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Shaikh A, Sarin A. Inhalant abuse among street-involved children and adolescents in India: Case for epistemic recognition and reorientation. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:366-379. [PMID: 38695149 DOI: 10.1111/jora.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 07/09/2024]
Abstract
Contextualizing the void of research on inhalant abuse among adolescents as epistemic neglect, in this study, we use mixed-methods action research to understand inhalant abuse in a specific context in the Global South. Focusing on a large metropolitan city in Western India, we surveyed 158 street-involved children and adolescents (110 boys and 48 girls, age range from 5 to 17 years) in a group setting along with follow-up group interviews. Despite finding a high prevalence rate of inhalant abuse, our work suggests an absence of supporting structures and emphasizes the need to revisit our understanding and interpretation of substance-using behavior of street-involved youth. Instead of explaining inhalant-abusing behavior as emerging from pathological deficiencies in individuals or households, we stress the need to critically examine the exploitative environment they are embedded in. In doing so, we join efforts to decolonize conventional ways of understanding "deviant" behavior.
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Affiliation(s)
| | - Ankur Sarin
- Indian Institute of Management Ahmedabad, Ahmedabad, India
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Nasiri N, Kostoulas P, Roshanfekr P, Kheirkhah Vakilabad AA, Khezri M, Mirzaei H, Sharifi A, Sharifi H. Prevalence of HIV, hepatitis B virus, hepatitis C virus, drug use, and sexual behaviors among street children in Iran: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1674. [PMID: 37927540 PMCID: PMC10620850 DOI: 10.1002/hsr2.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Background and Aims Street children face a disproportionately higher risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) due to high-risk sexual and drug use practices. We aimed to estimate the prevalence of these infections and related risk behaviors among street children in Iran. Methods We searched PubMed, Web of Science (ISI), Embase, Scopus, and Google Scholar for the English-language records and Iranian databases, including SID, Magiran, and IRANDOC for the Farsi-language records up to September 18, 2022. Random effects analysis was used to obtain prevalence estimates for each condition. Homogeneity across included studies was assessed using I 2. Results We extracted data from 18 eligible studies, representing 5646 children (83.2% boys), with a mean age of 10.2 (range: 5-18). The prevalence of HIV, HBV, and HCV were 0.79% (95% confidence intervals [CIs]: 0.0-5.56), 1.97% (95% CI: 1.01-3.19), and 1.88% (95% CI: 0.74-3.46), respectively. The prevalence of lifetime drug use and sexual abuse was 8.32% (95% CI: 4.83-12.62) and 10.18% (95% CI: 3.02-20.67) among street children, respectively. Conclusion The estimated prevalence of HIV, HBV, and HCV among street children in Iran was higher than the estimates in the general population. Moreover, drug use and the experience of sexual abuse were prevalent among this population. These findings suggest the need for targeted prevention programs for street children in Iran.
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Affiliation(s)
- Naser Nasiri
- School of HealthJiroft University of Medical SciencesJiroftIran
| | - Polychronis Kostoulas
- Laboratory of Epidemiology and Artificial Intelligence, Faculty of Public & One HealthUniversity of ThessalyThessalyGreece
| | - Payam Roshanfekr
- Social Welfare Management Research Center, Social Health Research InstituteUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | | | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
| | - Hossein Mirzaei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
| | - Ali Sharifi
- Department of OphthalmologyShafa Hospital, Afzalipour School of Medicine, Kerman University of Medical SciencesKermanIran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
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Goodman ML, Seidel SE, Springer A, Elliott A, Markham C, Serag H, Keiser P, Raimer B, Raimer-Goodman L, Gatwiri C, Munene K, Gitari S. Enabling structural resilience of street-involved children and youth in Kenya: reintegration outcomes and the Flourishing Community model. Front Psychol 2023; 14:1175593. [PMID: 37680240 PMCID: PMC10482225 DOI: 10.3389/fpsyg.2023.1175593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Millions of children and youth live on city streets across the globe, vulnerable to substance use, abuse, material and structural neglect. Structural resilience, the re-establishment of access to structural goods within a society such as housing, education, and healthcare following some interruption, provides an orientation for research and interventional efforts with street-involved children and youth (SICY). Further, a structural resilience framework supports organizing interactions between levels and sectors of a socio-ecology. Methods Following the expressed interests of Kenyan SICY, and consistent with emerging policy interests at national and global levels, we assess reintegration trajectories of Kenyan SICY (n = 227) participating in a new program intervention and model. The intervention combines two coordinated, parallel programs - one focused on the rescue, rehabilitation, reintegration and resocialization of SICY, and the other focused on empowering families and communities to provide better care for children and youth who are reintegrating from life on the streets to the broader community. Data were collected and analyzed from multiple stages across SICY involvement with the intervention. Results We found 79% of SICY participants reintegrated with the broader community, and 50% reintegrated with families of origin and returned to school. Twenty-five percent of participants reintegrated to a boarding school, polytechnical school, or began a business. Probability of reintegrating successfully was significantly improved among participants whose families participated in the family- and community-oriented program, who were younger, with less street-exposure, expressed more personal interests, and desired to reintegrate with family. Discussion To our knowledge, these are the first quantitative data published of successful reintegration of SICY to the broader, non-institutionalized community in any low- or middle-income country. Future research should (1) identify factors across socio-ecological levels and sectors contributing to health and developmental outcomes of reintegrated children and youth, (2) mechanisms to support SICY for whom the interventional strategy did not work, (3) methods to prevent street-migration by children and youth, and (4) system development to coordinate follow-up and relevant investment by institutions, organizations and community leaders to continue reintegration work.
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Affiliation(s)
- Michael L. Goodman
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
- Sodzo International, Houston, TX, United States
| | | | - Andrew Springer
- The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Aleisha Elliott
- Texas AHEC East, The University of Texas Medical Branch, Galveston, TX, United States
| | - Christine Markham
- The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hani Serag
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Philip Keiser
- School of Public and Population Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Ben Raimer
- Office of the President, The University of Texas Medical Branch, Galveston, TX, United States
| | - Lauren Raimer-Goodman
- Community-based Clinics, The University of Texas Medical Branch, Galveston, TX, United States
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. The global distribution and epidemiology of alcohol and drug use among street-involved children and youth: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:381-398. [PMID: 37310881 DOI: 10.1080/00952990.2023.2201872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 06/15/2023]
Abstract
Background: Street-involved children and youth (SICY) who work and live on/of the streets are more likely to inject drugs and engage in psychoactive substance use.Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic determinants, and risk-taking associated with alcohol and drug use among SICY.Methods: Studies published in English related to alcohol and drug use among SICY were searched for from December 1 1985 to July 1 2022, on PubMed, Scopus, Cochrane, and Web of Science.Results: After full-text paper evaluation, 73 studies were included in the meta-analysis. Results indicated that lifetime prevalence rates were 44% (alcohol), 44% (crack), 33% (inhalants), 44% (solvents), 16% (tranquilizer/sedatives), 22% (opioids), and 62% (polysubstance use). The current prevalence rates were 40% (alcohol), 21% (crack), 20% (inhalants), 11% (tranquilizer/sedatives), and 1% (opioids). Also, life-time and current prevalence of alcohol and crack use, current prevalence of tranquilizer/sedative use, and life-time prevalence of polysubstance use were higher among older age groups. Life-time prevalence of tranquilizer/sedative use was lower among older age groups.Conclusions: The high prevalence of using alcohol, crack, and inhalants is a major issue because they are used extensively among different age groups, including minors. Such findings are beneficial for policymakers, health authorities, and professionals in developing programs aimed at minimizing inhalant use and other types of substance use harms among this group. It is important to accurately monitor this risk-exposed population to understand the mechanisms that might help protect them from high-risk substance use.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Ayaya S, DeLong A, Embleton L, Ayuku D, Sang E, Hogan J, Kamanda A, Atwoli L, Makori D, Ott MA, Ombok C, Braitstein P. Prevalence, incidence and chronicity of child abuse among orphaned, separated, and street-connected children and adolescents in western Kenya: What is the impact of care environment? CHILD ABUSE & NEGLECT 2023; 139:104920. [PMID: 33485648 PMCID: PMC8289926 DOI: 10.1016/j.chiabu.2020.104920] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 06/04/2023]
Abstract
BACKGROUND The effect of different types of care environment on orphaned and separated children and adolescents' (OSCA) experiences of abuse in sub-Saharan Africa is uncertain. OBJECTIVE Our two primary objectives were 1) to compare recent child abuse (physical, emotional, and sexual) between OSCA living in institutional environments and those in family-based care; and 2) to understand how recent child abuse among street-connected children and youth compared to these other vulnerable youth populations. PARTICIPANTS AND SETTING This project followed a cohort of OSCA in Uasin Gishu County, Kenya (2009-2019). This analysis includes 2393 participants aged 18 years and below, 1017 from institutional environments, 1227 from family-based care, and 95 street-connected participants. METHODS The primary outcome of interest was recent abuse. Multiple logistic regression was used to estimate the odds of recent abuse at baseline, follow-up, and chronically for each abuse domain and adjusted odds ratios (AOR) between care environments, controlling for multiple factors. RESULTS In total, 47 % of OSCA reported ever experiencing any kind of recent abuse at baseline and 54 % in follow-up. Compared to those in family-based care, street-connected participants had a much higher reported prevalence of all types of recent abuse at baseline (AOR: 5.01, 95 % CI: 2.89, 9.35), in follow-up (AOR: 5.22, 95 % CI: 2.41, 13.98), and over time (AOR: 3.44, 95 % CI: 1.93, 6.45). OSCA in institutional care were no more likely than those in family-based care of reporting any recent abuse at baseline (AOR: 0.85 95 % CI: 0.59-1.17) or incident abuse at follow-up (AOR: 0.91, 95 % CI: 0.61-1.47). CONCLUSION OSCA, irrespective of care environment, reported high levels of recent physical, emotional, and sexual abuse. Street-connected participants had the highest prevalence of all kinds of abuse. OSCA living in institutional care did not experience more child abuse than those living in family-based care.
