinfolds, and calf skinfolds.

Data entry and statistical analysis were carried out using the Statistical Package for the Social Sciences (SPSS, IBM Corporation, Chicago) software, version 16.[23]

Data and parameters recorded include their ages, highest levels of formal education, and whom they were living with before adopting the current living status. Others were as follows: after the end of their daily activities where they go to rest/sleep for the night. We also recorded and summarized the kinds of daily activities they engaged in, and ascertained their eating and food habits. Dietary data were collected and analyzed, anthropometric measurements and many observations were made by the field assistants from afar to authenticate their responses to the questionnaire.

Frequencies and mean values were calculated for continuous variables. For categorical data, the chi-squared test was used to calculate statistical differences and associations between variables. For quantitative data, Student’s t-test was used to test for significant differences between the mean values. Statistical significance was set at P < 0.05. Dietary data of the children were analyzed using the food processor (ESHA Research) microcomputer software. Relative body fat mass was calculated from triceps and calf skinfolds according to the following equations[24]:

PBF = 0.735 × (Triceps skinfold[mm] + calf skinfold[mm]) + 1.0 (Males)

PBF = 0.610 × (Triceps skinfold[mm] + calf skinfold[mm]) (Females)

where, PBF = percentage body fat.


  Results Top


The mean age was 14.8 ± 1.8 years with the median age of 15.0 years. Confidence interval at 95% for the mean age was 14.596 < µ < 15.004. Children in the age bracket of 16–17 years formed 38.7% of the respondents. Children with primary education (PS) formed 74.7% of the respondents. Junior high school (JHS) level children formed 21.7% and only 0.3% of the respondents had some form of senior high school education (SHS) [Table 1]. Children who lived with only their mother or father formed 12.3% and 1.3% respondents, respectively. Children those who sleep at home when night falls formed 33.0% respondents. A significant difference was observed between gender and place of sleep (P < 0.01). A higher percentage of females (47.8%) slept at home than that of males (26.7%) [Table 2].
Table 1: Characteristics of Respondents

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Table 2: Living conditions and economic activity of children

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Children who were hawkers formed 32.3%, whereas porters formed 29.3% of all. Drivers’ mates formed 9.7%, whereas those who earned their income through aiding drivers to park their cars formed 2.0%. Children who claimed to have no job but who lived on charity formed 12.0%. A higher percentage of females (62.2%) were hawkers than that of males (19.5%). The mean hours spent working daily was 7.60h among boys and 7.69h among girls. The mean amount earned daily by the children was approximately US$3.00 [Table 2].

The study found out that approximately 84% of the children ate breakfast daily and 4.0% never took breakfast. Almost half (47.7%) of the children bought their own food always. Children who bought food and also got food from friends formed 19.3% of the respondents. Those who consumed street foods, ate food at home, and at the refuge formed 5.7%. The overall energy intake by the children was 1395 kcal. The mean energy intake of boys (1393.00 kcal) was lower than that of the girls (1401 kcal). Confidence interval at 95% for mean kilocalories was 1340.842 < µ < 1450.298. The mean protein intake by the boys was 48.52g/day and that of girls was 50.21g/day. Mean carbohydrate intake was found to be higher among the boys (189.81g/day) than that among the girls (180.67g/day). The mean calcium intake was found to be higher among the girls (441.96mg/day) than that among the boys (417.13mg/day). The mean iron intake by the boys and the girls was 17.78 and 19.05mg/day, respectively [Table 3] and [Table 4].
Table 3: Eating habits of the street children

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Table 4: Energy and nutritional values of children’s diet

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Females in the age group of 11–13.9 years had higher mean weight than males in the same age group. The males in the age group of 16–17.9 years had higher mean weight than their female counterparts. Arm muscle area (AMA) among females in all age groups was significantly lower than that among males in the same age group (P < 0.01) [Table 5]. The mean weight among boys was 46.95kg and that of the females was 47.94kg. Among the boys, the mean height was 158.13cm and the mean height of the girls was 155.51cm. The mean triceps skinfolds for boys and girls were 5.58 and 12.29mm, respectively (P < 0.01). The mean body mass index (BMI) was higher among females (19.74kg/m2) than that among males (18.54kg/m2) (P < 0.01). Children who were of normal height (according to CDC growth chart) formed 82.3% of the respondents.[25] Those who were stunted formed 17.7% of the total respondents [Table 6]. With regard to BMI for age, 92.7% of the respondents had normal weight. The number of children who were underweight formed 5.3% according to CDC growth chart.[25]
Table 5: Mean anthropometric characteristics of the children according to gender

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Table 6: Frequency of stunted and underweight among the street children

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  Discussion Top


In this study, males formed the large proportion (70%) of the street children. This finding confirms a previous suggestion that boys become independent from their parents at an earlier age than girls.[26] A similar study in Latin America and some part of Africa showed that males were dominant among street children (about 75%–90% of the street children).[11] The gender imbalance in this study also corroborated with a study conducted in Zimbabwe that found 15% of street children were girls and 85% of them were boys.[27] In Africa, female children who otherwise would have been street children are kept in homes as house helps where they perform numerous household chores.

Education level of the children was mainly the primary level. The net primary school enrollment rate for Ghana is 60% for boys.[28] In this study, 74.7% of the children had PS and 21.7% JHS. This indicates that it is common for children to travel to the city after they have completed PS or JHS in search for jobs.

Majority of the children were those living on their own without any parental guidance, and most of them migrated from the hinterlands into the bigger towns to work for a living. They therefore have a psychological profile of self-reliance.[18],[29] It was discovered that street children from single-parent families (46%) were from female-headed and 7% from male-headed households.[11] Family disruption in the form of death, desertion, separation, and divorce often resulted in poor, single-parent-headed households.[15]

The job that was found to be dominant among the street children was vending/hawking. Similar results were found in the study of street children in Dhaka, Bangladesh,[30] contrary to what were found among the street children in Bamako, Mali, and Accra, Ghana, in 2005.[22] These children went to their employers for items such as sachets of ice water for sale and at the end of the day accounted for what they had sold and were given commission in the form of food and/or a token of cash. As a part of the urban poor, street children rely heavily on their labor for income.[31] They work for relatively long hours as they are paid for the work they do. There is a competition for limited jobs, they need to work hard and for long hours before making enough money.

Most of the children followed the tradition of eating three times in a day, however difficult it might be for them. The main aim of their hustle was to acquire money for food. A study documented that their central problem was access to food and food deprivation.[32] The street children always buy their food as prepared meals, which was supported by other studies.[33],[34]

The mean caloric intake of the children is 55.8% of the recommended dietary allowance,[35] which is inadequate because their bodies require high energy for the rapid physiological and psychological development and to make up for the high energy expenditure associated with the nature of their daily activities. The intake of calcium is inadequate for the development of their bone mass.[36] Calcium intakes of 800–1200mg/day can decrease blood pressure[37] compared with the intake of 400mg/day or less in this study [Table 4]. Long-term intake of low calories, zinc, and iron is not suitable for these children who were in their important phase of growth (adolescence).[38] They are exposed to harsh weather conditions and infections.


  Conclusion Top


It could be concluded that street children in Accra City Center of Ghana have relatively poor nutritional status, especially with energy and essential micronutrients making them highly prone to deficiency diseases such as anemia. The prevalence of stunting and underweight was unacceptably high, which suggests prompt interventions to curb malnutrition among these children.

Acknowledgements

This study was made possible by the caretakers at the various officials from street children centers and field assistants who helped under very extreme and risky conditions in collecting the information, especially Edward Chame-Manukure of School of Allied Health Sciences, University of Ghana, Legon-Ghana.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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