Child labour and health: a systematic review

Prevalence and correlates of child labour in five low-income countries: a descriptive study based on UNICEF Multiple Indicator Cluster Surveys 6 (MICS6)

BACKGROUND

The Convention on the Rights of the Child states that children need to be protected from 'any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development'. We aimed to determine the prevalence and correlates of child labour in five low-income African countries using the sixth wave of UNICEF Multiple Indicator Cluster Surveys (MICS6).

METHODS

Data on child labour, reported by the household respondent for a randomly selected child (5-17 years), were extracted from MICS6 reports from Chad, Guinea Bissau, Malawi, Sierra Leone and Togo. Prevalence rates were extracted from three categories of child labour (household chores, economic activity and hazardous work) stratified by gender, age, wealth and residence.

RESULTS

140 598 children aged 5-17 years (61.2% 5-11; 22.0% 12-14; 16.8% 15-17) were included in the reports; 59 090 (42%) were engaged in child labour. The highest proportion of child labourers by age was 12-14 years old (61.1%) followed by 15-17 years old (51.1%) and 5-11 years old (36.1%). There were differences between countries, with Chad having the highest proportion of working children. Gender differences in working were limited (43.9% boys vs 40.3% girls); rural children were almost twice as likely to be working compared with urban children (47.5% rural vs 25.6% urban) as were children in the poorest quintile compared with those in the wealthiest quintile (46.9% vs 23.7%). Over a third (35.3%) of working children were exposed to hazardous conditions. Older, male, rural or poor children were over-represented among those in hazardous work.

CONCLUSIONS

Almost half of all children in these five sub-Saharan African countries are engaged in labour, of which one-third are in hazardous work. MICS6 surveys do not report on working children's health; however, working puts their health and development at risk.

Access to health and rights of children in street situations and working children: a scoping review

BACKGROUND

Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations.

METHODS

From 2000 to the present, we conducted systematic searches for SWC (0-18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation.

RESULTS

The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential.

CONCLUSION

Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed.

Child labor and associated risk factors in the wake of the COVID-19 pandemic: a scoping review

Child labor can significantly impact the health, welfare, and development of children engaged in labor. The spread of child labor around the globe is predicted to accelerate as a consequence of the COVID-19 pandemic. To this end, a scoping review was conducted to (a) synthesize emerging themes and results from recent research on child labor during the COVID-19 pandemic, (b) identify factors that increase the risk of children falling into child labor and (c) provide recommendations that can inform the development of policies and programs to ensure that previous efforts to combat child labor are not lost. Six electronic databases (Medline, EMBASE, Scopus, CINAHL, Global health, and Web of Science) were searched on January 21, 2022. The database searches, along with the grey literature search, identified 5,244 studies, of which 45 articles were included in the final review. Several of those articles (8 of 45 articles) reviewed concluded that the pandemic could increase child labor worldwide including the worst forms of child labor. The reviewed studies identified primary risk factors for child labor during the COVID-19 pandemic including economic challenges, temporary school closure and a greater demand for child labor, mortality among parents, and limited social protection. This scoping review identified the need for more field research on child labor following the COVID-19 pandemic to detect emerging patterns of child labor and to develop effective intervention measures. There is also a need for further empirical research on the consequences of the COVID-19 pandemic on gender differences in occupational exposure and health outcomes among working children and marginalized groups such as migrants, refugees, and minority groups. Based on the conclusions drawn from this review, it is evident that addressing child labor in the wake of the pandemic necessitates a multi-sectoral response by the government, businesses, civil society, and funding/donor agencies. This response should address various areas such as education, social and child protection, and legislation to support vulnerable children and their families in order to combat child labor subsequent to the pandemic.

Inequities in birth registration, violent discipline, and child labour by disability status and sex: Evidence from the Multiple Indicator Cluster Surveys in 24 countries