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Affiliation(s)
- Samuel Ayaya
- Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Lonnie Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | | | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya; Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mary A Ott
- Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, USA
| | - Caroline Ombok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, College of Health Sciences, School of Medicine, Eldoret, Kenya.
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Armoon B, Griffiths MD, Mohammadi R. The Global Distribution and Epidemiology of Psychoactive Substance Use and Injection Drug Use Among Street-Involved Children and Youth: A Meta-Analysis. Subst Use Misuse 2023; 58:746-764. [PMID: 36924274 DOI: 10.1080/10826084.2023.2181036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background: Globally, street-involved children and youth (SICY) who work and live on/of the streets are at higher risk of increased psychoactive substances and injecting drug use. Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic factors, and risk-taking behaviors associated with psychoactive substances and injecting drug use among SICY. Methods: Studies in English published from December 1 1985 to July 1 2022, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on psychoactive substances and injecting drug use among SICY. The pooled-prevalence estimates were obtained using a robust fixed-effects model. Results: The most commonly reported life-time and current psychoactive substance was tobacco followed by cannabis, LSD/ecstasy, cocaine, methamphetamine, heroin and injection drug use. The results showed that life-time and current prevalence of methamphetamine and cannabis use, as well as life-time prevalence of cocaine, LSD/ecstasy, heroin, tobacco, and injecting drug use increased as age rose while current prevalence of cocaine and tobacco use decreased as age rose. SICY who were male, homeless, had parents who had died, had history of substance use among family members or best friends, had experienced violence, had casual sex partners, had a history of working in the sex trade, and had unprotected sex were all related to psychoactive substance use and injecting drug use. Conclusions: Research examining this population suffers from lack of studies, therefore, improving the knowledge for interventions aimed at reducing risk behaviors, particularly those related to the transmission of sexually transmitted infections such as HIV is of great importance.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Gomes NMDO, Caldas ED. Street and drug use experiences among sheltered children and adolescents in the Federal District of Brazil. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 36:105-113. [PMID: 36453194 DOI: 10.1111/jcap.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
PROBLEM The use of drugs by street children and adolescents is a problem found in most large cities around the world. METHODS This is a cross-sectional study of street children and adolescents living in shelters in the Federal District, Brazil. An objective questionnaire was applied to 84 individuals from September 2016 to October 2017; 14 of them participated in the qualitative study. FINDINGS Most participants were adolescents (84.5%) and males (64.3%), with a history of abandonment, domestic violence, and family drug abuse. All spent some time on the street; boys had a higher chance of being behind the school level and using drugs than girls. Over 60% had used drugs in the previous year, mainly alcohol and marijuana. Over 70% understand the health consequences of this behavior, but most have never tried or failed to stop. About 40% consider themselves dependent on drugs. CONCLUSIONS The results showed that street-life experience, peer pressure, and exposure to drugs within the family had an important impact on respondent's drug use behavior, reinforcing the importance of education programs that focus on the family.
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Affiliation(s)
| | - Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmacy, Faculty of Health Sciences University of Brasilia Brasilia Federal District Brazil
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Asfaw Z, Mitiku M, Abebe HT, Atsbeha MT. A Community-Based Study of Level and Determinants of Substance Use: Findings from Children Experiencing Homelessness in Major Cities of Northern Ethiopia. Subst Abuse Rehabil 2022; 13:101-110. [DOI: 10.2147/sar.s381768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
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Roshanfekr P, Ali D, Noroozi M, Bahrami G, Vameghi M. Lifetime alcohol-use prevalence and correlated factors among street children in Iran. Brain Behav 2022; 12:e2781. [PMID: 36227702 PMCID: PMC9660407 DOI: 10.1002/brb3.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several studies on street children in Iran reported a high prevalence of alcohol consumption among this group. This study assessed the prevalence of lifetime alcohol use and correlated factors among street children in Iran. METHODS We conducted a cross-sectional survey among 856 street children from six provinces of Iran. Behavioral data were collected by trained interviewers using a structured questionnaire. Our target outcome was lifetime alcohol use. We examined associations between individual variables and lifetime alcohol use using the chi-square. A multiple logistic regression model included variables with a p-value < .2. Lastly, we reported the adjusted odds ratio (an OR) point estimate and 95% confidence interval (95% CI) as the effect measure. RESULTS Mean age and standard deviation (SD) of alcohol drinkers were 14.94 ± 2.16. Overall, 16.6% (CI95%: 14.38%, 19.55%) of participants reported lifetime alcohol use, and almost 60% of children reported alcohol use over three past months. In the final model, factors that were independently associated with alcohol use included the 15-18 age range (AOR 2.35, 95% CI 1.48-3.73), Iranian nationality (AOR 3.36, 95% CI 2.07-5.45), working longer than 5 years in the streets (AOR 2.90, 95% CI 1.72-4.88), father's drug use (AOR 1.93, 95% CI 1.22-3.01), and illiteracy (AOR 1.65, 95% CI 1.03-2.66). CONCLUSIONS The results of the present study demonstrated that preventive plans for alcohol use among street children must be addressed using the services provided by governmental and nongovernmental organizations.
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Affiliation(s)
- Payam Roshanfekr
- Social Welfare Management Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Delaram Ali
- Social Welfare Management Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Mehdi Noroozi
- Social Determinants of Health Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Giti Bahrami
- Social Determinants of Health Research CenterAlborz University of Medical SciencesKarajIran
| | - Meroe Vameghi
- Social Welfare Management Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
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Screening of Occult Hepatitis B and C Virus Infection in Working Children, Tehran, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect-118763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Working children are susceptible to infection with various infectious microorganisms. Unfortunately, the difficulties of working children are growing at a remarkable speed worldwide. Objectives: The aim of this research was to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, as well as to evaluate the level of anemia, calcium, and phosphorus in working children. Methods: This cross-sectional research was performed on 370 Iranian and Afghan working children from February 2018 to May 2019. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and anti-HCV Ab were evaluated using an enzyme-linked immunosorbent assay (ELISA). Furthermore, HCV-RNA and genomic HBV-DNA in the plasma and peripheral blood mononuclear cell (PBMC) specimens of the participants were investigated. The restriction fragment length polymorphism (RFLP) method was used to determine the genotype of HCV, and sequencing was performed to confirm. Results: The mean age of the participants was 10.1 ± 2.1 years (range, 6 - 15 years), and 229 (61.9%) were male. None of the studied children had any detectable HBV-DNA in the plasma and PBMC. The HCV genome was not detected in the plasma of the children, but HCV-RNA was assessed in the PBMC sample of 1 child (0.3%). Therefore, one of the children had occult HCV infection (OCI). The genotype of HCV in this child was subtype 1a. Furthermore, HBsAb was detected in Iranian (41.5%) and Afghan children (40.0%), and 2 (0.54%) of the working children were HBsAg positive. In 3 participants (0.8%), a positive HBcAb test result was noted. Conclusions: The prevalence of HCV and HBV infection in working children in Iran is extremely rare. However, there is a possibility of the presence of OCI in these children.
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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Skylstad V, Nalugya JS, Skar A, Opesen C, Ndeezi G, Okello ES, Moland KM, Engebretsen I, Tumwine JK. 'As soon as they can hold a glass, they begin taking alcohol': a qualitative study on early childhood substance use in Mbale District, Uganda. BMC Public Health 2022; 22:812. [PMID: 35459136 PMCID: PMC9033416 DOI: 10.1186/s12889-022-13140-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.
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Affiliation(s)
- V Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - J S Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Ams Skar
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - C Opesen
- Department of Sociology and Anthropology, School of Social Sciences, Makerere University, Kampala, Uganda
| | - G Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - E S Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza Campus, Mwanza, Tanzania
| | - K M Moland
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ims Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - J K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.,Kabale University School of Medicine, Kabale, Uganda
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Skylstad V, Babirye JN, Kiguli J, Skar AMS, Kühl MJ, Nalugya JS, Engebretsen IMS. Are we overlooking alcohol use by younger children? BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001242. [PMID: 36053657 PMCID: PMC8905875 DOI: 10.1136/bmjpo-2021-001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/13/2022] [Indexed: 11/04/2022] Open
Abstract
Alcohol use is a leading contributor to the burden of disease among youth. Early-onset use is associated with later life dependency, ill health and poor social functioning. Yet, research on and treatment opportunities for alcohol use among younger children are scarce. Despite knowledge that alcohol intake occurs in childhood, and the fact that children understand alcohol related norms and develop alcohol expectancies from age 4, younger children are rarely included in studies on alcohol use.Patterns of early alcohol use vary greatly across the globe and are part of complex interplays between sociocultural, economic and health-related factors. Family influence has proven important, but genetic factors do not seem to play a crucial role at this age. Stressful circumstances, including mental health problems and sociocultural factors can entice alcohol use to cope with difficult situations. The World Health Organization has developed guidelines for effective strategies to reduce the harmful use of alcohol, including preventative and treatment interventions, but important gaps in implementation remain. An increased focus on research, policy and implementation strategies related to early alcohol use is warranted, granted its wide-ranging implications for public health and social functioning. In this summary of literature on alcohol use among younger children and adolescents, we show that younger children (aged 10 and younger) tend to be systematically overlooked. However, research, interventions and policy implementation strategies need to include younger children to mitigate the global burden of harmful alcohol use more effectively.
