I live in Sierra Leone, and on a daily basis I see chronically neglected, traumatized, homeless children and adolescents, even young children walking around the streets of Freetown with ragged clothes and mostly in unhealthy situations begging for food, money or any small odd jobs that could provide them food and other basic necessities and these acts usually exposes them to the danger of violence and drug abuse. I am a social work practitioner, and I am very concerned with the health and well-being of these young people, and see that they are helped and given a future away from the streets.
These are not naughty children, criminals or dangerous individuals. Many Street children do exhibit behavioral problems, aggression, and substance abuse issues, but these are coping mechanisms of children who are in a great deal of psychological pain because Street Children are traumatized, abandoned, orphaned, chronically neglected, physically, sexually and mentally abused children, children who are exploited by others to beg, for commercial exploitation and other things. Every street child we know always wants to be back with his family, it’s just that they can’t because of the family situation or because being vulnerable they are being exploited and used by others.
This is a concern because they also bear a greater disease burden, their vulnerability on the streets places them at high risk of experiencing health problems. Many factors have been identified to contribute to their vulnerability to poor health. However, engaging this population in health research has been shown to present unique challenges such as participant enrollment and ethical issues. Street children have been shown to roam the streets of urban areas begging and looking for jobs in order to obtain food and other basic necessities. They usually work in poor conditions, dangerous to their health, and starve some days. Street children are reported to often be found in busy places such as bus stations, in front of film or night clubs, with no adult supervision, sleeping in half-destroyed houses, abandoned basements, under bridges and in the open air, exposing them to the cold. Developmental and health-related problems experienced during childhood affect street children in the present and are likely to follow them into adulthood.
African countries have many good national laws and some are specifically aimed at street children, but these policies are often not properly implemented or evaluated. According to UNICEF, the street children phenomenon presents one of the most complex challenges in low- and middle-income countries for policymakers today.
The Dangers These Street Children Face are as follows;
Growth and nutritional disorders
Studies on street children in Sierra Leone have documented poor growth and nutritional status by using basic primary measures of body mass index or stunting. Furthermore, a study conducted showed that the number of malnourished and anemic street children was very high, reporting a prevalence of 78% for the respective conditions. The studies revealed that street children with strong family ties were more likely to have a better growth outcome than those with little or no family ties. The nutritional disorder was reported in West African countries to affect growth and development; predisposing street children to other health problems including chronic diseases, anemia, infections, and impaired sight. Countries like Sierra Leone and some others do have policies that include street children, but implementing these policies has been a challenge. Reviews show that overconsumption of food, which leads to obesity, is not common among street children in Sierra Leone, but that they suffer from anemia due to insufficient iron and impaired sight due to vitamin A deficiency. This damages the growth and development of these children and may lead to chronic diseases, infections, and many other health problems.
Physical Injuries
Physical injuries are reported to be among the leading causes of child mortality, especially among street children. A review of physical injuries showed a higher rate among street boys than girls and those from the age of 16 years and older are associated with an increased risk of injury on the streets. This group is reported to be injury-prone because they have emotional, physical, developmental or behavioral characteristics that explain why they are frequently injured. The injuries mostly reported include sprains, cuts, scratches, lacerations, amputations, burns, bruises from street fights and accidents with motorcycles and moving cars. Reducing morbidity and mortality among street children, as has been emphasized in some studies, should be a priority and further research is needed to provide a better understanding of why the injury rate is much higher among this population.
Parasitic and other Community-acquired infectious diseases
Parasites and other infectious diseases remain a serious public health problem in West Africa. Some studies reported that infectious diseases are more prevalent among street children than children who live in homes. Parasitic infections identified to mostly affect street children in Sierra Leone are caused by worms as Ascaris lumbricoides (the common roundworm), and protozoa (a tiny organism whose body is a single cell) as Giardia lamblia (associated with diarrhea). Tuberculosis, pneumonia, and malaria, as major infectious diseases, were reported to be among the leading causes of morbidity and mortality among street children, with a higher prevalence of malaria in Sierra Leone
HIV/AIDS and Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) like gonorrhea including HIV/AIDS among street children have been reported as being very high and some studies showed that it can be higher than that of female sex workers, laborers, and prisoners. This is a significant reason why this population should be attended to immediately, providing necessary intervention to help educate this group of children about the dangers and consequences of unprotected sex, STDs and HIV infection. HIV knowledge is limited among most street children as most obtain information about HIV from their peers. Only a few of the respondents knew that the primary mode of HIV transmission is by unprotected sex. Many street children were already sexually active and most of them mainly cited satisfying their bodily needs as a reason. Furthermore, condom use is still very low among both male and female respondents. Studies have proven that most street children have heard of HIV, but engaged in unprotected sex nonetheless, having multiple partners, with some being involved in sex work. Some major risk factors for STDs and HIV/AIDS among street children are transactional sex, violence, sexual abuse, and multiple sexual partners. Transactional sex is a term often being used with regards to children and youths than survival sex to express the style of exchanging sex for material needs, while survival sex is used as a work style and prostitution as work in poverty. Observational research reported that transactional sex was described by street children as the practice of exchanging sex for their most urgent need at the time, which might be money, shelter, drugs or protection from dangers on the streets, and these practices were most prevalent among street girls and among of-the-street children.
