Street Children in Alexandria : Profile and Psychological Disorders

Background: Today developed and developing countries are facing the problem posed by street children. The continuous and unrestrained exposure to the street and its associated lifestyles makes these children vulnerable to a range of health, social, and other problems. Objective: The aim of the present work was to assess the profile of street children and their living condition from different aspects, in addition to assessment of some psychological disorders among them. Methods: A cross-sectional study was conducted on 50 street boys present at El-Horreya institute for Children Community Development, which is a non-governmental organization in Alexandria. An equal control group of 50 school boys were selected at random from the first and second grades of one governmental boys preparatory school of the Middle District of Alexandria. Every child was subjected to an interviewing questionnaire. The Arabic version of Revised Ontario Child Health study scale, children Depression Inventory and the Cooper-Smith Self-Esteem Inventory, were used to identify children with conduct disorder, depression, and assess self-esteem, respectively. Anthropometric measurements including weight and height were measured for each street child and BMI was calculated. Results: The present study revealed that more than half of street children (58.0%) came from large size families, about three-quarters (72.0%) reported insufficient income, most of them had low educated parents and unskilled fathers, 80.0% reported not living with both parents before coming to the institute, and 91.2% reported bad inter-parental relationship. Family history of drug abuse, alcohol intake, smoking, and imprison were significantly higher among street children compared to school children (p<0.001). The present study showed that 74.0% of street children were smokers, 22.0% reported drug abuse, and 90.0% were dropped out of school. Family violence, beating, and beating without reason significantly increase the risk of being a street child (OR= 31.90, 2.0, and 44.58, respectively). The risk of conduct disorder, depression, and low-self esteem were significantly more among street children compared to school children (OR= 44.59, 14.64, and 9.66, respectively). The main cause of leaving home was beating, 80.0% lived in street after leaving home, 72.0% their main source of living was begging, and most of them faced problems in the street especially with the police. The results revealed that 92.0% were satisfied with the institute and 86.0% prefer to stay in the institute than returning to the street. Recommendations: planning programs to prevent, protect, and rehabilitate street children are essential.


INTRODUCTION
The issue of street children continues to attract the attention of social scientists and governmental bodies worldwide.Children who spend their days largely unsupervised in public spaces of urban centers are commonly referred to as "street children". 1The International Year of the Child (1979)  Approximately ten million children round the globe are homeless and 150 million spend much of their time on the streets. 4The number of street children is a big issue in Egypt and is on the rise. 5Estimates on the number of street children range from 200,000 to one million and a quarter of the street child population is believed to be less than 12 years old. 5reet children are both victims and barometers of extreme social and economic stress.Their presence is an indication of rapid urbanization, environmental degradation, inequitable distribution of wealth and income, and breakdown of traditional family and community values and structures. 6The key factors pushing children onto the streets in Egypt are family breakup (divorce, separation, remarriage, and death), large family size, child abuse and neglect, low income and educational levels, unplanned rural-urban migration, and children's difficulties in coping with the formal school system, increasing the rate of drop-out. 7e continuous and unrestrained exposure to the street and its associated lifestyles makes these children vulnerable to a range of health, social and psychological problems. 8udies reported that the use of drugs, violence by police and sexual exploitation constitute important problems among those children. 9,10Also street children have a high prevalence of depressive disorder, anxiety, behavioral problems and suicidal attempts. 11,12ull High Inst Public Health Vol.37 No. 1 [2007]   United Nations stresses the right of every child to have opportunities for developing physically, mentally, and socially in conditions of freedom and dignity within home and outside.Hence, the problems faced by the street children should be viewed as a human rights issue as exploitation on the street and exposure to violence infringes on their human rights. 13 is important that the special problems of this group are recognized so that the City can target its resources on areas most critical to preventing delinquency thereby helping these youth in making a successful transition into adulthood. 14 The aim of the present work was: To assess the profile of street children and their living condition from different aspects, in addition to assessment of some psychological disorders among them.

Study setting and sampling:
A cross-sectional study was conducted at

Methods:
For the conduction of the study, the following tools were used: 1) A pre-designed interviewing questionnaire was used to collect the following data from the street and school children:

A) The Arabic version of Revised Ontario
Child Health study scale 15 It was used to identify the children with conduct disorder (CD).The scale consists of 12 questions concerning the child behavior and problems they sometimes have.Each question has three choices (no "0", sometimes "1", and always "2") forming a total score that ranges between "0-24".Those who scored above 6 were considered as CD children. 16

B) The Arabic version of Children Depression Inventory 17
It is a self report rating scale to assess depression in children.The scale consists of 27 multiple choice items concerned with symptoms of childhood depression.Each item consists of 3 choices graded from 0 to 2, with a total score ranging between 0-54.The cutoff score used was 25. 17 Those with total score ≥25 were considered depressed.