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Affiliation(s)
- Vilde Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Juliet Kiguli
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ane-Marthe Solheim Skar
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway.,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Melf-Jakob Kühl
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Joyce Sserunjogi Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Ministry of Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Ingunn Marie Stadskleiv Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Shegaw M, Fekadu W, Beka M, Menberu M, Yohannes K, Yimer S, Seid M, Necho M, Moges S, Anbesaw T. Problematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia. Front Psychiatry 2022; 13:930059. [PMID: 35966470 PMCID: PMC9365990 DOI: 10.3389/fpsyt.2022.930059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Problematic substance use is becoming a common problem in marginalized groups such as street youths. However, there is a dearth of studies on the prevalence and factors associated with problematic substance use among street youth in Ethiopia. OBJECTIVE The objective of this study was to determine the prevalence of problematic substance use and identify its associated factors among street youth. METHODS This community-based cross-sectional study was conducted between June and July 2020. A total of 252 participants were included in this study. Systematic random sampling was used to recruit participants. Cut down, annoyed, guilty feeling, and eye opening-adapted to include drugs (CAGE-AIDs) were used to assess problematic substance use. The data were entered into epidata and exported to SPSS version 25 for analysis. Logistic regression with a 95% confidence interval (CI) was used to show the strength of association. A p-value < 0.5 was statistically significant. RESULTS The prevalence of problematic substance use was 55.8%, 95% CI (49-63%). Peer pressure [adjusted odds ratio (AOR) = 3.01, 95% CI: 1.38, 6.59], family conflict [AOR = 5.05, 95% CI: 1.67, 15.25], physical abuse [AOR = 2.56, 95% CI: 1.11, 5.84], and substance use in the family [AOR = 2.85, 95% CI: 1.29, 6.27] were the factors significantly associated with problematic substance use. CONCLUSION The prevalence of problematic substance use was high. It was also found that peer pressure, family conflict, substance use in the family, and physical abuse were the factors associated with problematic substance use. Therefore, proper screening and intervention for individuals with problematic substance use are needed, and further research should be conducted for marginalized groups.
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Affiliation(s)
- Maregu Shegaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Michael Beka
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melake Menberu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Solomon Yimer
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Mohammed Seid
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Solomon Moges
- Department of Psychiatry, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Capturing the heterogeneity of life on the streets: A person-centered analysis of street histories and social connections of youth. J Adolesc 2021; 93:80-89. [PMID: 34678621 DOI: 10.1016/j.adolescence.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/16/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The heterogeneity of street-involved youth was examined using a person-centered approach. Youth were classified based on patterns of street involvement and the identified profiles compared to identify theoretically coherent and practically significant differences. METHODS Participants were 111 street-involved youth aged 9 to 18 (M age = 14.15 years; 81.1% male, 91.1% non-white) from three Brazilian cities. Youth completed a life history interview and structured assessment. Latent class analysis was used to identify three profiles of youth based on reasons for going to the street and connections to major developmental contexts (street, family, institutions). Profile comparisons on psychosocial variables (e.g., age, life events) and adjustment indicators (e.g., drug use, life satisfaction) were conducted using multinomial logistic regression. RESULTS The largest profile (48.6%) included youth drawn to the street by drug use or trafficking, who had moderate connections to street and family. Another group (40.5%) went to the street to escape family dysfunction, and the street represented their primary developmental context. These groups differed on some psychosocial indicators but had similar patterns of adjustment. The third group of youth (10.8%) had families with a history of street involvement and maintained strong ties to all three developmental contexts. These youth had generally better adjustment than their peers (e.g., less drug use, higher life satisfaction) but had higher levels of sexual risk related to the overrepresentation of girls. CONCLUSIONS Street involvement is a multidetermined phenomenon that may expose young people to distinct conditions of vulnerability. Findings have implications for research, practice, and policy.
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Social Determinants of Narcotics Use Susceptibility among School-Attending Adolescents in Bissau, Guinea-Bissau: A Cross-Sectional Analysis. ADOLESCENTS 2021. [DOI: 10.3390/adolescents1030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Balanced medical and criminal justice approaches addressing determinants of alcohol and other drugs (AOD) use are central to achieving the United Nations Sustainable Development Goals 3 and 16. However, data on AOD use in resource-poor settings are characterised by relative paucity and anecdote. This study aimed to describe and analyse AOD use susceptibility and its determinants among school-attending adolescents in the capital Bissau, Guinea-Bissau. Survey data were collected through a locally adapted Planet Youth questionnaire in June 2017 across 16 schools in Bissau. The 2039-strong sample was selected through a multi-stage, random cluster process. Participants’ lifetime alcohol use was 27.3%, smoking 10.8%, and cannabis use 3.6%. In each instance, the ‘15 years and above’ age bracket was the most common initiation period, signifying increased instigation in later adolescence. Subsequent Varimax Principal Component Analysis (PCA) of 312 variables captured data-driven models of AOD use susceptibility, implying imitated, polydrug use among initiates. Linear regression analysis revealed drinking, group violence, male gender, school dismissal and relationship breakdown as explanatory variables. Overlapping predictive variables suggest singular interventions may pre-empt myriad antisocial behaviours. PCA offers alternatives to singular, potentially myopic quantifications of drug use. PCA facilitates the creation of context-sensitive composite variables, enabling the identification of related outcome behaviours relevant to studies’ sociocultural settings.
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Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med 2021; 18:e1003750. [PMID: 34424908 PMCID: PMC8423293 DOI: 10.1371/journal.pmed.1003750] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. METHODS AND FINDINGS We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. CONCLUSIONS Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018085216). TRIAL REGISTRATION PROSPERO CRD42018085216.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Biomedical Innovation Academy, Berlin Institute of Health, Berlin, Germany
| | - Karl Deutscher
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Asante KO, Nefale MT. Substance Use among Street-Connected Children and Adolescents in Ghana and South Africa: A Cross-Country Comparison Study. Behav Sci (Basel) 2021; 11:bs11030028. [PMID: 33673464 PMCID: PMC7997445 DOI: 10.3390/bs11030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/02/2022] Open
Abstract
Using two cross-sectional surveys with a purposive sample of 376 homeless children and adolescents in both Ghana and South Africa, this study was conducted to examine the prevalence, sociodemographic and psychosocial correlates of substance use among street children and adolescents. An interviewer-administered questionnaire was used to obtain information on substance use, sociodemographic and psychosocial variables. Both bivariate and multivariate analyses showed that street-connected adolescents in Ghana reported higher prevalence of lifetime alcohol use and past-month alcohol use than those in South Africa. The protective effect of male gender was not observed in South Africa but significantly more pronounced in Ghana for all substances except past-month marijuana use. Sexual assault, indirect sexual victimization, physical beating, robbery, assault with a weapon and survival sex increased the odds of lifetime alcohol use and past-month alcohol use in Ghana. However, in South Africa, only robbery and assault with a weapon increased the odds of lifetime alcohol use while robbery and sexual assault increased the odds of past-month alcohol use. These results have implications for the development of harm reduction interventions, taking into consideration both the psychosocial and cultural context of substance use.
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Affiliation(s)
- Kwaku Oppong Asante
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein 9301, South Africa
- Correspondence: or
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Jones HE, Momand AS, Lensch AC, Browne T, Morales B, O’Grady KE. Increasing Substance Use Disorder Treatment Professionals Knowledge: The Child Intervention for Living Drug-free (CHILD) Curriculum. JOURNAL OF SUBSTANCE ABUSE AND ALCOHOLISM 2021; 8:1086. [PMID: 35419487 PMCID: PMC9004722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND A worldwide and ever-growing population of children are using psychoactive substances. To slow this problem, the Child Intervention for Living Drug-Free (CHILD) Curriculum was created to train treatment providers on how to screen, assess, and treat children between the ages of 4-12 years of age exposed to or actively using psychoactive substances. The purpose of the present project was to evaluate the extent to which completion of a six-session training of the six courses of the CHILD Curriculum met the objective of increasing the participants' knowledge of the Curriculum's approach to treating children for substance use problems. METHODS 71 participants from Africa, Asia, and South America were invited for training and 100% accepted the invitation. Trainees completed an in-person small-group course, occurring over 32 days and comprising 256 total hours. During the CHILD Curriculum training, they completed six separate, 20-item, multiple choice knowledge assessment measures, one for each of the six courses comprising the Curriculum. RESULTS Significant (ps<.001) improvement in knowledge in each course was associated with a multivariate measure of strength of the relationship that indicated the change was substantial for five courses (R2s>.5) and moderate for a sixth course. Percentage change from baseline varied from a low of 17% to a high of 63%. CONCLUSION The CHILD Curriculum provides a useful educational framework to ensure knowledge gains by trainees. This curriculum content and evaluation provides a framework for future training of providers to pre-adolescent children who use psychoactive substances or are at risk for such use.
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Affiliation(s)
- Hendrée E. Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD USA
| | - Abdul Subor Momand
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD USA
| | | | - Thom Browne
- Colombo Plan Secretariat, Colombo, Sri Lanka
| | - Brian Morales
- Bureau of International Narcotics and Law Enforcement Affairs (INL), U.S. Department of State, Washington, DC USA
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD USA
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Santana JP, Raffaelli M, Vezedek L, Koller SH. Adolescents, Street, Drugs and Psychoactive Substances: A Study on Risk and Protection. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The article describes the consumption of psychoactive substances (PSs) by street-involved children and adolescents (SCA) in three Brazilian state capitals and examines adverse life events due to drug involvement. The longitudinal study included 108 SCA (9-18 years old, both sexes), grouped according to the main reason for going to the street: drugs, caregivers, escape, work and freedom. It also discusses the impact of drugs, trafficking and the place that this theme has occupied in public policies, social interventions and the life trajectory of these participants, through a case study. It is intended that these data can support the operation of interventions and the formulation of public policies that guarantee integral protection.