Sexual and reproductive health disorders (adolescent pregnancy and mortality)
There are limited studies on the sexual reproductive health of street children in Sierra Leone. The few studies that were found revealed that street children reported sexual initiation from the ages of 10 to 16 years. Most of the studies reported an initiation range from ages 8 to 14 years and that of-the-street children were more sexually active than on-the-street children. The prevalence rate for gonorrhea, syphilis and genital herpes ranged from 2 to 22% among respondents.
No studies were found that specifically covered the issue of pregnancy and mortality. However, unwanted pregnancy remains a significant issue with very little information regarding its prevalence among street children being available. These children have no steady source of income and have limited knowledge of childbearing or child-rearing.
Violence and sexual abuse
Violence and hostility remain some of the main threats to Sierra Leone street children’s existence according to evidence from the reviewed studies. The evidence further demonstrated that street children experienced most violence at night and this came from police officers, security guard officers, disturbed street adults and shop owners in the cities. Some children also experienced some level of violence at home, but this cannot be compared with what street children experience. Children at home may endure maltreatment, often from their parents and often when they were younger than 14 years of age. Street children, on the other hand, are exposed to community violence because of their continuous working and sleeping on the streets at night. Violence against children is generally accepted in many African cultural settings, strongly rooted in some cultures and social practices, and some government laws turn a blind eye to the plight of children in this regard.
Sexual abuse/crime to date has the lowest reporting rates compared to that of other crimes. Some authors believe that this might be due to the stigma attached to sexual abuse. Only estimates of the rate of sexual abuse are given, based on those transgressors who have been arrested. All researchers agreed that it is only a small fraction of sexual offenders who are being apprehended. The adequate study could not find the distribution rate of sexual abuse among Sierra Leone street children. Most Evidence is based on self-reports by most street children with a high rate of rape and all forms of sexual abuse but reported a higher prevalence in street girls than boys. From all the reviewed studies on sexual abuse among street children in Sierra Leone, children generally reported being sexually abused by street adults, peers, employers and officers who use their authority to compel street children to engage in unwanted sexual activities at their exposed sleeping places at night. This could be the reason why over 50% of street girls reported that their first sexual experience was either rape or forced sex at night on the streets. There were several reports by street children accusing the authorities who should be there to protect them. The rate of police abuses towards street children in Sierra Leone, however, remains unknown.
High rates of sexual abuse were also suspected at the Northern and Southern of Sierra Leone, but researchers have reported difficulties in assessing the rate of sexual abuse, as this can only be obtained from forensic data looking at the sample of those who have been arrested and convicted for sexual abuse. Only a small number of the offenders have been arrested and convicted as it is difficult for street children to report the offenders for a number of reasons, e.g. authorities not taking them seriously and especially street girls being seen as prostitutes.
Substance Use and Abuse
Psychoactive substance use and abuse among street children were reported in most of the literature and prevalence ranged from 35 to 100%. The age of initiation was between 10 and 15 years for Sierra Leone street children who commonly use and abuse substances such as alcohol, cigarettes, inhalants, marijuana, tramadol, codeine syrup, and even excessive consumption of medications for elderly pressure patient, with a higher prevalence reported among the street children. The country has policies on drug abuse and punishment for those selling drugs to minors, but the policies have not been implemented as drugs are being sold on the roadside, enabling street children to purchase psychoactive substances.
The reasons given by street children for using psychoactive substances included coping and fitting into street life circumstances, boldness to withstand violence, survival sex, pleasure, to curb hunger, to induce sleep, to numb emotions and for entertainment. Of concern is the fact that these children use the little money they earn on the street to buy substances because they are cheaper than food. Factors associated with psychoactive substance abuse among street children included male gender, depression, lack of family contact, survival sex, unprotected sex, multiple sexual partners, early sexual debut, mini theft, street fights, and STDs, thus the duration of time spent on the street worsens the situation.