C) The Arabic version of the Cooper-Smith
Self-Esteem Inventory 18 It is a self report rating scale to assess Those whose BMI for age was < 5 th percentile were considered as underweight, ≥5 th percentile and <85 th percentile as normal, ≥85 th percentile and <95 th percentile as overweight, and ≥95 th percentile as obese. 20

Statistical analysis:
The data were coded, entered, and analysed using SPSS (version 10) software program.Mean and standard deviation, chisquared test, and Odd's ratio were used.Table 6 shows that the main causes of leaving home as stated by the children were beating (44.0%), bad treatment of stepparent (30%), bad treatment of father (14.0%), and lastly feeling board at home (12.0%).The main way of joining the institute was through a family member (36.0%), followed by with colleagues (28.0%), supported by staff member from the institute (16.0%), alone (16.0%), and lastly the police (4.0%).

RESULTS
Table 7 shows that after leaving home, 80 % of street children were residing in street and their main source of living (e.g., getting food) was begging (72.0%), followed by the institute (14.0%), work (8.0%), and relatives (6.0%).
The study also revealed that 80% of street children faced problems in the street, mainly with the police (65.6%), followed by problems with other street children (53.1%), then problems with people in the street (31.3%).
Nearly half of street children (47.5%) were subjected to injuries during their stay in the streets.Concerning the nutritional status of street children, the present study showed that 14.0% were underweight.Several studies found that street children have been found to be seriously underweight. 23,25This could be explained by the prevalence of malnutrition together with chronic diseases among street children.In contrast, other studies 26,27 have found the health and nutrition status of street children to be better than their socioeconomic peers.A possible explanation is their better financial resources than those of children who rely solely on their parents, consequently giving them better access to food.
Family history of drug abuse, alcohol intake, smoking, and imprisonment were significantly higher among street children of in India showed that more than 50% of boys had used one or more substance while out on the streets (e.g.smoking was the commonest).Other studies reported 69-90% substance use. 29,30 he lower rate of drug abuse in the present study could be explained by the fact that those children were Homelessness would probably impact upon cognitive development and function, not least through such proximal causes as malnutrition, physical, sexual, and substance abuse, neurological and psychiatric disorder. 33other explanation for the increase rate of school drop out among street children is poverty.
Childhood maltreatment is pervasive and known to be associated with a variety of adverse effects on health and social functioning. 34The present study showed that family violence, beating especially using sticks and/or sharp objects, the presence of beating complications (e.g., contusions, wounds, and fractures), and beaten without reason significantly increase the risk of leaving home to the streets.Although rates of runaway adolescent reports of abusive family backgrounds vary widely across studies, all these indicate severe risk for physical and sexual abuse. 35,36 seems reasonable to suggest that street children will have varying degrees of individual and family pathology in their backgrounds that may make them vulnerable to current or future mental health problems.The present study revealed that the risk of conduct disorder, depression, and low self-esteem were significantly higher among street children.In a study done by Kerfoot et al., (2007)  37 in Ukraine, behavioral and emotional difficulties, particularly depression were a marked feature of the street children.Various studies have reported estimates of depression among this population ranging from 20-80%. 36,38In the study done by Sarbjeet et al., (2004)  36 in India among street children they found that about 69% had behavioral problems, 81% of children had antisocial behavior, 7.8% were neurotic.
One explanation for the high rate of conduct disorder may be the fragmented family background and consequent lack of social support and socialization. 32This obviously has implications when implementing life skills education, especially in addressing the emotional needs of these children. 32Also low self-esteem has been found to be one important cause of psychological disorders among these children. 39derstanding the causes of street homelessness is important since the street homeless often faces the most severe living homeless.Knowing which households are most likely to end up outside the shelter system will allow policy makers to target aid better toward that group. 28The present study revealed that the main possible causes of leaving home were beating, followed by bad treatment of stepparent, bad treatment of father, and lastly feeling board at home.Other studies reported physical abuse at home as a major cause. 23,40 t seems possible that street boys' families were poor and this contributed to their street life, but they did not report this because they did not consider themselves to be poor, or they felt other reasons were more important.
The main way of joining the institute as revealed by the present work was through a family member, through a colleague, member from the institute, alone, and lastly the police.
brought into focus the plight of street and working children, especially in the developing countries.In the context of the developing world, UNICEF (1986), has categorized street Mounir et al., 2 children as: 'children at risk', those who live in families but work on the streets to supplement the family income, 'children on the street', those who have some family support but work on the streets, and 'children of the street', those who live and work on the streets without any family support. 2Many of these children survive by begging, theft, prostitution, or some other marginal activity.Others are engaged in occupations such as shoe-shining, selling cigarettes, car washing, etc.They sleep in bus shelters, under bridges, or in old sewage pipes. 3The number of street children has increased worldwide and they represent one of our most serious global challenges.