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Motazedian N, Sayadi M, Beheshti S, Zarei N, Ghaderi J. High risky behavior and HIV/AIDS knowledge amongst street children in Shiraz, Iran. Med J Islam Repub Iran 2020; 34:138. [PMID: 33437734 PMCID: PMC7787017 DOI: 10.34171/mjiri.34.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Indexed: 11/05/2022] Open
Abstract
Background: Street children around the world are accompanying a wide range of risky behaviors. The most common ones include risky sexual behavior, substance and alcohol abuse, and violence. This study aimed to assess risk behaviors and HIV knowledge of street children in Shiraz. Methods: A total of 329 street children (7-18 years of age who spend days or nights on streets with or without their family for earning money) were interviewed through 2014-2016 in Shiraz. Data were collected through a structured interview about high-risk behaviors and HIV/AIDS Knowledge based on a form and questionnaire. Street children were asked to identify HIV/AIDS mode of transmission. All correct answers were scored as one (1), and incorrect, "don't know" responses and no responses scored as zero. The data were analyzed by SPSS software 16 (SPSS, Inc. Chicago, USA) using the Independent t-test and chi-square test, and Pearson's correlation test. P value< 0.05 was considered as statistically significant Results: The mean ± SD age was 13.46±3.09. A total of 86.6% of them were boys. A total of 97.6% of them reported staying with their parents. Street children reported sleeping place as follow: with their parents (n=312, 94.8%), sharing accommodation with other kids (n=13, %4), sleeping in parks (n=2, 7%), and one with relatives. The frequency of smoking, alcohol drinking, and drug abuse were 35 (10.6%), 47 (14. 3%), and 6 (1.8%) respectively. A total of 43 (13.1%) street children reported sexual activity, among them 30 (9.1%) had sexual activity without a condom. Mean ± SD HIV/AIDS knowledge scoring of street children was, 4.1±3.9. Conclusion: Special programs should be implemented in order to reduce high-risk behavior among street children. Intervention should include increasing awareness about alcohol and drug abuse, HIV/AIDS knowledge, sexual and verbal abuse through an organized system with the help of peer education.
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Affiliation(s)
- Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Beheshti
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Nooshin Zarei
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Javad Ghaderi
- Faculty of Educational Sciences and Psychology, Payame Noor University, Eqlid, Iran
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Aly SM, Omran A, Gaulier JM, Allorge D. Substance abuse among children. Arch Pediatr 2020; 27:480-484. [PMID: 33011026 DOI: 10.1016/j.arcped.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/21/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Substance abuse (SA) among children is a recognized challenge for policymakers and law enforcement and has life-threatening consequences owing to the impact on the children's development and the consequent increase in vulnerability. This work outlines several important issues related to SA among children: (1) SA prevalence including onset, common examples, extent, and spectrum of SA; (2) the presence of new psychoactive substances, which are rapidly spreading worldwide with limitations regarding their prevalence, detection, and interventions; (3) street children and their recruitment in drug supply; (4) SA and substance use disorder pathways, risk and protective factors for the development of SA; (5) SA consequences in the case of early initiation, including deaths; and (6) current preventive interventions for the pediatric population. In conclusion, this challenge requires consistent and unremitting attention in order to execute effective prevention programs with continuous re-evaluation of the situation.
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Affiliation(s)
- Sanaa M Aly
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France.
| | - Ahmed Omran
- Pediatrics and Neonatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt(d)
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France; Université de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France; Université de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
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23
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Embleton L, Shah P, Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. Int J Equity Health 2020; 19:147. [PMID: 32859193 PMCID: PMC7455900 DOI: 10.1186/s12939-020-01255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
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Affiliation(s)
- L Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - P Shah
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - A Gayapersad
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - R Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - D Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
- Department of Behavioural Science, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - P Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.
- Department of Medicine, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya.
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Ayenew M, Kabeta T, Woldemichael K. Prevalence and factors associated with substance use among street children in Jimma town, Oromiya national regional state, Ethiopia: a community based cross-sectional study. Subst Abuse Treat Prev Policy 2020; 15:61. [PMID: 32819391 PMCID: PMC7441729 DOI: 10.1186/s13011-020-00304-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Street children constitute a marginalized population in most urban centers of the world. According to UN sources, there are up to 150 million street children in the world today. The estimated number of children who live on the streets in Ethiopia was 150,000, of which about 60,000 of them in Addis Ababa. However, aid agencies estimate that the problem may be far more serious, with nearly 600,000 street children country-wide and over 100,000 in Addis Ababa. World Health Organization estimates that globally, 25-90% of street children indulge in substance use. Even if substance use has become a common problem in Ethiopia, most of the studies done mainly focused among schools, college and university students. Research on street children and their substance use habits in Ethiopia was limited and specifically non in Jimma town. OBJECTIVES To assess the prevalence and factors associated with substance use among street children in Jimma town of Ethiopia in 2019. METHODS Cross sectional study was undertaken from March 1-31, 2019. Complete enumeration of study subjects was done and all 312 children of the streets were included. Interviewer administered structured questionnaires was used to collect the data. Bivariable logistic regression was carried out to select candidate for multiple logistic regression analysis with p-value < 0.25 at 95% confidence. Multiple logistic regression was carried out with those candidate variables using backward method and the associations predictors to the response variable was declared with p value of < 0.05 at 95% confidence level. RESULT Three hundred twelve street children were included in the study. The prevalence of substance use was 30.8% with 95% CI [25-36.2]. Age > 14 [AOR: 1.97 95%CI:1.00-3.889], attending grade 1-4th [AOR: 0.33 95%CI:0.151-0.737], attending 5th grade and above [AOR: 0.27 CI:0.093-0.756], child whose mother used substances [AOR: 7.78 95%CI:3.00-20.11], child did not know his maternal substance use status [AOR:5.1 95%CI: 2.19-11.81], child whose sibling use substance [AOR: 2.23 95%CI:1.254-5.63], best friend substance use [AOR: 11.01 95%CI:5.47-25.04] and staying 12-60 months on the street [AOR:3.00 95%CI:1.511-5.96] and staying > 5 years on the street [AOR:4.6 95%CI:1.06-19.7] were significantly associated with substance use. CONCLUSION AND RECOMMENDATION The prevalence of substance use among street children in Jimma town was high. Mothers and siblings have crucial roles in determining substance use behavior of the children. Stakeholders who are working on the improvement in the life of children of the street should try to satisfy the need of the children by intervening at individual level, at family or community level and at levels beyond community to lessen the problem to some extent. Researchers should do similar researches in more detail on these vulnerable but neglected groups of children to fully understand about the problem so the findings will be used as inputs for concerned bodies.
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Affiliation(s)
- Mengistu Ayenew
- Department of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Teshome Kabeta
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kifle Woldemichael
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Dhawan A, Mishra AK, Ambekar A, Chatterjee B, Agrawal A, Bhargava R. Estimating the size of substance using street children in Delhi using Respondent-Driven Sampling (RDS). Asian J Psychiatr 2020; 48:101890. [PMID: 31841817 DOI: 10.1016/j.ajp.2019.101890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
Street children as a population sub-group exist in significant numbers in the developing world and have been reported to be vulnerable to adverse health and risk behaviours that include physical and sexual risk behaviour. However, the estimation of prevalence for various psychoactive substances among the street children in a representative sample has not been attempted in the developing country like India. This is challenging due to the absence of an appropriate sampling frame, the population living in isolation, hiding their identity and concealing their behaviour. Use of psychoactive substances in street children is riddled with these challenges. The present investigation describes the findings from size estimation study on a representative sample of street child (n = 766) in Delhi, by implementing the Respondent Driven Sampling Methodology (RDS). The weighted prevalence for three commonest substances was found as Tobacco (31.1 %), alcohol (13.5 %) and inhalants (11.3 %) used during the last one year with the estimated number as -Tobacco (21,770), Alcohol (9450) and Inhalants (5600). Almost one third of street children were using some substance. Also, a large majority of ever users were also using substances currently. The study demonstrates successfully the implementation of RDS for the estimation of the prevalence of psychoactive substances in a representative manner. A large majority of street children use psychoactive substances, and there is a need for more of such studies in other metropolitan cities so that local level interventions and planning can be done for treatment and prevention of psychoactive substances among the street children. The important public health implications had been discussed.
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Affiliation(s)
- Anju Dhawan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Biswadip Chatterjee
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Agrawal
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Rachna Bhargava
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
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Antenatal Dads and First Year Families program: a qualitative study of fathers' and program facilitators' experiences of a community-based program in Australia. Prim Health Care Res Dev 2019; 20:e154. [PMID: 31818342 PMCID: PMC7003524 DOI: 10.1017/s1463423619000768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Currently, there is limited knowledge on the impact of father-only sessions or parenting programs supporting impending fatherhood. This research explored an antenatal dads program aimed at fathers to assess the benefits of such interventions. Background: Literature regarding parenting programs and early childhood education initiatives, especially those aimed at children and families in disadvantaged circumstance, have been demonstrated to act as a buffer to poorer health and lifestyle outcomes in later life. Methods: A qualitative research approach was used to explore the experiences of 16 fathers and 6 staff of a community-based parenting program with sessions focusing on fatherhood. Findings: Four main themes were identified from the data regarding the experiences of groups engaged with the Antenatal Dads and First Year Families program. The first theme ‘Knowledge and Capacity Building’ stated that the information provided in the program helped fathers to be better informed and prepared for their impending fatherhood. The second theme was ‘Mental Health Awareness’ and identified the importance of raising awareness of depression and suicide in fathers, including where and how to get help. The third theme was ‘Soft-Entry’ and highlighted how the attendance at one service helped participants to learn about additional services through word of mouth and targeted promotion. The final theme was ‘Feeling Connected’, which helped fathers to feel more connected with the process of childbirth and development including playing and engaging with their children. Overall, the fathers found that the male-only sessions assisted them by supporting frank discussions on fatherhood. Additionally, the study helped identify the advantages of fathers meeting other fathers through attendance in the program, or even other couples in similar situations that helped fathers to feel less lonely regarding their situation.