Nearly 240 million children are estimated to have a disability globally. We describe inequities by disability status and sex in birth registration, child labour, and violent discipline outcomes. Data come from Round 6 of the Multiple Indicator Cluster Survey programme and includes 323,436 children, aged 2-17 years in 24 countries. We estimated non-registration of birth, child labour, and violent discipline, stratified by sex and disability in each country. We estimated age-adjusted prevalence ratios and prevalence differences, accounting for survey design, to calculate inequities by disability. There was large variation across countries in the percentage of children with disabilities (range: 4% to 28%), in non-registration (range: 0% to73%), child labour (range: 2% to 40%), and violent discipline (range: 48% to 95%). We found relative inequities by disability in birth registration in two countries among girls and one country among boys, and in birth certification in two countries among girls and among boys. Child labour was higher among girls with disabilities in two countries and among boys in three countries. We found larger and more prevalent inequities by disability in hazardous labour in six countries among girls (aPR range: 1.23 to 1.95) and in seven countries among boys (aPR range: 1.24 to 1.80). Inequities in the prevalence of violent discipline by disability were significant in four countries among girls (aPR range: 1.02 to 1.18) and among boys (aPRs: 1.02 to 1.15) and we found inequities in severe punishment nine countries among girls (aPR range: 1.12 to 2.27) and in 13 countries among boys (aPRs: 1.13 to 1.95). Context specific research is needed to understand the large variations in inequities by disability status and sex within and across countries. Monitoring inequities in child rights by disability status and sex is important to achieve the SDGs and ensure child protection programs reduce inequities.

The Epidemiology of Young People's Work and Experiences of Violence in Nine Countries: Evidence from the Violence against Children Surveys

Globally, 497 million young people (15-24 years) are in the labour force. The current research on work and violence indicates reciprocal links across the life course. This study draws on data from 35,723 young people aged 13-24 years in the Violence Against Children Surveys (VACS) in nine countries to describe the epidemiology of work in order to explore associations between (1) current work and violence and (2) childhood violence and work in a hazardous site in young adulthood. The prevalence of past-year work among 13-24-year-olds was highest in Malawi: 82.4% among young men and 79.7% among young women. In most countries, young women were more likely to be working in family or domestic dwellings (range: 23.5-60.6%) compared to men (range: 8.0-39.0%), while men were more likely to be working on a farm. Work in a hazardous site was higher among young men compared to women in every country. Among children aged 13-17 years, we found significant positive associations between past-year work and violence among girls in three countries (aORs between 2.14 and 3.07) and boys in five countries (aORs 1.52 to 3.06). Among young people aged 18-24 years, we found significant positive associations among young women in five countries (aORs 1.46 to 2.61) and among young men in one country (aOR 2.62). Associations between childhood violence and past-year work in a hazardous site among 18-24-year-olds were significant in one country among girls and in three countries among boys. Continued efforts are needed to prevent hazardous work, improve work environments, and integrate violence prevention efforts into workplaces.

Child Labor and Psychosocial Wellbeing: Findings from Ethiopia

For children who work, there has been little research into the intricate relationship between their home lives and their work lives and the implications that this relationship might hold for their psychosocial development and functioning. This cross-sectional study was conducted in the Amhara region, Ethiopia, between March and April 2020 on a sample of 1311 working children with the aim, in part, of exploring ways in which various dimensions of children’s psychological wellbeing are influenced by their working conditions and their family contexts. In addition to collecting data on some personal traits, family relationships, home environments, and detailed occupational characteristics, we gathered information on psychosocial wellbeing using 22 items from the Instrument for the Psychosocial Assessment of Working Children (IPAC). Exploratory factor analysis enabled us to identify five factors characterizing the dimensions of psychosocial wellbeing: work-related self-esteem, work-related stress, workplace supervision, emotional and somatic wellbeing, and self-determination. Linear regressions of these factors were then conducted on social, occupational, and environmental variables. We found that all dimensions of psychosocial wellbeing were significantly associated with the children’s working conditions. Of particular interest, work-related dimensions of wellbeing, such as stress, self-esteem, and supervision, were significantly associated with the characteristics of the home and family environment. These findings illustrate that work and working conditions must be considered jointly, along with family life and home environments, as factors in both environments affect working children’s socioemotional development and wellbeing. They also strengthen the call for a systemic approach to protecting children involved in child labor, in which families are central to all discussions.

Education, Age and Gender: Critical Factors in Determining Interventions for Child Brick Workers in Pakistan and Afghanistan

Working in factories fashioning bricks by hand seems the epitome of hazardous child labor. Yet, efforts to remove children from this work have shown little success; impoverished families balance the value of their children’s contribution against the risks they see. Unfortunately, psychosocial impacts are often not visible, and are rarely taken into consideration when designing interventions. A comprehensive occupational health study of children working in brick factories included a module on psychosocial risks and impacts. This analysis reports on the Pakistan and Afghanistan portion of the study which was administered to 450 child brick workers and 486 controls, aged 11–17. Factorial ANOVAs confirmed that working in brick factories was the strongest predictor of respondent’s psychosocial health. However, they also identified subgroups of children that escape this prediction. Older girls, for example, actually felt better when working, compared with staying at home. Schooling had positive associations, especially in younger boys and adolescent girls. In fact, the results of this study showed that those who are at greatest psychosocial risk were girls who do not go to school. These findings underscore the importance of assessing psychosocial impacts and tailoring policy and interventions to specific gender and age categories of young workers.