Mental Health Problems
Only a small number of non-ethnographic studies have addressed mental health issues of street children in Sierra Leone despite the fact that they are considered as a vulnerable population that suffers from adult exploitation in all forms, poor quality of life and stress, often leading to mental health problems. Their behaviors were frequently reported in the literature, but diagnostic criteria were not described and testing tools were not validated. Studies on mental health in Sierra Leone reported traumatic experiences among street children, but different methodologies were used, making it difficult to compare the results. These studies found that some street children were more likely to report feelings of hopelessness and the general suicide rate among street children was reported to be relatively low at around 2% among the street children population; female street children, in particular, were more affected. Another study identified particular psychiatric disorders in street children like schizophrenia and others. The following psychiatric disorders among street children in Sierra Leone were reported: depression, hopelessness, and suicide ideation, among others. Risk factors like stress and trauma faced by street children were only described in the studies and no standardized diagnostic tools were used in measuring post-traumatic stress disorder, which was described in the studies. Again, these studies used different methods making comparison of the results difficult, but there was an agreement in those street children who are more exposed to stressors are more at risk of depression, hopelessness, and self-harm, which can eventually lead to suicide if immediate intervention is not provided.
Structural factors affecting the health of street children
Reports revealed the complexity of push and pull factors that pose a risk to the health of street children (poverty, divorce, separation of parents, death of one or both parents, economic decline, single-parent households, child abuse, neglect, alcohol abuse, school dropout, family size and traditional values) and while on the streets they become victims of circumstances. Of the economic activities, 98% of street children are marginal jobs (survival jobs) that do not require technical knowledge. Such jobs include washing cars, collecting garbage, cleaning shops, begging, shining shoes, carrying luggage, loading/offloading goods, selling newspapers, collecting plastics from waste bins to sell to recycling companies, collecting scrap iron or copper, working as shop boys when there is a demand for manpower, prostitution, and dancing in night clubs/bars. Considering the lifestyle of street children, societal perspectives are the reasons behind their denial of certain basic needs. These children’s efforts towards the satisfaction of basic needs are, therefore, more difficult compared to children under adult supervision and who are well cared for.
Access to health care services by street children
Literature reported little or no access to health care due to high hospitalization and consultation costs in health care facilities, which is a major barrier for Sierra Leone street children who earn little or nothing on the streets. Other barriers included stigmatization by health care providers, minority status and not being sure of the quality of care they will receive in health care centers due to their disadvantaged status. The reports further stated that some street children could not find time to visit health care centers as they struggle during the day to raise money for food and other basic necessities and are only free at night.
As a Social Work Practitioner the recommendations I suggest should be made or put into practice by the Sierra Leone Government and its Development partners are in order to resolve these issues;
To put together professional social workers, given the facts that they are more equipped with the knowledge in handling such situations and sponsor them so that they can build positive relationships with children on the street, because these children need our care, concern, and protection, they can also gently encourage such children to return home or to go to the Homestead Intake Shelter and help provide the proper education and development they deserve. Support professional and comprehensive intervention services for street children, support The Homestead.
Other major Interventions that could prevent poor health and improve the health status of street children include provision of safe shelter, proper nutrition, access to health care, health education, education about sexual reproductive health, protection against any form of abuse, violence and substance abuse, thus enforcing state policies and laws about street children in the country is very important.
Violence and injuries are frequent health problems among street children and place a great burden on their health, so more regulations should be made regarding traffic and the availability of emergency first aid services to street children.
The prevalence of unwanted pregnancy and mortality and the current situation regarding these issues among street children in Sierra Leone is unknown and more information is urgently needed. Further research on the health risks and health status of street children is also required, particularly in West Africa as a whole.
Furthermore, in proper detail, an action like CHILD TRACING should be into effective practice. A program should be instituted whereby the Government or its development partners can trace children’s parents and reunite them with their families, details of the child should be gathered and accurately followed up until the proper family is found, this could take time but will be worth it at the end.
The Government should especially work hard to reunite underage children with their parents or relatives because growing within their family is vital.
An effective short term or long term education could be sought, a link-up with various schools for admission is necessary, scholarship grants for school needs is vital.
Skills Training; Older kids could be taught skills through a short term program or be reintegrated into organized skills training programs for future self-employment or employment.
Adult Literacy will be a very good platform for uneducated older children for reintegration into the regular school system or job markets.
Reintegration into Society; Street children are very much part of the societies, their present status often results in being problematic citizens, therefore a well re-orientation will result in a good citizen for society at large.
Boarding School System provides a stable environment for trouble for troubled kids, especially those coming from troubled homes, The Government could link up with these boarding homes and get children with and from problem homes to grow and develop in a stable environment, which is necessary for proper development and growth.
Working with Prostitutes; Many street children become prostitutes or are victims of sexual abuse. Since child by virtue of the status cannot care for themselves end up as child prostitutes and are sometimes misused by dysfunctional adults, However, outreach to the girls can give the Government or its developmental partners an opportunity to know these kids and their problems and better ways in which help can be offered to them.
Relocation to Orphanages; Many orphanages are open to receive street kids and provide a stable home environment for these children, they even get them to enroll in schools.
If all of these solutions are effectively practiced, I believe the number of street children will be minimized or even abolished from the streets of Sierra Leone
By Franklyn Horton