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Vameghi M, Roshanfekr P, Ali D, Noroozi M, Madani S, McFarland W, Mirzazadeh A. Population Size Estimates of Street Children in Iran: Synthesis of Multiple Methods. J Urban Health 2019; 96:549-557. [PMID: 30963510 PMCID: PMC6890866 DOI: 10.1007/s11524-019-00354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We used four methods (direct count, indirect count, wisdom of the crowd, and unique object multiplier) to map and estimate the population size of street children in six major cities in Iran in 2017. In aggregate for the six cities, the number of street children was estimated at 5296 (interquartile range [IQR] 4122-7071) using the median of the four methods. This corresponds to a rate of 16.3 (IQR 12.5-24.5) per 10,000 children age 5-18 years old, or 3.2 (IQR 2.4-5.3) per 10,000 total population. The total number for street children in the country is estimated at 26,000 (IQR 20,239-34,719) children. Results can help policy-makers advocate for resources, plan programs, and evaluate the reach of programs for street children. The maps created through the course of the population size estimation exercise can also guide outreach efforts to provide street children with health and social welfare services.
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Affiliation(s)
- Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Saied Madani
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran.
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Shah P, Kibel M, Ayuku D, Lobun R, Ayieko J, Keter A, Kamanda A, Makori D, Khaemba C, Ngeresa A, Embleton L, MacDonald K, Apondi E, Braitstein P. A Pilot Study of "Peer Navigators" to Promote Uptake of HIV Testing, Care and Treatment Among Street-Connected Children and Youth in Eldoret, Kenya. AIDS Behav 2019; 23:908-919. [PMID: 30269232 PMCID: PMC6458975 DOI: 10.1007/s10461-018-2276-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research suggests a burden of HIV among street-connected youth (SCY) in Kenya. We piloted the use of peer navigators (PNs), individuals of mixed HIV serostatus and with direct experience of being street-connected, to link SCY to HIV testing and care. From January 2015 to October 2017, PNs engaged 781 SCY (585 male, 196 female), median age 16 (IQR 13-20). At initial encounter, 52 (6.6%) were known HIV-positive and 647 (88.8%) agreed to HIV testing. Overall, 63/781 (8.1%) SCY engaged in this program were HIV-positive; 4.6% males and 18.4% females (p < 0.001). Of those HIV-positive, 48 (82.8%) initiated ART. As of October 2017, 35 (60.3%) of the HIV-positive SCY were alive and in care. The pilot suggests that PNs were successful in promoting HIV testing, linkage to care and ART initiation. More research is needed to evaluate how to improve ART adherence, viral suppression and retention in care in this population.
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Affiliation(s)
- Pooja Shah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mia Kibel
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Regina Lobun
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - John Ayieko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Collins Khaemba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Lonnie Embleton
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Katherine MacDonald
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, USA
| | - Edith Apondi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
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Amr S, Garas M, Boulos DNK, Saleh DA, Jillson IA, Loffredo CA. Circumstances of Substance Use by Street Youth in Egypt Support the Case for Intervening to Prevent Adverse Childhood Experiences. JOURNAL OF SUBSTANCE USE 2019; 24:341-345. [PMID: 31798339 PMCID: PMC6889872 DOI: 10.1080/14659891.2019.1572804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 10/14/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Egyptian street youth use substances including tobacco, illicit drugs, and pharmaceutical drugs. To understand the circumstances, including adverse childhood experiences, that place adolescents at risk for engaging in substance use, we conducted in-depth interviews among a sample of Egyptian street children. METHODS From youth residing at or attending Caritas, a non-profit organization, which provides shelter and education to street youth, seven girls and twelve boys, aged 12 to 18 years, participated in open-ended, in-depth interviews. RESULTS Eight out of the 19 participants reported family history (early exposure) to substance use; and seven of them were initiated by either a family member (sibling), friend or coworker. Most of the participants reported a history of conflict with or abuse (verbal or physical) by their parents or siblings, or stressful situations at home; they used substance(s) to alleviate their stress. Few attended school, and some were forced to work and help their family. CONCLUSIONS Among Egyptian youth, adverse childhood experiences, such as poverty, child abuse, and family substance use, challenge somewhat susceptible youths and lead them to the path of substance use and addiction. Prevention intervention should be multifaceted, culturally adaptable, and primarily targeting the social environment during childhood.
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Affiliation(s)
- Sania Amr
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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Kibel M, Shah P, Ayuku D, Makori D, Kamaara E, Choge E, Nyairo J, Abuya P, Wahome M, Wachira J, Braitstein P. Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision and HIV Education for Street-Connected Youth in Western Kenya. J Adolesc Health 2019; 64:43-48. [PMID: 30327277 DOI: 10.1016/j.jadohealth.2018.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and 'coming-of-age' retreat implemented as a pilot with SCY. METHODS Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention's acceptability. RESULTS There were 116 SCY (median age 14, IQR 13-15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program's acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers. CONCLUSIONS This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub-Saharan Africa where circumcision is part of traditional coming-of-age processes.
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Affiliation(s)
- Mia Kibel
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pooja Shah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - David Ayuku
- Department of Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Eunice Kamaara
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Emily Choge
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Joyce Nyairo
- African Christian Initiation Program, Eldoret, Kenya
| | - Pamela Abuya
- African Christian Initiation Program, Eldoret, Kenya
| | - Mary Wahome
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Juddy Wachira
- Department of Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
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Jones HE, Momand AS, Morales B, Browne T, Poliansky N, Ruiz D, Aranguren M, Sanchez S, Fratto V, O'Grady KE. The CHILD Intervention for Living Drug-free Comprehensive Assessment of Risk, Resilience, and Experience (CHILD CARRE) Measure: Initial Findings. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2019; 28:411-425. [PMID: 33603319 DOI: 10.1080/1067828x.2020.1766621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper summarizes the development and evaluation of an assessment instrument for children ages 7-12. The CHILD CARRE measure is a semi-structured interview with 7 domains. Children from the USA and Argentina (N=134) completed baseline and follow-up assessments. Substance use occurred at an average age of 8. Almost 33% of the children were taking medications for medical issues, more than 50% of them said that medical problem gets in the way of doing things they like to to do and almost 64% of the children stated that they would like to feel better. On average, children completed third grade in school, 56% of them knew how to read and 26% of the children started making money at age 8. Most children (74%) saw someone drunk or high and 23% of children reported alcohol or psychoactive substance use. Among these children using substances, such substance use occurred at an average age of 8, and in the past 30 days they used these substances an average for 5 days. The rating of level of risk on the part of the interviewer placed these children in the "risky" to "very risky" categories. Most children reported seeing their family members smoking (83%) or using alcohol (67%), and 49% reported seeing their family members high on drugs. Few children (10%) had conflicts with the law, while 46% of their family members had legal problems. Some children (30%) reported having serious problems getting along with family members, neighbors, or friends. These results suggest that this measure can serve as the first comprehensive measure to assess multiple life domains for young children at risk for or using psychoactive substances.
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Affiliation(s)
- Hendrée E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Carrboro, NC USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, MD USA
| | - Abdul Ssubor Momand
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Carrboro, NC USA
| | - Brian Morales
- Bureau of International Narcotics and Law Enforcement Affairs (INL), U.S. Department of State, Washington, DC USA
| | - Thom Browne
- Colombo Plan Secretariat, Colombo, Sri Lanka
| | | | | | | | | | | | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD USA
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Behzadifar M, Gorji HA, Rezapour A, Bragazzi NL. Prevalence of hepatitis C virus among street children in Iran. Infect Dis Poverty 2018; 7:88. [PMID: 30269685 PMCID: PMC6166285 DOI: 10.1186/s40249-018-0469-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023] Open
Abstract
Background Street children are forced to spend a lot of time away from their homes and some of them do not have homes at all, due to economic and family problems, which makes them exposed to many health problems, such as the hepatitis C virus (HCV) infection. Iran, like many other countries in the world, experiences the burden of street children, however, the rate of HCV among street children is virtually unknown. This study aimed to determine the prevalence of HCV among street children in Iran. Main body This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol of this review was registered in PROSPERO under identification term CRD42018082336. A comprehensive literature search was conducted to identify published studies reporting on the prevalence of HCV among street children in Iran. Several international scholarly databases, including Web of Science, PubMed®/MEDLINE®, Embase, Scopus®, Google Scholar and Directory of Open Access Journals, as well as Iranian databases such as MagIran and Barakathns were searched. Studies published between 1988 and December 2017 with any of the following keywords were selected: (street OR homeless OR labour) AND (children OR child OR infant) AND (hepatitis C OR hepatitis C virus OR HCV OR viral hepatitis OR hepatitis OR hepacivirus) AND Iran. Moreover, a grey literature search was performed in order to obtain other potentially relevant studies. The search was carried out without any language restrictions. Four studies, surveying a total of 1691 street children, conducted between 2006 and 2017 were found to be eligible for inclusion in the review and therefore analysed. Three studies were conducted in Tehran and one in Isfahan. The prevalence of HCV among street children in Iran was found to be high, at 2.4% (95% CI: 1.8–3.3). Conclusions Since the prevalence of HCV among street children in Iran is quite high, health decision- and policy-makers should pay more attention to street children and widen support channels, both social and economic. Further studies should be conducted among street children in different cities of Iran to add to the knowledge base of HCV among street children in the country. The health system should provide facilities for street children to be screened to quickly diagnose illnesses and prevent them from developing complications. Electronic supplementary material The online version of this article (10.1186/s40249-018-0469-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masoud Behzadifar
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Embleton L, Ayuku D, Makori D, Kamanda A, Braitstein P. Causes of death among street-connected children and youth in Eldoret, Kenya. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:19. [PMID: 29764412 PMCID: PMC5952842 DOI: 10.1186/s12914-018-0160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Street-connected young people carry a disproportionate burden of morbidities, and engage in a variety of practices that may heighten their risk of premature mortality, yet there are currently no reports in the literature on the rates or risk factors for mortality among them, nor on their causes of death. In low- and middle-income countries they are frequently in situations that violate their human rights, likely contributing to their increased burden of morbidities and vulnerability to mortality. We thus sought to describe the number of deaths annually, causes of death, and determine the number of deaths attributable to HIV among street-connected young people aged 0 to 30 years in Eldoret, Kenya. METHODS Eldoret, Kenya has approximately 1900 street-connected young people. We collected data on deaths occurring from October 2009 to December 2016 from Moi Teaching and Referral Hospital records, Academic Model Providing Access to Healthcare HIV program records, and utilized verbal autopsies when no records were available. Descriptive analyses were conducted stratified by sex and age category, and frequencies and proportions were calculated to provide an overview of the decedents. We used logistic regression to assess the association between underlying cause of death and sex, while controlling for age and location of death. RESULTS In total there were 100-recorded deaths, 66 among males and 34 among females; 37% of were among those aged ≤18 years. HIV/AIDS (37%) was the most common underlying cause of death, followed by assault (36%) and accidents (10%) for all decedents. Among males, the majority of deaths were attributable to assault (49%) and HIV/AIDS (26%), while females primarily died due to HIV/AIDS (59%). CONCLUSION Our results demonstrate a high number of deaths due to assault among males and HIV/AIDS among males and females. Our findings demonstrate the need for studies of HIV prevalence and incidence among this population to characterize the burden of HIV, particularly among young women given the higher number of deaths attributed to HIV/AIDS among them. Most deaths were preventable and require the urgent attention of service providers and policymakers to implement programs and services to prevent premature mortality and uphold children's rights.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Regenstrief Institute Inc., Indianapolis, USA. .,Fairbanks School of Public Health, Indiana University, Indianapolis, USA. .,Division of Epidemiology, 155 College Street, Toronto, ON, M5T 3M, Canada.