Comparison of adverse childhood experiences of working and nonworking adolescents

BACKGROUND

Although adverse childhood experiences (ACEs) in adolescents are partially presented at the national level, few studies of ACEs in working adolescents by comparing them with those who are not working that provide an opportunity for international comparison have been conducted.

OBJECTIVE

This study was aimed to compare the ACEs of working and nonworking adolescents.

METHODS

This study was conducted in Turkey with 213 working adolescents enrolled in the vocational training center and 457 nonworking adolescents enrolled in high schools between the ages of 15 and 18.

RESULTS

As a result of the study, the prevalence and incidence of psychological and physical ACEs and neglect in nonworking adolescents were found to be higher than the prevalence and incidence in working adolescents.

CONCLUSIONS

Research should be conducted to define the awareness of neglect and abuse among working and nonworking adolescents and to explain the reasons why nonworking adolescents experience more ACEs.

Exploring urinary biomarkers to assess oxidative DNA damage resulting from BTEX exposure in street children

Children are highly susceptible to environmental contaminants as their physiology and some metabolic pathways differ from adults. The present cross-sectional study aimed to assess whether exposure to benzene, toluene, ethylbenzene, o,p-xylene, and m-xylene (BTEX) affects oxidative DNA damage in street children using a biomonitoring approach. Thirty-five boys (7-13 years of age), exposed by working at a busy intersection, and 25 unexposed boys of similar age and living in the neighborhood near the busy intersection were recruited. Urinary un-metabolized BTEX levels were quantified by a headspace gas chromatography-mass spectrometry (GC-MS). Urinary malonaldehyde (MDA) was measured with spectrophotometry. Sociodemographic and lifestyle conditions information was collected by interviews using administered questionnaires. Exposed subjects provided urine before (BE) and after work exposure (AE), while unexposed boys gave a single morning sample. Urinary BTEX concentrations in BE samples were similar to unexposed. Concentrations in AE samples were 2.36-fold higher than observed in BE samples (p < 0.05) and higher than those in the unexposed group (p < 0.05). In addition, urinary MDA levels in AE samples were 3.2 and 3.07-times higher than in BE samples and in the unexposed group (p < 0.05). Environmental tobacco smoke (ETS) increased urinary BTEX and MDA levels in both groups. Our findings confirm that street children working at busy intersections are significantly exposed to BTEX, which is associated with oxidative stress. Implementing protective measures is crucial to reduce exposure and to improve health outcomes in this group.

Work-related injuries among Syrian refugee child workers in the Bekaa Valley of Lebanon: A gender-sensitive analysis

Background

Syrian refugees in Lebanon have endured increasing hardships since the onset of the Syrian war in 2011, with many resorting to child labor. Working refugee children endure socioeconomic deprivation and harsh working conditions. This study explores the relationship between working conditions and the reporting of injuries among male and female Syrian refugee children in Lebanon and the related gender differences.

Methods and findings

A cross-sectional survey of Syrian refugee children working in the Bekaa Valley of Lebanon was conducted in 2017. Face-to-face interviews with children (8 to 18 years) collected sociodemographic information and testimonies of their work experiences. Logistic regression tested the association between reporting of injuries and risk factors including school enrolment, field of work, means of transportation to work, age started working, number of working hours, multiple jobs, work pressure and hazards, and abuse. Analyses were stratified by gender.