3 )
a) Socio-demographic data: including, age, family size, income, father education and occupation, mother education, living condition, and inter-parental relationship.Illiterate, read and write, and primary educated parents were considered low educated, preparatory and secondary educated parents were considered middle educated, and university and higher educated parents were considered high educated.b) Family data: family history of drug abuse, alcohol intake, smoking, and imprisonment.c) Social relations and some characteristics: relation with mother, father and siblings, drug abuse, and smoking behavior.d) Family violence, type, and tools of punishment.2) A pre-designed interviewing questionnaire was used to collect the following data from the street children: a) Causes of leaving home and the ways of coming to the institute.b) Circumstances of living condition: place of living, source of living after leaving home, and street problems and injuries.c) Participation in institute activities and beliefs about the institute.d) Going to school and causes of not going.Psychological tests: Both the street and school children were subjected to psychological tests using the following tools: self-esteem in children.It consists of 25 items.Each item consists of 2 choices with a score of Bull High Inst Public Health Vol.37 No. 1 [2007] 0-1, and thus the total score ranged between 0-25.Those with total score ≥20 were considered of high self-esteem, ≤14 were considered of low self-esteem and >14-<20 were considered average self-esteem. 194) Anthropometric measurements: Weight and height were measured for the street children and BMI was calculated using the formula BMI= Weight in kg/ (Height in meter) 2 .
children due to death of their father ° Excluding 3 school children due to death of their father # Excluding 4 street children due to death of their mothers • Excluding 16 street children due to death of either one parent or both parents * Statistically significant at p<0.001 Figure 1 Nutritional status of street children Dismissed by school authority -Father took his child out of school -Multiple school exam failure # 4 street children their mother's were dead.• 9 street children and 3 school children their father's were dead.º 4 street children and 2 school children didn't have siblings.* Statistically significant at p<0.001

DISCUSSION
The presence of vast numbers of children in the streets in unsupervised and unprotected situations reflects an unprecedented social problem of profound deprivation and inequality.21A 'National Strategy to Protect, Integrate and Rehabilitate Street Children' was launched by the National Council of Childhood and Motherhood (NCCM) in March 2003.7The aim of the present work was to assess the profile of street children and their living conditions from different aspects.In addition to assessment of some psychological disorders among them which is important in planning programs to prevent, protect, and rehabilitate them.In consistence with other studies,22,23 the present study revealed that more than half of street children belonged to families having six or more children, and most of them had low educated parents and unskilled fathers.It can be noticed also that about three-quarters of street children came from low income home backgrounds.The lower the family income level, the more the children are exposed to the risk of abandoning the home to seek their needs in the street.24The present study found that higher proportions of street children experienced difficult circumstances at home; most of them reported not living with both parents before coming to the institute which was mainly due to divorce followed by having a parent who had died.Also bad inter-parental relationship was evident among most of parents of street children.The study done by Matchinda (1999)24 in Cameroon revealed that 71.4% of street children came from unstable home backgrounds where parents are either temporally or permanently living in separation, or where parental quarrels and fights are very frequent.In a study done on working and street children in Khartoum, they found that many had experienced the death of at least one of their parents, most often a father. 1 It is, therefore, not surprising that these children were mostly reared either by single parent, stepparent, or relatives.This parental neglect is evidenced, and may explain why most of the youth were driven to the street for economic survival.
the present study compared to school children.The results of the study done by Early (2005) 28 , in USA suggested that the probability of being homeless increased if the head of the family had a problem with alcohol Bull High Inst Public Health Vol.37 No. 1 [2007] or illicit drugs.It is reasonable to assume that the risk taking behaviors are more common among families of street children due to bad living conditions as marital disruption, poverty, and domestic violence.The present study also revealed that, about three quarters of street children were smokers and nearly a quarter of them reported drug abuse.The study done by Poornima (2007) 14 of frequent use of drugs and of performing other delinquent activities.Moreover, they generally reported more experience of familial abuse, and/or parental death or homelessness.Such prior trauma may in turn have contributed to the drug abuse.It is difficult to determine the degree to which substance abuse is a cause or a consequence of homelessness. 31Bad relations with mother, father, and siblings were more significantly reported among street children of the present study especially relation with father, which was one of the reported causes of leaving home.Most of street children in the present study reported not going to school, the causes were mainly truancy, followed by dismissed from school, father took him out of school, and lastly multiple failure in exams.The study done by Olley (2006) 32 on street youth in Nigeria revealed that 46% of the youth had a history of school refusal; 27% had a history of suspension from school; and 47% had a history of truancy from school.Street children tend to have lower intellectual functioning and decreased academic achievement.
conditions and are more difficult to target for outreach and other types of programs designed to aid the very poor and the Bull High Inst Public Health Vol.37 No. 1 [2007]