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Desmennu AT, Titiloye MA, Owoaje ET. Behavioural risk factors for sexually transmitted infections and health seeking behaviour of street youths in Ibadan, Nigeria. Afr Health Sci 2018; 18:180-187. [PMID: 29977272 PMCID: PMC6016990 DOI: 10.4314/ahs.v18i1.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Street youths are faced with a number of health challenges that could be linked to their exposure to the risk elements, accessing medical care including motivation and /or ignorance to utilise available health care. OBJECTIVE This qualitative study therefore aimed at determining the behavioural risks for sexually transmitted infections (STIs) and health seeking behaviour of street youths in Ibadan. METHODS Sixteen focus group discussion (FGD) sessions were conducted among 160 street youths aged between 15-24 years. RESULT The result showed that most of the respondents had low perception of risk of contracting STIs in spite of their risky behaviours which included multiple sexual partnering, sharing of personal effects, malnourishment and sexual harassment. Most of the street youth could not identify the various types however; Gonorrhea and HIV were commonly mentioned by them. The major treatment regimen for STIs was traditional remedies and drugs obtained from patent medicine vendors. Traditional remedies were preferred by most of the participants and considered to be more effective. CONCLUSION Majority of the street youths were sexually active, engaged in high risk sexual behaviours and had inappropriately treated sexually transmitted infections. Development of risk reduction and appropriate sexual health interventions targeted at prevention and appropriate treatment is recommended.
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Affiliation(s)
| | - Musibau Ayoade Titiloye
- Department of Health promotion and Education, FAculty of Public Health, University of Ibadan
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Kakchapati S, Shrestha B, Li DY, Rajbhandari R, Poudel T. Drug use, injecting behaviors, and survival sex among street children and youths in Kathmandu valley, Nepal. Int J STD AIDS 2017; 29:588-597. [PMID: 29264955 DOI: 10.1177/0956462417746532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A disproportionate number of street children use and inject drugs and engage in survival sex as coping mechanisms. This study aimed to determine the prevalence of drug use, injecting drugs, survival sex, and condom use and determinants associated with these behaviors among street children. Cross-sectional surveys were conducted in 2016 with an aim to sample 350 street children and youths in Kathmandu Valley, Nepal. Information about sociodemographic characteristics, injecting drugs, sexual risk behaviors, and biological specimens for HIV testing were obtained. The logistic regression model was used to identify the determinants associated with drug use, injecting drugs, survival sex, and condom use during last sex. Variables that were significantly associated with being a current drug user (versus never) in the presence of other variables included being a rag picker (adjusted odds ratio [AOR] = 3.2; 95% confidence interval [95% CI] = 1.73-5.9), history of imprisonment (AOR = 2.21; 95% CI = 1.21-4.04), alcohol consumption (AOR = 2.66; 95% CI = 1.46-4.84), and solvent sniffing (AOR = 5.12; 95% CI = 2.74-9.59). Variables that were significantly predictive of injecting drugs (versus never) in the presence of other variables include being 17 years old (AOR = 3.42; 95% CI = 1.11-10.55) and being a rag picker (AOR = 3.5; 95% CI = 1.25-9.75). Variables that were significantly associated with having survival sex (versus never) in the presence of other variables include being 17 years old (AOR = 3.58; 95% CI = 1.31-9.81) and having forced sex (AOR = 9.62; 95% CI = 3.21-28.8). Drug use and survival sex are major coping mechanisms among street children in Kathmandu Valley and are associated with many risk behaviors. Targeted programs should be implemented to meet their special needs.
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Affiliation(s)
- Sampurna Kakchapati
- 1 Department of Mathematics and Computer Science, Faculty of Science and Technology, 65108 Prince of Songkla University, Pattani , Thailand
| | | | - Dan Y Li
- 3 59431 Touro University California , Vallejo, CA, USA
| | | | - Tarun Poudel
- 5 National Centre for AIDS and STD Control, Kathmandu, Nepal
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Attia MS, Tayel KY, Shata ZN, Othman SS. Psychosocial profile of institutionalised street children in Alexandria, Egypt: a comparative study with school children. J Child Adolesc Ment Health 2017; 29:103-116. [PMID: 28974166 DOI: 10.2989/17280583.2017.1339606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The phenomenon of street children in Egypt constitutes a public health concern. This study aimed to investigate the characteristics of institutionalised street children in Alexandria, to compare the prevalence of substance abuse and conduct disorder between street children and school children, and to identify predictors of these mental health outcomes among street children. METHODS Institutionalised street children (n = 102) participated in a cross-sectional comparative study with a matched group of school children (n = 156). An interviewing questionnaire was used to assess demographic characteristics and substance use. Conduct disorder was measured using the Revised Ontario Child Health study scale. RESULTS Poverty, family breakdown, and domestic violence were the main reasons for street children having left home. Street children recorded significantly higher rates of substance use (9.8%) and conduct disorder (35.3%) compared to school children. In street children, smoking was a significant predictor of substance use and conduct disorder. Other predictors of conduct disorder included physical illness and having 5 to 7 siblings. CONCLUSION Substance abuse and conduct disorder were present among institutionalised street children at higher rates than school children. Absence of basic life needs and disrupted families constituted the main reasons for leaving home. Interventions at the governmental and non-governmental levels are needed.
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Affiliation(s)
- Medhat S Attia
- a Mental Health, Family Health Department, High Institute of Public Health , Alexandria University , Alexandria , Egypt
| | - Kholoud Y Tayel
- b Adolescent and School Health, Family Health Department, High Institute of Public Health , Alexandria University , Alexandria , Egypt
| | - Zeinab N Shata
- a Mental Health, Family Health Department, High Institute of Public Health , Alexandria University , Alexandria , Egypt
| | - Sally S Othman
- a Mental Health, Family Health Department, High Institute of Public Health , Alexandria University , Alexandria , Egypt
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Abdi F, Saeieh SE, Roozbeh N, Yazdkhasti M. Health policy making for street children: challenges and strategies. Int J Adolesc Med Health 2017; 31:ijamh-2016-0134. [PMID: 28817378 DOI: 10.1515/ijamh-2016-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 01/28/2017] [Indexed: 11/15/2022]
Abstract
Background The phenomenon of street children is a bio-psychological and social issue that not only harms children, but also endangers the health of a society. In line with the national programs for the development and promotion of street children's health in Iran, health policy making and essential strategies for this group of children will be presented in this paper. This paper will discuss the main issues and challenges of street children's health and, also, health policy and guidelines for this population. Methods In this review study, the keywords; street children, health, challenges, policy, and health policy making were searched through PubMed, SID, Iranmedex, World Health Organization (WHO), Emro, the Cochran Library, Medline and Google scholar to collect data. The search resulted in 84 related resources from which 48 cases that were more relevant to this research and covered the issue more comprehensively, were used. All data published during 2002-2015 have been included in this paper. Results Key concepts including street children and their health, health policy, strategies to improve the health of street children, health policy approaches for street children, the WHO's strategies, and social support program for street children must be considered in the health policy making processes for street children, as precise identification of the relevant information makes planning more effective in health policy making for this group of children. Conclusion The phenomenon of street children is a growing problem in the world and it has turned into a serious concern in many countries including Iran. The findings of this study can be used for identifying necessary measures in order to use research outcomes more effectively in policy making processes and reforming street children's health policies in Iran.