Of the 4090 surveyed working children, the majority reported working in agriculture (75.8%). Around a third (31.4%) reported being injured at work with a higher proportion in males. The most common reported injuries were cuts and wounds (44.9%), with males showing a higher proportion for all types of injuries compared to females. Nearly one fifth of reported injuries (19.8%) required medical attention in a hospital, with males reporting higher proportions than females for most types of injuries. The study findings revealed the association of multiple risk factors with an increased odds of reporting an injury, which included working in more than one job (AOR, 1.71; CI, 1.20–2.43; p = 0.003), working under pressure (AOR, 1.64; CI, 1.36–1.97; p<0.001), the use of sharp or heavy objects (AOR, 1.88; CI, 1.58–2.24; p<0.001), and experiencing physical abuse at work (AOR, 2.46; CI, 1.97–3.08; p<0.001). The odds of reporting an injury increased with every additional hour of work per day (AOR 1.08; CI, 1.02–1.14; p = 0.006). Most of these findings persisted in the male and female stratified models, with few exceptions. Males who went to work in a pickup truck had significantly lower odds of being injured than those who walked (AOR, 0.65; CI, 0.51–0.83; p = 0.001); this finding did not reach significance for females. Having longer work hours per day was significantly linked to higher odds of injury for females (AOR, 1.07; CI, 1.02–1.12; p = 0.008); but not for males. The main limitations of this study were its cross-sectional design and the use of self-reported variables.

Conclusions

This study is the first to obtain direct testimony on work-related injuries and working conditions, exploring gender differences, among Syrian refugee children in Lebanon. Results demonstrated the association between the occurrence of injury and multiple risk factors highlighting their strenuous working conditions, with some differences detected between males and females. Many injuries can be prevented through direct safety interventions and proper implementation of child labor policies. Multidimensional interventions are essential to address the complex evolving challenges facing refugees.

The Health Impacts of Hazardous Chemical Exposures among Child Labourers in Low- and Middle-Income Countries

Of 218 million working children worldwide, many are suspected to be exposed to hazardous chemicals. This review aims to synthesize reported evidence over the last two decades on chemical exposure and adverse health consequences in children labourers in low- and middle-income Countries (LMIC). Included studies investigated health outcomes related to chemical exposures among child labourers aged 5-18 in LMIC. Twenty-three papers were selected for review, focusing on pesticides (n = 5), solvents (n = 3), metals (n = 13) and persistent organic pollutants (POPs) (n = 2). Adverse health effects identified among child labourers included abnormal biomarkers, for example elevated blood and urine chemical concentrations, neurobehavioural deficits and neurological symptoms, mental health issues, oxidative stress and DNA damage, poor growth, asthma, and hypothyroidism. Workplace exposure to chemicals has pernicious health effects on child labourers. Large research gaps exist, in particular for long-term health impacts through chronic conditions and diseases with long latencies. A sizeable disease burden in later life is likely to be directly attributable to chemicals exposures. We urge national and international agencies concerned with child labour and occupational health, to prioritize research and interventions aiming to reduce noxious chemical exposures in workplaces where children are likely to be present.

Youth with disabilities are more likely than their peers to engage in hazardous child labour

BACKGROUND

Little is known about the extent to which children and adolescents with disabilities are exposed to child labour.

OBJECTIVE

To estimate prevalence rates and adjusted rate ratios of exposure to child labour among children and adolescents with/without disability in middle- and low-income countries and to determine whether these rates vary between functional limitations associated with disability.

PARTICIPANTS AND SETTING

Nationally representative samples involving 142,499 children aged 5-14 from 15 countries.

METHODS

Secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys.

RESULTS

Overall children and youth with disability were not at significantly greater risk of exposure than children without disability to child labour when demographic and contextual factors were taken into account. However, children and youth with disability were at significantly greater risk of exposure than children without disability to hazardous child labour (adjusted relative risk [ARR] = 1.15 [1.10-1.21], P < 0.001). Specifically, children and youth with impairments related to poorer mental health or cognitive functioning were at significantly greater risk of exposure to hazardous child labour (e.g., ARR for learning impairment = 1.27 [1.14-1.42], P < 0.001). In contrast, children with impairments related to sensory functioning, mobility and expressive communication were at no greater risk of exposure than children with no disability.

CONCLUSIONS

Children and youth with disability are at greater risk of exposure to hazardous child labour than children with no disability in middle- and low-income countries. Responses to eradicate hazardous child labour need to take account of the situation of children and youth with disability.

How the Bidi Tobacco Industry Harms Child-workers: Results From a Walk-through and Quantitative Survey

Objective

Bidi is an inexpensive, low-processed, hand-rolled tobacco product. In Bangladesh, especially in Rangpur, tobacco farming and bidi processing are common. In this study, we aimed to evaluate the impact of bidi making on children working in bidi factories.

Methods

This qualitative(walk-through survey) and quantitative(questionnaire-based survey and a urine cotinine level quantitation) study was conducted in Rangpur, Bangladesh in 2017. Study population included child-workers aged ≤14 years who were regularly employed as bidi makers.