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Affiliation(s)
- Fatemeh Abdi
- Student Research Committee, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Esmaelzadeh Saeieh
- Department of Midwifery, Faculty Member of Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mansoureh Yazdkhasti
- Department of Midwifery, Faculty Member of Midwifery, Alborz University of Medical Sciences, Karaj, Iran
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Guo X, Slesnick N. Reductions in Hard Drug Use Among Homeless Youth Receiving a Strength-Based Outreach Intervention: Comparing the Long-Term Effects of Shelter Linkage Versus Drop-in Center Linkage. Subst Use Misuse 2017; 52:905-915. [PMID: 28426359 DOI: 10.1080/10826084.2016.1267219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The current study sought to test hard drug use outcomes for youth receiving a strengths-based outreach and advocacy intervention that linked youth to either a shelter or a drop-in center. METHODS Homeless youth (14-24 years old) were engaged by research assistants (RAs) at soup kitchens, parks, libraries, and other locations that homeless youth were known to frequent. Youth were randomly assigned to receive six months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). Follow-up assessments were conducted at 3, 6, and 9 months post-baseline. Hard drug use over time was the main outcome. Intervention condition and service connection were used as predictors for the baseline level and the slope of change in hard drug use over time. Data analysis was conducted with Bernoulli Hierarchical Generalized Linear Modeling in HLM7. RESULTS The current study found that those who were in the drop-in linkage condition exhibited a greater reduction in their odds of using hard drugs during the follow-up points than their counterparts in the shelter linkage condition. And finally, those who utilized services more often during the follow-ups were those who exhibited less hard drug use at baseline and less reduction in their odds of using hard drugs. CONCLUSIONS This study suggests that drop-in centers, which are often characterized by low-demand programming and few behavioral restrictions, are effective for addressing hard drug use among homeless youth.
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Affiliation(s)
- Xiamei Guo
- a Institute of Psychology, Xiamen University , Xiamen , China
| | - Natasha Slesnick
- b Department of Human Sciences , The Ohio State University , Columbus , Ohio , USA
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Oppong Asante K, Meyer-Weitz A. Prevalence and predictors of suicidal ideations and attempts among homeless children and adolescents in Ghana. J Child Adolesc Ment Health 2017; 29:27-37. [PMID: 28403747 DOI: 10.2989/17280583.2017.1287708] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence and risk factors associated with suicidal ideations and attempts among a sample of homeless street children and adolescents found in Accra, Ghana. METHODS A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana. An interviewer-administered questionnaire was used to collect data due to a low level of literacy among the study population. Bivariate and multivariate logistic regressions were fitted to analyse the data. RESULTS The results indicated that 26.4% and 26.0% of the participants had attempted suicide and reported suicidal ideations respectively. The multivariate logistic regression showed that smoking, past and present use of alcohol, use of marijuana, and engagement in prostitution, were associated with suicidal ideations and suicide attempts. Suicidal ideations were associated with having been physically beaten, robbed, and assaulted with a weapon; while a suicide attempt was predicted by having been robbed and physically beaten. CONCLUSION This study increased our understanding of the determinants of suicidal ideations and attempts among homeless youth. These findings suggest urgency to up-skill mental health workers to assess for risk factors and offer pathways to care for this vulnerable group.
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Affiliation(s)
- Kwaku Oppong Asante
- a Department of Psychology , University of KwaZulu-Natal , Durban , South Africa.,b Institute for Psychosocial Research in Child and Adolescent Wellbeing , Accra , Ghana.,c Department of Psychology , University of Ghana , Accra , Ghana
| | - Anna Meyer-Weitz
- a Department of Psychology , University of KwaZulu-Natal , Durban , South Africa
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Tanaree A, Assanangkornchai S, Kittirattanapaiboon P. Pattern and risk of developing alcohol use disorders, illegal substance use and psychiatric disorders after early onset of alcohol use: Results of the Thai National Mental Health Survey 2013. Drug Alcohol Depend 2017; 170:102-111. [PMID: 27883946 DOI: 10.1016/j.drugalcdep.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/10/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although underage drinking is a global concern, little is known about the relationship between age at first drink and development of various psychiatric comorbidities. METHODS A secondary data analysis was done among 2928 lifetime drinkers from the Thai National Mental Health Survey 2013. Age at first drink, and onset of related psychiatric outcomes were inquired. Survival analysis using Cox regression was performed to estimate the risk over time for psychiatric problems across age ranges at first drink. RESULTS Two-thirds of male and one-third of female drinkers were considered underage at drinking onset. Substance use and abuse developed earlier (<5 years) than alcohol use disorders (AUDs) and other outcomes (mostly >10 years). Those who started drinking before age 15 years were more likely to develop use of cannabis (HR=4.75; 95% CI 2.73, 8.24), club drugs (HR=2.88; 95% CI 1.46, 5.71) and inhalants (HR=6.46; 95% CI% 1.64, 25.37), compared to those who were 20 years or older at drinking onset. Using age as an alternative time-scale, those aged <15years at drinking onset were significantly more likely to experience AUDs, psychotic symptoms, intermittent explosive disorder and panic disorder. However, the early onset drinkers were less likely to develop depression compared to those who started at age 20 years and over. CONCLUSION Premature alcohol consumption tends to be a gateway to various serious consequences. Efforts of such drinking age policy and interventions are needed to address vulnerable young populations.
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Affiliation(s)
- Athip Tanaree
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai, Songkhla 90110, Thailand; Songkhla Rajanagarindra Psychiatric Hospital, 472 Saiburi Road, Mueang Songkhla, Songkhla 90000, Thailand.
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Phunnapa Kittirattanapaiboon
- Mental Health Service Administration, Department of Mental Health, 88/20 Moo 4, Soi 4, Muang, Nonthaburi 11000, Thailand
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Firouzkouhi Moghadam M, Hashemian SS, Pishjoo M, Ghasemi S, Hajebi A, Noroozi A. Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e5133. [PMID: 27729958 PMCID: PMC5046230 DOI: 10.5812/ijp.5133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/03/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND About 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors. OBJECTIVES The objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city. METHODS Clinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years) who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients' files using a checklist developed by the authors. RESULTS Twenty-four (60%) patients were male, and 16 (40%) were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran) was the most common (75%) drug of use, followed by opium (10%) and opium residue (7.5%). None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5%) mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30) days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome. CONCLUSIONS To our knowledge, this is the first study to report on the safety and feasibility of inpatient symptomatic pharmacological treatment for assisted withdrawal among opioid-dependent children and adolescents in Iran. More well-designed studies to investigate the long-term outcomes of opioid treatment among children are warranted.
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Affiliation(s)
- Mahboubeh Firouzkouhi Moghadam
- Child and Adolescent Psychiatry Department, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Research Center for Children and Adolescents Health, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Seyed-Sepehr Hashemian
- Student research committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Masoud Pishjoo
- General Practitioner, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Sanaz Ghasemi
- Child and Adolescent Psychiatric Ward, Ali Ebne Abitaleb Hospital, Zahedan, IR Iran
| | - Ahmad Hajebi
- Addiction and High Risk Behavior Research Center, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences (IUMS), Tehran, IR Iran
| | - Alireza Noroozi
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
- Corresponding author: Alireza Noroozi, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran. Tel: +98-2181454963, E-mail:
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Szkwarko D, Mercer T, Kimani S, Braitstein P, Buziba N, Carter EJ. Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya. Public Health Action 2016; 6:142-6. [PMID: 27358809 DOI: 10.5588/pha.16.0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Street-connected youth and young adults (SCY) suffer a myriad of health problems. In Kenya, SCY are at high risk for tuberculosis (TB) due to their congregate living situations. TB screening is not routinely implemented in SCY and there has been no published literature on the burden of TB in SCY in western Kenya. PROGRAM DESCRIPTION In 2011, the AMPATH TB Program, an experienced TB screening program, partnered with the Tumaini Center, a trusted street youth organization, to conduct intensified case finding (ICF) for pulmonary TB among SCY. Our program aimed to investigate the numbers of SCY who reported symptoms and those diagnosed with smear-positive pulmonary TB, and link SCY with TB to treatment. RESULTS Of 116 SCY who were screened, 114 (98%) had a positive questionnaire; 104 (90%) provided a spot sputum sample, 39 (34%) provided a morning sputum sample, and 111 (97%) reported cough of >2 weeks. One street youth tested smear-positive for TB and was treated through to cure. CONCLUSIONS Implementing TB ICF is feasible in low-resource settings through unique collaborations between health care programs and community-based organizations. In addition to identifying smear-positive TB, our program uncovered a high burden of respiratory symptoms among SCY in Eldoret, Kenya.
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Affiliation(s)
- D Szkwarko
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - T Mercer
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - P Braitstein
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - N Buziba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - E J Carter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Tyler KA, Handema R, Schmitz RM, Phiri F, Kuyper KS, Wood C. Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth. Subst Use Misuse 2016; 51:922-31. [PMID: 27144671 PMCID: PMC4963184 DOI: 10.3109/10826084.2016.1156702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection. OBJECTIVES The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use. METHODS A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods. RESULTS Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.
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Affiliation(s)
| | | | | | | | | | - Charles Wood
- Center for Virology, University of Nebraska-Lincoln, USA
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Embleton L, Lee H, Gunn J, Ayuku D, Braitstein P. Causes of Child and Youth Homelessness in Developed and Developing Countries: A Systematic Review and Meta-analysis. JAMA Pediatr 2016; 170:435-44. [PMID: 27043891 PMCID: PMC5497301 DOI: 10.1001/jamapediatrics.2016.0156] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A systematic compilation of children and youth's reported reasons for street involvement is lacking. Without empirical data on these reasons, the policies developed or implemented to mitigate street involvement are not responsive to the needs of these children and youth. OBJECTIVE To systematically analyze the self-reported reasons why children and youth around the world become street-involved and to analyze the available data by level of human development, geographic region, and sex. DATA SOURCES Electronic searches of Scopus, PsychINFO, EMBASE, POPLINE, PubMed, ERIC, and the Social Sciences Citation Index were conducted from January 1, 1990, to the third week of July 2013. We searched the peer-reviewed literature for studies that reported quantitative reasons for street involvement. The following broad search strategy was used to search the databases: "street children" OR "street youth" OR "homeless youth" OR "homeless children" OR "runaway children" OR "runaway youth" or "homeless persons." STUDY SELECTION Studies were included if they met the following inclusion criteria: (1) participants were 24 years of age or younger, (2) participants met our definition of street-connected children and youth, and (3) the quantitative reasons for street involvement were reported. We reviewed 318 full texts and identified 49 eligible studies. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers. We fit logistic mixed-effects models to estimate the pooled prevalence of each reason and to estimate subgroup pooled prevalence by development level or geographic region. The meta-analysis was conducted from February to August 2015. MAIN OUTCOMES AND MEASURES We created the following categories based on the reported reasons in the literature: poverty, abuse, family conflict, delinquency, psychosocial health, and other. RESULTS In total, there were 13 559 participants from 24 countries, of which 21 represented developing countries. The most commonly reported reason for street involvement was poverty, with a pooled-prevalence estimate of 39% (95% CI, 29%-51%). Forty-seven studies included in this review reported family conflict as the reason for street involvement, with a pooled prevalence of 32% (95% CI, 26%-39%). Abuse was equally reported in developing and developed countries as the reason for street involvement, with a pooled prevalence of 26% (95% CI, 18%-35%). Delinquency was the least frequently cited reason overall, with a pooled prevalence of 10% (95% CI, 5%-20%). CONCLUSIONS AND RELEVANCE The street-connected children and youth who provided reasons for their street involvement infrequently identified delinquent behaviors for their circumstances and highlighted the role of poverty as a driving factor. They require support and protection, and governments globally are called on to reduce the socioeconomic inequities that cause children and youth to turn to the streets in the first place, in all regions of the world.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Hana Lee
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Jayleen Gunn
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada6Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya7Department of Epidemiology, Fairbanks Scho
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Wachira J, Kamanda A, Embleton L, Naanyu V, Ayuku D, Braitstein P. 'Pregnancy Has Its Advantages': The Voices of Street Connected Children and Youth in Eldoret, Kenya. PLoS One 2016; 11:e0150814. [PMID: 26942724 PMCID: PMC4778759 DOI: 10.1371/journal.pone.0150814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Little is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy. Methods This qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders. Results The majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries. Conclusion Our findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.
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Affiliation(s)
- Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- * E-mail:
| | | | - Lonnie Embleton
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Indiana University, Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, Indiana, United States of America
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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The increasing global health priority of substance use in young people. Lancet Psychiatry 2016; 3:251-64. [PMID: 26905480 DOI: 10.1016/s2215-0366(15)00508-8] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
Abstract
Substance use in young people (aged 10-24 years) might disrupt key periods of transition that occur as the adolescent brain undergoes cognitive and emotional development, and key psychosocial transitions are made. Adolescence is the peak time for initiation of substance use, with tobacco and alcohol usually preceding the use of illicit drugs. Substantial variation is noted between countries in the levels, types, and sequences of substance use in young people, indicating that a young person's use of substances depends on their social context, drug availability, and their personal characteristics. The Global Burden of Disease (GBD) 2013 study suggests that the burden attributable to substance use increases substantially in adolescence and young adulthood. In young men aged 20-24 years, alcohol and illicit substance use are responsible for 14% of total health burden. Alcohol causes most health burden in eastern Europe, and illicit drug burden is higher in the USA, Canada, Australia, New Zealand, and western Europe. Large gaps exist in epidemiological data about the extent of drug use worldwide and much of what we know about the natural history of substance use comes from cohort studies in high-income countries undertaken decades ago, which hinders effective global policy responses. In view of the global epidemiological transitions from diseases of poverty to non-communicable diseases, the burden of disease and health risks among adolescents and young adults is likely to change substantially, in ways that will no doubt see substance use playing an increasingly large part.
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Adams-Guppy JR, Guppy A. A systematic review of interventions for homeless alcohol-abusing adults. DRUGS: EDUCATION, PREVENTION AND POLICY 2016. [DOI: 10.3109/09687637.2015.1044499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Embleton L, Ott MA, Wachira J, Naanyu V, Kamanda A, Makori D, Ayuku D, Braitstein P. Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya. BMC Med Ethics 2015; 16:89. [PMID: 26687378 PMCID: PMC4684915 DOI: 10.1186/s12910-015-0084-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
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Affiliation(s)
- L Embleton
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - M A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - V Naanyu
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - A Kamanda
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - D Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - D Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - P Braitstein
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Fairbanks School of Public Health, Department of Epidemiology, Indiana University, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., Indianapolis, IN, USA.
- Division of Epidemiology, 155 College Street, Toronto, M5T 3M7, ON, Canada.
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Embleton L, Wachira J, Kamanda A, Naanyu V, Winston S, Ayuku D, Braitstein P. "Once you join the streets you will have to do it": sexual practices of street children and youth in Uasin Gishu County, Kenya. Reprod Health 2015; 12:106. [PMID: 26573581 PMCID: PMC4647324 DOI: 10.1186/s12978-015-0090-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents living in HIV endemic settings face unique sexual health risks, and in the context of abject poverty, orphanhood, social marginalization, and discrimination, adolescents may be particularly at-risk of horizontal HIV transmission. Street-connected children and youth are a particularly vulnerable and marginalized population and therefore may be a key population at-risk. METHODS We sought to describe the sexual behaviours of street-connected children and youth in order to comprehend their sexual practices and elucidate circumstances that put them at increased risk of contracting HIV utilizing qualitative methods from a sample of street-connected children and youth in Eldoret, Kenya. We recruited participants aged 11-24 years who had lived on the street for ≥ 3 months to participate in 25 in-depth interviews and 5 focus group discussions stratified by age and sex. RESULTS In total we interviewed 65 street-connected children and youth; 69 % were male with a median age of 18 years (IQR: 14-20.5 years). Participants identified both acceptable and unacceptable sexual acts that occur on the streets between males and females, between males, and between females. We grouped reasons for having sex into four categories based on common themes: pleasure, procreation, transactional, and forced. Transactional sex and multiple concurrent partnerships were frequently described by participants. Rape was endemic to street life for girls. CONCLUSION These findings have important policy and programming implications, specifically for the government of Kenya's adolescent reproductive health policy, and highlight the need to target out-of-school youth. There is an urgent need for social protection to reduce transactional sex and interventions addressing the epidemic of sexual and gender-based violence.
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Affiliation(s)
- Lonnie Embleton
- Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. .,University of Toronto, Institute of Medical Sciences, Faculty of Medicine, Toronto, ON, Canada.
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | | | - Violet Naanyu
- Department of Behavioral Sciences, Moi University, College of Health Sciences, Eldoret, Kenya.
| | - Susanna Winston
- Warren Alpert Medical School, Brown University, Providence, RI, USA. .,Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA.
| | - David Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,Department of Behavioral Sciences, Moi University, College of Health Sciences, Eldoret, Kenya.
| | - Paula Braitstein
- Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,Indiana University, Fairbanks School of Public Health, Indianapolis, IN, USA. .,University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada. .,Regenstrief Institute, Inc, Indianapolis, IN, USA.
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Goldblatt A, Kwena Z, Lahiff M, Agot K, Minnis A, Prata N, Lin J, Bukusi EA, Auerswald CL. Prevalence and Correlates of HIV Infection among Street Boys in Kisumu, Kenya. PLoS One 2015; 10:e0140005. [PMID: 26461494 PMCID: PMC4604137 DOI: 10.1371/journal.pone.0140005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Despite their perceived vulnerability to HIV, East African street youth have been neglected in HIV prevention research. We examined HIV seroprevalence and correlates of HIV infection in a sample of male street youth in Kisumu, Kenya. Methods We enrolled a street-recruited sample of 13–21 year old street youth. Participants completed a survey followed by voluntary HIV counseling and testing. Survey items included demographics, homelessness history, survival activities, sexual behavior and substance use. We examined the relationship between predictor variables, markers of coercion and marginalization and HIV. Results The sample included 296 males. Survival activities included garbage picking (55%), helping market vendors (55%), begging (17%), and working as porters (46%) or domestic workers (4%). Forty-nine percent of participants reported at least weekly use of alcohol and 32% marijuana. Forty-six percent of participants reported lifetime inhalation of glue and 8% fuel. Seventy-nine percent of participants reported lifetime vaginal sex, 6% reported lifetime insertive anal sex and 8% reported lifetime receptive anal sex. Twelve (4.1%; 95% CI: 2.3–7.0) participants tested positive for HIV. Of those, all had been on the street for at least one year and all had engaged in vaginal sex. Occupations placing youth at particular risk of coercion by adults, including helping market vendors (prevalence ratio (PR) = 8.8; 95% CI: 1.2–67.5) and working as domestic workers (PR = 4.6; 95% CI: 1.1–19.0), were associated with HIV infection. Both insertive anal sex (PR = 10.2; 95% CI: 3.6–29.4) and receptive anal sex (PR = 3.9; 95% CI: 1.1–13.4) were associated with HIV infection. Drug use, begging, and garbage picking were not associated with HIV infection. Conclusions Although HIV prevalence in our sample of street youth is comparable to that of similarly-aged male youth in Nyanza Province, our findings highlight behavioral factors associated with HIV infection that offer opportunities for targeted prevention among street youth in East Africa.
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Affiliation(s)
- Ariella Goldblatt
- University of California, Berkeley–University of California at San Francisco Joint Medical Program, UC Berkeley School of Public Health, Berkeley, California, United States of America
| | - Zachary Kwena
- Center for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Maureen Lahiff
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Alexandra Minnis
- School of Public Health, University of California, Berkeley, California, United States of America
- Women's Global Health Imperative, RTI International, San Francisco, California, United States of America
| | - Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, California, United States of America
| | - Jessica Lin
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Elizabeth A. Bukusi
- Center for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Colette L. Auerswald
- University of California, Berkeley–University of California at San Francisco Joint Medical Program, UC Berkeley School of Public Health, Berkeley, California, United States of America
- * E-mail:
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