Findings

The results of the walk-through survey revealed hazardous working environments at bidi factories. For the quantitative survey, 171 child-workers were categorized into "less-working"(<5 hours/day) and "more-working"(≥5 hours/day) groups; additionally, "forced-working"(forced into work by parents) and "voluntary-working"(working voluntarily) groups were delineated within the same population. In the logistic regression analysis, odds ratios(ORs) of respiratory symptoms and unusual absence(absent ≥5 days/month) were higher in the "more-working" group than in the "less-working" group(unusual absence: OR, 2.91; 95% confidence interval[CI], 1.43-5.94), and this association became higher in the "forced-working" group with longer working hours(OR, 5.68, 95%CI 2.30-14.00).

Conclusions

Cheap, hand-rolled tobacco(bidi) is harmful to the health of bidi-making child-workers. Children in poverty bow to the demands of cheap labor and poverty and jeopardize their health and future prospects by working in bidi factories. Tobacco control policies should consider the social effects of tobacco beyond its biological effects.

Evaluation of Benzene Exposure and Early Biomarkers of Kidney Damage in Children Exposed to Solvents Due to Precarious Work in Ticul, Yucatán, México

BACKGROUND

The child labor situation has been associated with precarious job conditions and poor health conditions because children are often exposed to unsafe work environments, stressful psycho-social work conditions, scarce or no access to protective services, and heavy work burdens.

OBJECTIVE

The aim of the study was to evaluate markers of exposure to benzene through the exposure biomarker trans, trans-muconic acid (tt-MA), and biomarkers of early renal damage in children who work in sites that are under precarious job conditions.

METHOD

Samples of urine were obtained from children (aged 6-12 years old) who resided in Ticul, Yucatan, Mexico. Exposure to benzene was assessed through trans, trans-muconic acid (t,t-MA). Evaluated renal damage biomarkers were: Cystatin-C (Cys-C), Osteopontin (OPN), α1-Microglobulin (α1-MG) and Neutrophil Gelatinase-Associated Lipocalin (NGAL).

FINDINGS

Children who live where the workplace is inside the dwelling presented higher mean levels of tt-MA (0.59 mg/g creatinine) compared with those who live away from the workshops (0.19 mg/g creatinine). Likewise, mean levels of NGAL (4.7, 5.2 ng/ml), albuminuria (10, 10 ng/ml), Cys-C (11.8, 7.5 ng/ml), OPN (224.4, 226.5 ng/ml) and α1-MG (96.6, 73.6 ng/ml) were found in children where the workplace was inside the dwelling and outside, respectively.

CONCLUSION

Our data indicate that the children who work under precarious job conditions are exposed to benzene, and they exhibit protein levels that suggest renal damage in a population in precarious working conditions. Therefore, the child population should be considered as the most vulnerable and susceptible to suffer adverse health effects.

Displacement, deprivation and hard work among Syrian refugee children in Lebanon

Background

The protracted Syrian war resulted in the largest refugee crisis of our time. The most vulnerable are children who face separation from parents, interruption of schooling and child labour. This study explores the living and working conditions of Syrian children in Lebanon.

Methods

In this cross-sectional study, we randomly selected 153 informal tented settlements and conducted interviewer-administered surveys among Syrian refugee working children in the Bekaa Valley in Lebanon. Those aged 8-18 completed a questionnaire on sociodemographic and occupational characteristics; those aged 4-8 years were surveyed through a household questionnaire.

Results

We surveyed 1902 households, including 12 708 individuals and 4377 working children. Female-headed households were poorer and more food-insecure than male-headed households. Among working children (4-18 years), the average age of starting work was 10.9 years and 74.8% worked in agriculture. Compared with boys, girls earned less and were less likely to be enrolled in school. For 96.3% of working children aged 8-18 years, forced exodus to Lebanon was associated with a first child labour experience. Working conditions were harsh and worse for girls who compared to boys were less likely to receive their salary on time and take time off work. Girls worked longer in the sun and cold and were more likely to report having a health symptom at work, working under pressure and using sharp or heavy objects at work. Seventy-nine children reported knowing another child who died following a work accident.

Conclusion

Children, as young as 4, are forced to work, and many are compelled to forgo educational opportunities in favour of harsh and harmful labour due to difficult economic conditions. State policies facilitating access to work for adult refugees will help families meet basic needs and decrease their dependence on child labour as a coping strategy.